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WEB Benefit Questions CMA Questions from WEB Training
Page Updated: May 2, 2024
The following are frequently asked questions for the Wellness Education Benefit (WEB)
Q. What is the Wellness Education Benefit (WEB)?
- A. The WEB provides short, educational articles that are mailed to Children's Home and Community Based Services (CHCBS) waiver members on a monthly basis.
Q. Will the WEB be emailed?
- A. No, the WEB will be mailed via the U.S. Postal Service.
Q. Who qualifies for the WEB?
- A. All Health First Colorado members enrolled in the CHCBS waiver.
Q. What is the purpose of the WEB?
- A. The WEB is designed to reduce the need for a higher level of care by offering educational materials that provide CHCBS waiver members and their families with actionable tools that can be used to prevent the progression of a disability, increase community engagement, combat isolation, and improve awareness of Medicaid services.
Additionally, the WEB acts as a monthly waiver service that helps members maintain their waiver eligibility.
Q. What are the benefits of the WEB?
- A. The WEB provides:
- An additional monthly waiver service to help members maintain their waiver eligibility
- Information that is tailored to members based on their age and location
- Members with information on varied topics including:
- Adaptive exercise
- Balance training and fall prevention
- Daily living and wellness tips
- Developing social networks
- Engaging in community activities
- Local resources
- Nutrition
- Money management
Q. When does the WEB start?
- A. The WEB will begin for current CHCBS waiver members in May 2024.
Q. Will the WEB be sent to other waiver members?
- A. The WEB will expand to all HCBS waiver members in April 2025.
Q. Can members opt out of the WEB?
- A. Yes, however, if a member chooses not to receive the WEB, they could be at risk of losing their waiver eligibility. Members must receive at least one waiver service every 30 days to maintain their waiver eligibility.
Case Management Agency WEB Training Questions
Q. Since the Case Management service is phasing out as of July 1, will HCPF be backing out the PAR for CHCBS waiver members similarly to how WEB is being added onto the PAR come May 1st?
- A. The Department of Health Care Policy and Financing (HCPF) will not end date or close CHCBS HCBS Prior Authorization Requests (PAR) relative to Case Management Redesign and the sunsetting of the CHCBS Case Management Benefit. However, HCPF will make internal system adjustments to the Bridge and the interChange to ensure that providers will not be able to bill for CHCBS case management for dates of service on or after July 1, 2024 and case managers will not be able to authorize this service for dates of service on or after July 1, 2024. Case Management Agencies (CMAs) with contracts with HCPF effective July 1, 2024 will bill Targeted Case Management (TCM) for these members.
Q. With the Case management service leaving, will log notes for CHCBS waiver members change after this? Currently in the Care and Case Management (CCM) system, CHCBS waiver members need 2 log notes written: 1 activity log and 1 time-tracking log (this has had a lot of issues in the system with billing). Will we be able to switch to only creating log notes for our members the same as we do for all other waivers?
- A. If the removal of Case Management as a service in the CHCBS waiver is approved by the Centers for Medicare and Medicaid Services (CMS) on July 1, 2024, case managers will no longer be required to complete time-tracking documentation to justify the billing of Case Management as a service in the waiver. HCPF will notify case management agencies when time-tracking documentation for case management can be discontinued. Case managers will continue to be required to document case activities through the activity log.
Case Management for CHCBS waiver members will be provided by Case Management Agencies as a Targeted Case Management Service from July 1, 2024 forward. Although the billing manual is not yet updated to reflect CHCBS changes, for policy and billing guidance, please reference the “Persons with Intellectual and/or Developmental Disabilities Waiver Programs and Targeted Case Management for Home and Community Based Services Waiver Programs” billing manual under the HCBS dropdown on the HCPF Billing Manuals web page.
Q. How will monitoring requirements be impacted with the removal of Case Management as a service?
A. If the removal of Case Management as a service in the CHCBS waiver is approved by CMS on July 1, 2024, all Case Management activities for CHCBS will follow the regulations outlined in 8.7000. Requirements outlined in 8.506.4.B Case Management will no longer be in effect. This means the monthly requirement below will no longer apply. Instead, Case Managers will comply with monitoring requirements outlined at 8.7202.K
On a monthly basis, case managers will evaluate the effectiveness of the Support Planning document by monitoring services provided to the child. This monitoring may include:
- Conducting child, parent(s) or guardian, and provider interviews
- Reviewing utilization data
- Reviewing any written reports received
Q. How will the extended PAR benefits impact the automatic addition of WEB to PARs? What will happen on July 1st with the removal of the Case Management service if the member does not have an active PAR due to system/eligibility issues?
- A. HCPF is coordinating the stabilization efforts around provider payments with the system and operational changes necessary to ensure the effective launch of the WEB benefit. Details are not available at this time, but staff in the Operations and Administration Division within OCL as well as the Health Information Office are working on solutions.
Q. Should case managers who are completing continued stay reviews (CSRs) and PARs now for a July 1 start date preemptively continue to put Case Management on the PAR in case CMS does not approve the removal of the service from the waiver?
- A. If the removal of Case Management as a service in the CHCBS waiver is approved by CMS July 1, 2024 the HCPF will make internal system adjustments to the Bridge and to the interChange to ensure that providers will not be able to bill for CHCBS case management for dates of service on or after July 1, 2024 and case managers will not be able to authorize this service for dates of service on or after July 1, 2024. Until there is HCPF communication that CMS has approved the removal of the Case Management service, case managers should continue to put case management on CSRs they are completing now for July 1 start dates moving forward.
Q. How will the addition of the WEB on a PAR prior to 7/1/2024 impact the member’s Cost Containment? Will a new Over Cost Containment approval be required for a previously approved member? If the addition of WEB puts a member Over Cost Containment, will an initial approval be required?
- A. HCPF will not require a new Over Cost Containment approval for a previously approved member. If the addition of the WEB puts a member Over Cost Containment, case managers can wait until CHCBS case management is removed from members’ PARs to bring them back under Cost Containment.
Q. Who is responsible for the case closure process if a member does not receive a monthly service?
- A. While it is the Case Management Agency’s responsibility to complete the case closure process, HCPF is granting a grace period for CHCBS waiver members who may not be receiving the WEB due to an incorrect address. HCPF recognizes the logistical difficulties and timelines for updating member addresses and, as this is a new process and a new benefit, has no intention of closing cases while the process is rolling out. Case Management Agencies will be notified by HCPF monthly with a list of members whose WEB was not delivered due to an incorrect mailing address, and case managers are expected to work with members to update addresses as soon as possible.
Q. Is there a monthly charge on the PAR for the WEB?
- A. Yes, the WEB provider will bill against the PAR for the service on a monthly basis.
Q. Are there any intentions to allow electronic WEB notifications? Or only via physical mail?
- A. The WEB is only planned to be mailed physically at this time.
Q. Who should a case manager contact if there are issues with the PARs and the WEB?
- A. If there is an issue adding the service to a PAR in the Bridge, case managers should contact ccmhelpdesk@gainwelltechnologies.com
Q. Does there need to be an assignment of inventory of needs in the Bridge for the WEB?
- A. Yes. All inventory needs identified in the inventory needs section for HCBS need to be associated with an HCBS service on the PAR, or a goal to the service will need to be added.
For more information, email the Community First Choice (CFC) Team at hcpf_web@state.co.us