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Case Management News

New Case Management Related Memos 

Find all memos on the Memo Series webpage.

OM 25-063 Resuming Requirements for In-Person Case Management

Starting January 1, 2026, all Level of Care (LOC) Screens must be conducted in person for all Home and Community-Based Services (HCBS) members.

This change follows a temporary policy allowing virtual and phone LOC Screens during the COVID-19 pandemic and subsequent system challenges. Now that backlogs have been addressed and the system has stabilized, in-person assessments are required again.

OM 25-065 Long Term Care CBMS Enhancements for September 2025

Effective September 13, 2025, The Colorado Benefits Management System (CBMS) has been updated to improve processing for Long-Term Care (LTC) cases. Key enhancements include:

1. Multiple Level of Care (LOC) Entries: CBMS now allows users to enter multiple LOC records simultaneously, streamlining data entry and ensuring accurate financial eligibility calculations.
2. 30-Day Stay Calculation: The system now includes hospital stay days when determining if a member meets the 30-day stay requirement for LTC eligibility, aligning with existing policy.
3. Hospital Coverage: Users are no longer required to enter medical expenses for hospital coverage when processing LTC cases, simplifying the process.
4. Home Maintenance Allowance (HMA): CBMS has been updated to reflect policy regarding HMA for members residing in LTC institutions, ensuring compliance with regulations.

These enhancements aim to streamline the LTC eligibility process, reduce administrative burden, and ensure accurate and timely service delivery for members.

MSB Rules Affecting Case Management

Code of Colorado Regulations

Medical Services Board Webpage

Final Adoption by Consent Agenda-Proposed Effective Date 11/30/25

MSB 25-04-02-B Repeal of In-Home Support Services Section 8.552 and Transition Services, Sections 8.552 & 8.553  

This rule change removes the old sections of rule that described In-Home Support Services (IHSS) and Transition Services, including Life Skills Training, Home Delivered Meals, Peer Mentorship, Transition Setup Services, and Post-Hospital Home Delivered Meals.

These services are not being eliminated — they’ve just been moved to new rule sections with updated numbering and formatting. The old sections (8.552 and 8.553) are now being deleted to avoid confusion and duplication.

MSB 25-04-22-A Revision to the Medical Assistance Rule concerning the Program of All-Inclusive Care for the Elderly (PACE), Section 8.497 

This revision updates Colorado’s PACE rules to align with federal changes effective January 1, 2025, and strengthens application requirements to ensure only qualified organizations are approved, supporting responsible growth and quality services for members.

Case Management Policy: Questions and Answers

Q: Should Case Managers upload the signed Statement of Agreement (Service Plan Signature Page) in the CCM system with the PCSP or as a separate document?

A: Case Managers should upload the signed Statement of Agreement separately as outlined in the Service Plan Job Aid.

Q: Can Monitoring Contacts be conducted by text message?

A: No; at this time, Monitoring Contacts may not be conducted via text messages.

Q: Should Case Managers send a Case Status Advisement Letter then LTC NOA, if applicable, when a member fails to schedule and/or attend their PCSP? 

A: Yes; Case Managers shall complete the updated Case Status Advisement Letter requesting contact from the member to schedule and complete the PCSP. If the member does not schedule and complete the PCSP within 15 business days of the Case Status Advisement Letter Date or if the member fails to schedule and complete the PCSP at least 10 business days prior to the current certification end date, the Case Manager must complete an LTC NOA Benefits Status Letter to deny services using the "over a 30-day period you failed to participate in the scheduling and/or completion of a 100.2 or Service Plan meeting required for all HCBS member’s" reason and citing 8.7001.C.1(f) and 8.7001.C.4(a)(iv)(3) no less than 10 calendar days prior to the Action Date (current certification end date). Please OM 25-027 for further guidance. 

Q: When a member newly enrolled in HCBS takes more than 30 days to start services, does "The individual has not received an HCBS Waiver service for one calendar month" apply?

A: Yes; Case Managers shall issue an LTC NOA for any member enrolled in HCBS that does not receive HCBS services for one calendar month as outlined in §8.7202.R.1(c)(1). For more information on issuing LTC NOAs, Case Managers can refer to OM 25-027. If a member has been approved for HCBS services but cannot find a provider, the CM is required to explore other HCBS waiver services that may help them maintain eligibility while they continue searching for a provider (for example, utilizing the WEB).

Q: Are Case Management Agencies required to complete Targeted Case Management (TCM), monitoring and service planning for members that are residing in Psychiatric Residential Treatment Facilities (PRTF) or Qualified Residential Treatment Programs, within the state of Colorado? Are these activities billable?

A: Yes; If the child is still enrolled in HCBS, the CMA would need to continue providing ongoing case management services to maintain the member's eligibility. If the member is receiving treatment paid for by Health First Colorado and still enrolled in a HCBS waiver it is expected that the CMA ensures the member maintains Level of Care (LOC), that the Case Manager develops communication with their providers, and completes a Person Centered Support Plan (PCSP) for any non-duplicative waiver services. 

Q: Are Case Management Agencies required to complete Targeted Case Management (TCM), monitoring and service planning for members that are residing in Out of State Psychiatric Residential Treatment Facilities (PRTF) or Qualified Residential Treatment Programs (QRTP)? Are these activities billable? 

A: Yes; Even if the PRTF or QRTP facility is outside of the state of Colorado and given that the child is still enrolled in HCBS, the CMA would need to continue providing ongoing case management services to maintain the member's eligibility. If the member is receiving treatment paid for by Health First Colorado and still enrolled in a HCBS waiver it is expected that the CMA ensures the member maintains Level of Care (LOC), that the Case Manager develops communication with their providers, and completes a Person Centered Support Plan (PCSP) for any non-duplicative waiver services. 

Q: Are Case Management Agencies required to obtain a Release of Information (ROI) for every provider who is providing HCBS services to a member on their Person-Centered Support Plan (PCSP)? Why is it necessary to list all providers on an ROI as opposed to using a general ROI for all Medicaid providers? In addition, why do they need to update ROI's when there is a change in provider? 

A: No; Case Management Agencies are not required to obtain an ROI for every provider who is providing HCBS services on the PCSP. Information shared between CMAs and members' providers, in the course of providing services and supports to the member, does not require an ROI. An ROI is required when releasing member records, not otherwise required by rule to be shared with the provider. 

Q: Can CMAs upload the statement of agreement (service plan signature page) with the service plan packet into the CCM or does this need to be uploaded as a separate document? 

A: The statement of agreement (or service plan signature page) currently needs to be uploaded separately as indicated in the directions provided. 

Q: What is the expectation for submitting PARs if providers have not signed the Statement of Agreement (SOA)? 

A: The Case Manager would authorize services agreed to by the member as indicated on the signed Statement of Agreement. As outlined in OM25-025 and in accordance with 8.7202.J.3(b), the Case Manager is required to distribute the PCSP documents with all providers that are providing services under the plan within 15 working days after the plan is completed. These documents include: 

• CCM Service Plan,

• Pages 3-8 of the Service Plan PDF,  

• PAR,  

• Completed Service Plan Signature Page,  

• CDASS Monthly Allocation and Task Worksheet, if applicable, 

• IHSS Care Plan Calculator, if applicable, and 

• Rights Modification, if applicable. 

However, as the signature serves as providers attestation agreeing to provide the service(s), services may not start until that Provider Agency's signature is obtained.

Q: Do Program Cards and Service Plans need to align with the fiscal year for State General Fund (SGF) programs?

A: No; Program Cards and Service Plans for members enrolled in SGF programs must be completed annually and be for no longer than one year but are not required to align with the fiscal year.

Notices/Tasks/Queues

Q: When a member transfers from one CMA to another, which CMA is responsible for completing any open tasks in the CCM system?

A: The transferring CMA is responsible for completing all tasks created prior to the member’s transfer unless there is an agreed upon arrangement with the new CMA. Critical Incident and Appeal related tasks and activities should not be transferred to the receiving CMA while they are in progress. The previous CMA shall remain active within the Care Team until the specific Critical Incident or Appeal has been closed/completed. The transferring CMA shall not end date their agency or Case Managers within the Care Team until after Critical Incidents and Appeals are closed/completed.

Program Specific Questions

Q: Why does the Children with Complex Health Needs (CwCHN) waiver populate as the old waiver, Children with Life Limiting Illness (CLLI) in the Bridge benefit plan and CCM Health Coverage card? 

A: In the "Choose Benefit Plan" field of the Base Information tab of the Pre-prior Authorization (PPA) in the Bridge, a Case Manager is not able to select CLLI, as CwCHN has replaced that dropdown option. Additionally, CwCHN will be viewable in the “Selected Benefit Plan” field of the PPA screen. However, the "Benefit Plan" field in the Client Information screen will still reflect CLLI. The Benefit Plan options that populate this field are not currently scheduled to be updated and will remain CLLI. This is similar to the change from SCI to CIH. As long as all other areas noted above ("Choose Benefit Plan" and "Selected Benefit Plan") reflect CwCHN, the “Benefit Plan” field in the Client Information screen noting CLLI is expected and not a system or eligibility issue. 

In CCM, CLLI reflected in the Benefit Plan in Bridge will populate the Health Coverage card in CCM to reflect CLLI rather than CwCHN. This is also an expected function of the system and not a system or eligibility issue.

Adding Language Preferences, Needs for Accommodations, and Additional Contacts to Member Record in CCM

The demographics section of a member record has fields that allow the Case Manager to indicate language preferences, accommodation needs, etc. While this information is not required, it is person centered and helpful to have the information documented within the member record for easy reference during any interaction with the member or their team. For documenting language preferences, method of communication, etc. go to the “Profile Summary” screen (Demographics > Profile) and then select “Show More” on the far right, above the “Communication Preferences” section. The fields will remain grayed out, until the user selects “Edit” in the top right.

This section includes fields to address spoken language, written language, any impairments or disabilities (visual, hearing, etc.), and communication preferences (email, phone, text, etc.). 

Additionally, Case Managers can add multiple contacts to a member’s record in the CCM. These contacts may include, and are not limited to, family members, advocates, or any individual the member chooses to include. These contact records do not include fields that allow Case Managers to indicate language or communication preferences. 

Legally appointed individuals (Guardians, POAs, etc.) should be documented in the “Decision Making & AD” screen (Demographics > Decision Making & AD). Any documentation, such as Power of Attorney, Guardianship, Medical Power of Attorney, Consent for Disclosures, etc. should be uploaded into the member record in CCM. 

For steps on how to add a Contact, see the Adding and Editing a Member Contact - Job Aid. For steps on how to upload documents, see the Document Management - Job Aid.

Community First Choice Eligibility Referral Flowcharts

The flowcharts below outline what the process looks like if a person is seeking Community First Choice from a self or community referral (they went straight to Case Management Agency) and from a county Department of Human Services referral (they started at their eligibility site). These flowcharts are also accessible through the Case Management Agency Communications Toolkit, along with many additional resources for Case Managers. 

Self and Community CFC LTC Referral Process Flowchart

County CFC LTC Referral Process Flowchart

Related Benefits & Services News

Reminder: CHRP Wraparound & Youth Mentorship Code Update

This is a reminder that Informational Memo 24-023, released in October 2024, outlines important updates to CHRP Wraparound and Youth Mentorship procedure codes. Claims with the HI modifier with service dates after November 1, 2025 will not pay. Case Managers with a PAR that still has an HI modifier that needs to be updated have been notified directly by email.

Going forward, any PPAs submitted with an H2021 line and an “HI” modifier will pend for state review. If a new PPA line H2021with an “HI” modifier pends for state review and does not have claims, please correct the modifier from “HI” to “HA”. The state will review weekly and approve any “HI” modifiers for lines with end dates before October 31, 2025 that may remain.

Thank you for your continued attention to these details and for supporting smooth service delivery for our CHRP youth and families.

Massage Therapy, Acupuncture, and Chiropractic Care Benefits Through the Complementary and Integrative Health Waiver

Reminder: Case Managers may continue to see increased interest from members on the Elderly, Blind, and Disabled (EBD) Waiver for massage therapy, acupuncture, and chiropractic care through the Complementary and Integrative Health (CIH) Waiver. Colorado Department of Health Care Policy and Financing (HCPF) is still working to increase eligible member's awareness of these services. 

When a member you are working with asks about these services, please work with them to determine if the CIH Waiver and these health benefits would be a good fit for them and then complete their waiver to waiver transfer.

CIH Service Provider Options:

Members can choose from enrolled CIH providers. For members wanting to work with local providers not yet enrolled, the Chanda Center for Health and PALCO can assist providers and members in accessing the services in their local area.

Resources:

Find eligibility requirements, provider listings, and FAQs on the CIH Waiver Webpage and Long Term Services and Support Training site. To help with the waiver-to-waiver transfers, Case Managers should also reference the job aids on the waiver to waiver transitions, opening a program card, and closing a program card.

Questions on CIH Services or Massage Therapy? 

Contact Kacey Wardle for technical assistance and support at Kacey.Wardle@state.co.us.

CIH Services and Massage Therapy HCBS Benefit Specialist

Peer Mentorship Program Enhancement

To assist individuals transitioning into the community from institutional settings, Peer Mentorship provides meaningful support to members through shared experience and practical instruction. Services can be individualized to provide emotional support and shared lived experience, life skills development, and community resource navigation. Members may access these services for up to 365 days. Peer Mentorship is available on the EBD, BI, CIH, CMHS, DD, and SLS waivers. 

Members transitioning to a less restrictive community-based setting include:

• Moving from a Host Home or Family Home to Apartment
• Moving from a Nursing Facility to an Alternative Care Facility
• Moving from an Alternative Care Facility to a Host Home or Family Home 

Following are links to relevant resources:

• Transition to Community Fact Guide
• Transition Frequently Asked Questions
• Code of Colorado Regulations, Section 8.7537
• 
  

Do you have questions regarding Transition Services or Peer Mentorship? Contact Janelle Poullier for technical assistance and support at Janelle.Poullier@state.co.us HCBS Benefit Specialist

PETI Reminder

As of September 8, 2025, updated ACF and SLP rates have been available in the Bridge. For new certifications starting on or after October 1, 2025, Case Managers should:

• Create new PARs and PETIs using the updated rates.
• Revise any PARs and PETIs created prior to September 8, 2025.
• Send updated copies to the member and provider.
• Obtain signatures and upload them to CCM.



For more details, refer to the 10/10/2025 CCM Newsletter. For Bridge issues, Case Managers may contact the CCM Help Desk at CCMHelpDesk@gainwelltechnologies.com.

Other News

At-Risk Diversion Pilot Program Continues

Upcoming Reminder: On November 15, 2025, the list of members identified as “At-Risk” will be distributed in the Care and Case Management System (CCM) and in the Case Management Agency's SharePoint. The At-Risk list is designed to run on the 15th of every quarter in CCM, regardless of weekends or holidays, at 12:55 AM EST. The following day, on the 16th of every quarter, CCM will notify the assigned Case Manager by alert and task that a member assigned to them has been identified as "At-Risk".

• At-Risk Alerts and At-Risk tasks will be system-generated in CCM. There are two types of tasks: At-Risk Initial Outreach and At-Risk Ongoing Outreach.

As outlined in contract requirements, Case Managers are responsible for contacting each listed member within the specified time frame and completing the required At-Risk Diversion Assessment in CCM within ten (10) business days from the completed activity. Referrals to Targeted Case Management-Transition Coordination (TCM-TC) Diversion Services need to be completed in CCM. 

• For additional guidance on these processes within the CCM, refer to the new job aids located in the CCM Google Drive: the At-Risk Diversion checklist, At-Risk Diversion Assessment, and Creating Referrals to the Transition Coordination Agency. 

Change in Office Hours/Work Group Sessions: Office hours have been shifted to an every-other-month schedule on the 3rd Tuesday from 2:00 to 3:00 p.m. The session on November 18, 2025, has been canceled, and the next scheduled Office hours/Work Group is scheduled for December 16, 2025. 

• Virtual via Zoom, New attendees: Register in advance here. New attendees will receive a confirmation email after registering, which will include information on how to join the webinar. This schedule update has been made in both Zoom and on the public calendar. Anyone already registered for the Zoom should have received an email about the November meeting cancellation and the new every-other-month schedule update.

If you have questions or concerns, please do not hesitate to contact victoria.lewis@state.co.us, HCPF In-Reach Coordinator.

Rapid Reintegration

Rapid Reintegration Overview: Rapid Reintegration will support members by providing education, available resources, individualized support, community-based services, and information about community living options. This process applies when a member—who qualifies for an initial Level of Care (LOC) for Nursing Facility services—expresses interest in exploring community living or returning to the community. Rapid Reintegration implementation is scheduled to begin in January 2026.

• There will be a memo with detailed guidance released before implementation on the HCPF Memo Series website.

Policy Alignment: Rapid Reintegration aligns with Case Management Agency (CMA) requirements outlined in 10 CCR 2505-10 8.7000. The Medical Services Board (MSB) revised rule 8.7200 Case Management Requirements to include Rapid Reintegration under Rule Number: MSB 24-01-25-B. Final adoption by Consent Agenda occurred on August 8, 2025. The Colorado Code of Regulations (CCR) effective date will be announced at a later time.

Upcoming Training Sessions: Mandatory Rapid Reintegration and CCM System Training sessions will be held in December 2025 for all Case Managers who support Nursing Facility admission processes/assessments.

• Three live virtual training sessions will be offered.
• Case Managers must register in advance and attend one of the available sessions.
• Prior to attending, Case Managers should complete the Web-Based Training (WBT) modules, which will be available in November 2025.

The HCPF Training team will send an official training announcement to CMA Training Leadership via email with registration details and instructions. Additional guidance and new job aids for the Rapid Reintegration processes within the CCM will be posted in November 2025 and can be found in the CCM Google Drive. 

For additional information on Rapid Reintegration, visit the Nursing Facilities Diversion Projects Page. The In-Reach Team Project Feedback form is available to provide feedback, ask questions, and report issues and/or concerns outside of traditional meetings. 

If you have questions or concerns, please do not hesitate to contact In-Reach Unit: HCPF_CLO_Inreach@state.co.us or Victoria Lewis: victoria.lewis@state.co.us.

Case Management Satisfaction Survey: Coming Soon

The Case Management Satisfaction Survey is an important tool that helps the HCPF understand and improve the experiences of case management staff employed by contracted Case Management Agencies (CMAs) providing Long-Term Services and Supports (LTSS) across Colorado’s 20 defined service areas. Your feedback is essential in helping HCPF strengthen supports, identify opportunities for improvement, and enhance case management systems statewide. Confidentiality: All responses are anonymous. Results will be reported in summary form only — no identifying information will be shared publicly.

2025 Survey Timeline

• Open: October – December 2025
• Distribution: All Case Managers will receive a survey link via email.

Survey Eligibility

The survey is intended only for direct case management employees performing case management activities. It does not include:

• Supervisors
• Program Managers
• Administrators

Questions or Support

If you have questions, need assistance, or did not receive a survey link but would like to participate, please contact the Quality Survey Team at HCPF_HCBS_Surveys@state.co.us.

Financial Eligibility and Level of Care Screen Timelines

This is a reminder that Case Managers should not delay the scheduling or the completion of the Level of Care Screen (ULTS 100.2) because financial eligibility has not been determined. Regulations do not require, nor allow for the LOC Screen to be delayed while awaiting the financial eligibility determination. In accordance with 8.7202.B.1(d) for initial enrollments, the Intake Screening, and Referral process includes referring applicants to complete the Medicaid Financial Eligibility application, if they have not already applied. 

When necessary, the Case Management Agency is responsible for coordinating the completion of the Financial Eligibility determination by, 

1. Verifying the individual’s current Financial Eligibility status; or

 2. Referring the applicant to their county’s department of social services; or 

3. Providing the applicant with a Financial Eligibility application (or referring them to PEAK); and

4. Conducting and documenting follow-up activities to complete the Functional Eligibility determination (LOC assessment) and coordinate the completion of the Financial Eligibility determination. For further guidance regarding enrollment timelines, please see OM 25-025.

Adding Language Preferences, Need for Accommodations, and Additional Contacts to Member Record in CCM

The demographics section of a member record has fields that allow the Case Manager to indicate language preferences, accommodation needs, etc. While this information is not required, it is person centered and helpful to have the information documented within the member record for easy reference during any interaction with the member or their team. This section includes fields to address spoken language, written language, any impairments or disabilities (visual, hearing, etc.), and communication preferences (email, phone, text, etc.). 

Additionally, Case Managers can add multiple contacts to a member’s record in the CCM. These contacts may include, and are not limited to, family members, advocates, or any individual the member chooses to include. These contact records do not include fields that allow Case Managers to indicate language or communication preferences. 

Legally appointed individuals (Guardians, Powers of Attorney, etc.) should be documented in the “Decision Making & AD” screen. Any documentation, such as Power of Attorney, Guardianship, Medical Power of Attorney, Consent for Disclosures, etc. should be uploaded into the member record in CCM. 

For steps on how to add a Contact, see the Adding and Editing a Member Contact - Job Aid. For steps on how to upload documents, see the Document Management - Job Aid.

Evaluation of Third Party User Access Tracker

The Third Party User Access Tracker for CCM and Bridge provides Case Management staff with visibility into System Access, Modification, and Revocation requests for CCM and Bridge.

However, current usage data shows the Tracker is accessed infrequently. HCPF is evaluating whether this resource continues to be valuable to staff or if it should be retired.

Please take a few moments to complete the Third Party User Access Tracker Feedback Survey. Your input will inform whether we maintain or discontinue this resource.

Intake Referral and Enrollment Processes Temporary Requirements Feedback Survey

As of April 1, 2025, OM 25-025 implemented temporary administrative relief through revised timelines and allowances in the intake referral and enrollment process for Case Management Agencies. We want to know how these changes are working on the ground.

Please take a few moments to complete the Intake Referral and Enrollment Processes Temporary Requirements Feedback Survey. Your input will help us identify where adjustments or supports are needed. Please answer all questions based on your experience since April 2025 by EOB October 31, 2025. All responses are confidential and themes from the survey will be discussed at the Case Management Policy Feedback Session on November 6, 2025.

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