The Need
A primary responsibility of the Department is ensuring the health, wellness, and safety of our members. As such, we must implement quality standards and maintain strict oversight of provider agencies. The Department proposes a series of projects to develop quality frameworks and oversight requirements, resulting in anticipated cost savings, provider accountability, and improved quality outcomes.
✅Initiative 8.06. - PACE Licensure - Completed
Project Achievements and/or Activities:
Programs of All-Inclusive Care For the Elderly (10 CCR 2505-10 8.497) was overhauled and updated effective 4/30/24 to comply with the requirements of Senate Bill 22-203. An audit tool was developed based on the new regulations, and two pilot audits of PACE organizations in Colorado were conducted in 2024.
Summary / Project Outcome:
Currently PACE organizations in Colorado are licensed as home care agencies under the Colorado Department of Public Health and Environment (CDPHE), with home care being just one of the “all-inclusive” services covered by PACE. The development of a PACE license will require more time, stakeholder engagement, and collaboration with CDPHE than was able to be completed with the time and ARPA resources originally committed to this project. Budgetary and statutory authority are required in order to create a PACE licensure category. It was decided that instead of jumping straight to a PACE license, HCPF will use a PACE audit process to hold PACE organizations accountable to the Colorado PACE regulations.
✅Initiative 8.04. - Pay-for-Performance for PACE - Completed
Project Achievements and/or Activities:
The project achieved the creation of a Colorado Programs for All Inclusive Care for the Elderly (PACE) Value Based Payment (VBP) program. As part of the development process, relevant best practices and current measurement processes were reviewed in an effort to create alignment where possible and promote opportunities for improving quality through potential payment incentives. The Department will conduct a multi-year program approach to assess improvement that will phase into pay-for-performance. The program has completed its first test year, and is now in a reporting-only period, during which data will continue to be gathered and evaluated in preparation of establishing program baselines and targets.
Summary / Project Outcome:
The PACE VBP Program Design Document describes the policy surrounding key model elements for the PACE VBP Program. The information provided in this document was informed by: (1) an options analysis that detailed the current national and state PACE and VBP landscape, and a qualitative analysis of focus group and key informant interview themes; and (2) strategic planning sessions that leveraged the options analysis and were used to assess, prioritize, and design a framework for program goals and components (e.g. model structure, financial mechanism, and performance metrics).
The project established key performance measures which are provided in the PACE VBP Specification Document. The purpose of the PACE VBP Specification Document is to provide the measure specifications and reporting guidelines for the program metrics.
External Facing Reports / Websites:
✅Initiative 8.08. - CMS Quality Metrics - Completed
Project Achievements and/or Activities:
ARPA project 8.08 HCBS Quality Dashboards have been created to meet a need of transparency, accessibility, and information distribution. Quality Dashboards were created with the assistance of stakeholder feedback, an accessibility team review, data team review, and HCPF staff direction. These dashboards contain member experience survey response information. The information has previously been gathered and shared in a lengthy annual report. This report was not easily digestible and was not accessible. These dashboards have been created to be interactive and show the information from these surveys in one space. The format of these dashboards should allow for members, community members, organizations, and other interested stakeholders to view the feedback gathered through HCBS member experience surveys and see the information in an accessible and interactive format. All of the information gathered for these dashboards is housed in a database that protects the privacy of those surveyed.
Also developed to accompany the dashboards is an accessible pdf version of the dashboard. This format will allow the information to be accessed through keyboard navigation and screen reader software.
Summary / Project Outcome:
HCPF participates in conducting Member experience surveys each year, called National Core Indicators (NCI) surveys. These surveys are completed by members who are enrolled in HCBS waivers. There are 3 versions of the NCI surveys:
NCI-AD: Aging and Disabilities HCBS waiver participants
NCI-IDD: Intellectual and Developmental Disabilities HCBS waiver participants
State of the Workforce: Direct Care Workforce providers
In addition to the NCI surveys, HCPF also conducts CWS: Children’s Waiver Satisfaction Surveys. These surveys were developed in collaboration with vendor Vital Research. It is a Colorado specific survey to gather feedback from families whose children are enrolled in HCBS Children’s waivers.
The purpose of these surveys is to understand member experiences with HCBS, address gaps to improve programs, ensure quality of services, and gather required HCBS Measure Set Data. The survey responses and outcomes are currently reported annually, but these reports are lengthy and contain a lot of industry information and jargon, making the reports less digestible for members, families, and other community members.
ARPA project 8.08 has created accessible, user-friendly HCBS Quality Dashboards to share the NCI survey member experience responses and State of the Workforce provider responses. These dashboards are interactive, filterable by defined service area, year, and waiver. These dashboards will house the data for the previous 3 years of NCI survey responses and provide a tool to pull reports, recognize gaps in services, and provide valuable information regarding the overall health of CO HCBS services. HCPF hopes to continue adding data for subsequent survey cycles to help evaluate trends over time. We look forward to sharing these dashboards on the HCPF website in the near future.
✅Initiative 8.11. - Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Benefits Training - Completed
(previously named Quality Measures and Benefits Training)
Key Project Achievements and/or Activities:
The project developed comprehensive training tools designed to enhance the understanding and utilization of Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefits within the Medicaid population, including children and youth with special health care needs (CYSHCN) and youth in any of the child welfare programs. These tools also serve to bridge the gap between EPSDT services and other programs, ensuring better integration of care for beneficiaries.
Summary / Project Outcome:
Training Development and Implementation
The group designed a series of 5 training modules that focus on EPSDT benefits, federal performance metrics, and their intersection with waiver services under HCBS.
Policy and Program Adjustments
Through the EPSDT analysis, HCPF identified areas where policies such as the CMS requirement that services be labeled as “free” could be strengthened or adjusted to better serve both Medicaid and CYSHCN populations. These insights were integrated into the training content, further contributing to policy refinement and continuous improvement of service delivery. The training supports compliance with the federal requirements of integrating EPSDT and waiver services as outlined in the CMS Part V Manual.
Educational Outreach and Member Engagement
To engage both members and providers, HCPF created an infomercial, now housed on our YouTube Channel, that was used as a push notification to introduce EPSDT services. This resource serves as an introductory tool to raise awareness of the benefits available under the EPSDT program, ensuring that members and providers have an accessible and concise overview of the services offered.
Sustainability and Accessibility
The EPSDT training modules were designed using adult learning principles, ensuring that the content is accessible, easy to understand, and adaptable to a wide audience, and available in English and Spanish. The training materials were made available on Department websites. This sustainability mechanism allows for continuous access to ensure compliance with evolving federal requirements and performance metrics.
Federal Compliance and Quality Performance Measures
The training and analysis process directly supports HCPF's efforts to meet federal compliance standards regarding the EPSDT program.
External Facing Reports/Websites:
Toolkits in English and Spanish
Child Welfare (CW) Explainer YouTube Playlist
EPSDT Parent/Caregiver YouTube Playlist
✅Initiative 8.02. - Provider Oversight - Completed
Key Project Achievements and/or Activities:
The project’s external vendor performed the following activities to further inform work to streamline provider enrollment processes:
Surveyed 13 state agencies regarding Home and Community Based Services (HCBS) service delivery and processes for licensing and Medicaid certification
Identified inconsistencies between the Code of Colorado Regulations and HCBS Final Rule requirements that contributed to provider enrollment difficulties
Through system user testing, recommended clearer guidelines and fixes within the interChange system for the improvement of the overall enrollment application process
Key Achievement #1 - Creation of a shared database to eliminate the isolated data maintained in other systems used by HCPF and Colorado Department of Public Health and Environment (CDPHE). The platform allows agencies to track provider enrollment and survey status.
Key Achievement #2 - Development of a training module that provides comprehensive guidance for new and revalidating provider enrollment. The training module includes a training manual, online training video, and electronic test/certification.
Key Achievement #3 – A comprehensive recommendation schedule was generated to resolve perceived inconsistencies in the Medical Assistance Act Section 7.000 Concerning Case
Management, Member Rights and Responsibilities Home and Community Based Services and Provider Agency Requirements.
Summary / Project Outcome:
In 2017, the Department engaged an external vendor to review interagency provider enrollment processes for areas of alignment, to improve data sharing, and reduce agency survey wait times. The vendor produced a report outlining several high-level recommendations to streamline the provider enrollment process between HCPF and CDPHE. The Provider Oversight project provided an opportunity to reevaluate previous findings by acknowledging changes in regulation, addressing the impacts of COVID-19 on agency health compliance, and updating current systems utilized by each department.
Regulatory Review - The vendor thoroughly reviewed state regulations and HCBS Settings Rule as they applied to provider enrollment and recertification. Recognizing that contradictions and inconsistencies between the rules were often confusing and impacting providers’ ability to fully comply, draft revisions to existing regulations that address inconsistencies related to person-centeredness were developed, removing compliance barriers and reducing unnecessary delays.
Data Sharing Capability - HCPF and CDPHE faced challenges in managing and sharing data due to maintaining separate systems; Gainwell and COHFI, respectively. A new database was developed utilizing Caspio which allows tracking of provider status and survey metrics, between the agencies. This also allows the agencies the ability to communicate within the system and upload relevant documents, streamlining the process by eliminating need for email communication and its inherent inefficiencies. Additionally, this platform has expansion capabilities for future shared database needs.
Provider Training Improvements - The existing online training materials for enrolling and revalidating providers were in need of updating, lacked appropriate guidance and support, and hosted an inefficient quiz/certification process. In collaboration between HCPF and CPDHE, the vendor developed a comprehensive online training program detailing the entire process to include, certification, enrollment, recertification, and revalidation. The dynamic training program now allows providers to access appropriate content depending on where they are in the process. The online training contains system demonstrations, links to additional resources, quizzes to test knowledge, and contact information for additional technical assistance.
✅ Initiative 8.05. - Pay-for-Performance for Home Health & HCBS - Completed
(combined 8.05 Pay for Performance for Home Health & 8.03 Pay for Performance for HCBS)
Key Project Achievements and/or Activities:
HCPF completed research and analysis that will guide future efforts in pursuing a pay-for-performance model in long-term home health and Residential HCBS. Through internal and external stakeholder interviews, a literature review, national scan, and actuarial analyses, HCPF received recommendations for a series of quality measures to employ in unison with a pay-for-performance payment model.
Summary / Project Outcome:
The team received a menu of potential metrics that could be used for pay for performance in long-term home health and Residential HCBS. If HCPF pursues pay-for-performance models in long-term home health or Residential HCBS services, they will finalize the selection of metrics with stakeholders.
✅Initiative 8.10. - Criminal Justice Partnership - Completed
Key Project Achievements and/or Activities:
One of the most significant achievements of ARPA project 8.10 is the relationships that were built and the resulting partnerships with the community, state and local government, and teams across offices at HCPF. These partnerships lay the foundation for successfully planning and implementing Medicaid reentry services in the years to come. We had strong participation in stakeholder engagement efforts and brought key stakeholders together to form the HCPF Criminal and Juvenile Justice Collaborative. Information gathered through research and stakeholder engagement was used in the development of a strategic plana and completion of the Medicaid & Criminal Justice Gap Analysis which will guide future work. Additional information is available on the Health First Colorado and Criminal Justice Involved Population webpage.
Summary / Project Outcome:
Serving the justice-involved population is an ongoing priority and will be continued through the Medicaid Reentry Services project.
External Facing Reports/Websites: