The Need
The HCBS system is complex with a number of technology systems and an enormous data infrastructure. To adequately prepare for the future, these systems need continual maintenance and updates. The tools and technologies the Department uses not only impact our administrative functions, but each is integral to our providers’ ability to perform their contractual obligations and to provide care to our members.
In addition, technological advancement is necessary to support our members and their families who rely on our systems to access services, seek resources, and gauge provider quality. For these reasons, the Department proposes a package of investments to elevate our current suite of tools and technology and to develop new and emerging systems that will prepare us for the future.
Initiative 6.01. - Home Health/PDN Acuity Tool
Home Health
The Department will design and develop an adult Long Term Home Health (LTHH) acuity tool and two Private Duty Nursing (PDN) tools for adult and pediatric members to better determine the appropriate medically necessary level of care and associated nursing hours for members. These tools will streamline the benefit delivery and ultimately provide long-term savings to the State by providing an additional basis with which to determine appropriate service needs for members.
The Department received funding to implement a LTHH acuity tool in FY 2019-20 through R-9, “Long Term Home Health/Private Duty Nursing Acuity Tool.” The Department used this funding to conduct an environmental scan in FY 2020-21 of other state approaches but was unable to identify an appropriate tool, concluding that the Department must build one from the ground up. There was not adequate funding to build and implement a tool with the funding from that request.
The Department will create, pilot, and validate an LTHH as well as pediatric and adult PDN acuity tools tailored to Colorado home health policies. The Department will conduct both a policy and systems crosswalk of the proposed variables required for the LTHH acuity tool with the long-term services and supports (LTSS) assessment tool that determines nursing facility and/or hospital level of care for members seeking LTSS services. This will help determine opportunities for alignment of the tools to ensure that as members’ needs change, they do not have barriers to accessing other State Plan or waiver benefits, nor is there duplication of services. A crosswalk has already been completed for PDN tools.
Once the acuity tools are developed, the Department will integrate the developed tools as a module within the Care and Case Management System. The utilization management vendor will either access the CCM tool directly or through a workflow that will allow them to perform the necessary medical necessity prior authorization determinations for PDN and LTHH benefits.
✅Initiative 6.06. - HCBS Provider Digital Transformation - Completed
Key Project Activities and/or Achievements:
Dollars to Digitize Grant
- Total Awarded Amount: $19.8 Million
- Who was Eligible: Medicaid-enrolled home and community-based services (HCBS) providers, Medicaid-enrolled behavioral health providers, and ‘outgoing’ Case Management Agencies (CMAs); not participating in CMA redesign.
- Summary of project: The purpose of this project was to provide funding to home and community-based providers to digitally transform their care delivery. Funding included investments in upgrading or implementing electronic health record systems to be able to better coordinate care, access real-time information through health information exchanges, and the purchase of tools necessary for the delivery of virtual services. This project leveraged lessons and processes from the Department’s Electronic Health Record incentive program and the Office of eHealth Innovation’s telemedicine projects, with a focus on inclusive and equitable approaches and solutions. These funds were provided through a competitive grant program that aligned with other efforts, such as HB 21-1289, “Funding for Broadband Deployment.”
- Fall 2022 Grantee List
- Summer 2023 Grantee List
- Summary of all 224 ARPA 6.06 D2D Grants awarded:
- 145 Home and Community Based Service (HCBS) Providers
- 55 Behavioral Health Providers
- 13 Community Mental Health Centers (CMHCs)
- 11 Outgoing Case Management Agencies
- Diversity and Impact Metrics based on 224 awarded grantees:
- 122 First time grant recipients (54%)
- 203 Small Businesses (91%)
- 107 Woman Owned (48%)
- 54 Minority Owned (24%)
- 11 Veteran Owned (5%)
- 64 Employ people with disabilities (28%)
- Actual Counties Impacted by the grant based on 209 completed projects:
- A major achievement of the ARPA 6.06 D2D grant is its reach and impact. Grantees collectively serve Health First Colorado members in all 64 Colorado counties.
- Number of grantees serving rural only, urban only, or both rural and urban counties:
Rural and Urban Counties Served | # D2D Grantees |
|---|---|
Grantees serving rural counties only | 16 |
Grantees serving urban counties only | 134 |
Grantees serving BOTH rural and urban counties | 59 |
Summary / Project Outcome:
The grant program funded specific types of electronic health record (EHR) upgrades and digital transformation projects for maximum impact and sustainability. Many of the grantees applied for more than one project type. For the purposes of data collection and analysis, the projects are categorized into 5 primary digital transformation types: electronic health record (EHR) Upgrade, Paper Conversion to an electronic health record (EHR), Paper Conversion to Client Management System, Device Only, or Telehealth, Health Information Exchange (HIE), Referral tool, or Client Management System.
The chart below shows the primary project types implemented by 209 grantees who completed their grant project according to agency type.
Primary Type of Digital Transformation Project | Total Grantees* | HCBS | BH Provider and CMHCs | CMA |
|---|---|---|---|---|
EHR System Upgrade or Enhancement | 47 | 20 | 26 | 1 |
Paper Conversion to EHR System | 85 | 71 | 11 | 3 |
Paper Conversion to Eligible System | 24 | 17 | 5 | 2 |
Device Only | 19 | 9 | 8 | 2 |
Telehealth, HIE, Referral, Upgrade of Client Management System | 34 | 22 | 11 | 1 |
*Data based on 209 grantees, which excludes grantees with a terminated grant agreement or no spending
Other Eligible Expenses to Support Primary Projects
- Services: To support projects, grantees may have requested services for technical assistance for training and implementation support, digitizing paper records, and scanning/shredding services.
- Personnel: Some grantees needed to hire personnel to assist with their digital transformation projects. In some cases, fringe benefits were awarded.
- 10% Indirect Costs: Grantees were awarded 10% of their direct costs for indirect costs (one grantee had a federally negotiated rate of 30%). To allow funds to stretch further, device-only applicants were not awarded indirect costs.
County Cybersecurity
- Over 25,979,731 pages of documentation documents used to execute programs and determine program eligibility from 46 counties were scanned and indexed. This process enhanced both the ability to search and find information as well as establish improved security when accessing documents.
- Physical security grants were offered to all county partners that determine eligibility and 26 received funding to add tools to support physical security such keypad/key card entry systems, door closers, and security camera systems.
External Facing Reports/Websites:
✅Initiative 6.08. - Care & Case Management System Investments - Completed
Key Project Activities and/or Achievements:
HCPF funded investments in system changes, software, and hardware to support the new Care and Case Management (CCM) System. These initiatives supported data sharing in ways that support person-centered, timely provisions of care, improving the member experience.
System Changes
Funding was used to implement system changes and enhancements that were not captured with the implementation of the CCM System. The project team collaborated with external systems vendors to execute the system changes through the Software Development Lifecycle (SDLC). Activities included:
Developed and submitted all system change policy requirements to vendors
Business and technical design session
Completed User Stories development
Completed User Acceptance Testing (UAT)
Aligning the project schedule to the vendor’s Care and Case Management (CCM) release schedule
Worked with HCPF Leadership and vendors to develop prioritization, risk mitigation, and contingency plans for system change requests
Initiated a training and communication plan for each system change
CMA Start-Up Grant
HCPF provided support to Case Management Agencies (CMAs) that provide Home and Community Based Services (HCBS) through the Case Management Redesign (CMRD) process. The 6.08 team collaborated with the APRA 5.01 (Care and Case Management Capacity Building) and 6.06 (Provider Digital Transformation and EHR Upgrades/Dollars to Digitize (D2D)) teams to provide a streamlined application process that only required one grant application for all three funding areas. Eligible funds were available for three areas of need:
Purchase of CCM System compatible devices (ARPA 6.08)
Upgrading or adopting a new Electronic Health Record (EHR) (ARPA 6.06)
Costs to support CMA start-up (ARPA 5.01)
Through 6.08’s funding, CMAs could purchase new mobile touch screen computing devices that capture electronic signatures upon a Member’s completion of the new Colorado Single Assessment (CSA) and Person-Centered Support Plan. Funding also allowed for the purchase of peripherals and accessories to expand the ability of and help protect and maintain devices.
Summary / Project Outcome:
Systems Changes
The CCM system is an electronic case management system that will allow case management staff to use a single system to implement all required activities and services. The system interfaces with the Medicaid Management Information System (MMIS), MMIS-Bridge service authorization system, and the Colorado Benefits Management System (CBMS). The system also includes three years’ worth of relevant information from the legacy systems (migrated October 2023).
Several enhancements to the CCM System were identified to improve case manager efficiency, allow for a more Member-centered approach, and be in compliance with state and federal requirements. Completed enhancements include:
Creating a batch process to end-date old Consumer Directed Attendant Support Services (CDASS) Worksheet and Allocation records and replace them when CDASS rate changes are established. This reduced the amount of needless (Prior Authorization Request) PAR revisions.
Only allowing Case Managers to add services to the PPA when those services match the assigned Calculated Support Level in the Bridge for Members on the Home and Community Based-Developmental Disabilities (HCBS-DD) waiver. This improves Bridge processing of records for more efficient and accurate claims processing of the services rendered.
Incorporating formulas into the Bridge derives from PETI calculation worksheets. This ensures information is documented clearly and accurately, alleviates the burden on Case Managers and HCPF to complete PETIs and PARs manually, and ensures Alternative Care Facility (ACF) and Supported Living Program (SLP) services are prior authorized at the correct Medicaid rate.
Calculating monthly average allocations for CDASS based on the daily rate for each service, as opposed to period allocation dollar amount. This creates a more consistent, efficient, and cost-effective process for CDASS rates, and allows HCPF to establish ownership of the monthly allocations versus depending on a vendor to calculate allocations.
Providing more capabilities to the Critical Incident Report (CIR) submission and verification process, including filtering parameters, hyperlink navigation key word search, updated incident statuses, and the ability to print and/or download CIRs from the CCM System.
Adding notifications for Case Managers when an Admission, Discharge, Transfer (ADT) emergency level event has occurred for a Member on their caseload. This improves care and case management services, navigation, and discharge planning.
CMA Start-Up Grant
The CMA Start-Up Grant was instrumental in facilitating key activities, including the renovation of workspaces, the purchase of essential office supplies, and comprehensive staff training. These initiatives established a solid foundation for stronger, more capable teams, fostering positive work environments and enhancing service delivery.
Case Managers were provided the technology to effectively implement the new Care and Case Management (CCM) System. The new, lighter, compact devices allow Case Managers to move
more comfortably in the field and across county office locations. The devices enable the Case Managers to review and sign documents in clients’ homes decreasing the use of paper forms and files.
One grantee provided the following feedback about the impact of the CMA Start-Up Grant:
“The start-up funds were particularly impactful, as they enabled us to equip our team with high-quality tools such as top-of-the-line laptops and ergonomic office setups. This helped us transition smoothly, with Case Managers stepping into their roles without delays. The versatility of our equipment, such as touchscreen laptops that convert to tablets, ensures that Case Managers can efficiently manage field visits, improving our service delivery.”
“[These grants were vital to set them up for the transition] and will allow for some degree of sustainability with up front costs covered.”
✅Initiative 6.09. - Updates to Salesforce Database - Completed
Key Project Activities and/or Achievements:
Prior to the start of this project, HCPF identified the Salesforce system as a viable means of tracking and centralizing issues and grievances, clinical documentation, and quality care complaints. In partnership with the Benefits and Clinical and Quality Health (QCM) and Improvement teams and our vendor, the project expanded upon the case management functionality in Salesforce to include the following subjects:
- Centralized Issue and Grievance Management
- Escalation/Complex Solution Forms
- Input / Output Tracking
- Clinical Review and Time Tracking
- Creative/Complex Solution Call Tracking
- Data Deduplication and Management and
- Enhanced Reporting and Dashboards
Summary / Project Outcome:
Through the successful enhancement of its Salesforce system, HCPF has significantly improved the management of escalated cases, streamlined workflow processes, and enhanced data quality. The implementation of creative and complex solution tracking, time management, and enhanced reporting mechanisms has positioned HCPF to better serve its members and meet its performance goals moving forward.
✅Initiative 6.12. - Systems Infrastructure for Social Determinants of Health - Completed
Key Project Activities and/or Achievements:
- Conducted the solicitation of the Social Health Information Exchange (SHIE)
- Completed a competitive Invitation to Negotiate (ITN) process to award a vendor to build the SHIE infrastructure, including both the foundational ARPA component through September 30, 2024, and an additional eight option years leveraging Capital Construction funding awarded beginning in State Fiscal Year 2025
- Executed the SHIE contract on November 14, 2023
- Launch the foundational Colorado SHIE architecture
- CoSHIE foundational architecture launched in September 2024 - CoSHIE will be launched for active use with an initial set of users in November 2024
- Secure ongoing funding for continued SHIE expansion
- Capital Construction request to secure continued SHIE funding beyond the ARPA funding period was approved by the legislature and began on July 1, 2024
Summary / Project Outcome:
Colorado SHIE (CoSHIE) is a ten-year transformational effort to integrate social, behavioral, and physical health data to better connect Medicaid members to the services they need to achieve their full health potential, like healthy food and affordable housing. This effort was initiated by leveraging ARPA funds with the intention of better connecting people in institutional settings, like long-term care facilities, back to their communities with the support of a Home and Community Based Services (HCBS) waiver.
In partnership with the CoSHIE vendor, OeHI successfully launched the CoSHIE Architecture in September 2024, beginning with a tailored HCBS use case that will go live with Options Counseling Agencies on November 12, 2024. The CoSHIE Architecture will automate an existing manual process and empower HCPF staff to monitor progress and take action on referrals that are not being addressed in a timely manner. This use case allowed OeHI to prove out the full scope of SHIE Architecture which will be expanded to many additional use cases over the next nine years of implementation.
External Facing Reports/Websites:
More information about CoSHIE is available on the OeHI website
✅Initiative 6.03. - Member Facing Provider Finder Tool Improvement - Completed
Project Achievements and/or Activities:
The “Find a Doctor” provider search tool can help members, family members, guardians, case managers, and other stakeholders, choose the best health care and/or service provider to meet members’ specific needs, including Home and Community Based Services (HCBS) providers. The search tool and the enhanced search criteria can be accessed on the Health First Colorado website, as well as the PEAK member portal.
To use the enhanced search criteria function in the search tool, use the “advanced filter” option. This option allows you to search for a provider by:
- Services provided in a specific county
- Alternate provider telephone numbers and/or addresses
- Cultural competencies
- Membership to a community association
- Language proficiencies
- Providers’ preferred name
Summary / Project Outcome:
The State of Colorado and HCPF hold equity and cultural competency among the provider community and health care systems at the forefront. With the additional search filters, members will have the most accurate and relevant information to choose the best health care provider to meet their specific needs, resulting in higher quality care and continued engagement with providers.
✅ Initiative 6.05. - Member Tech Literacy - Completed
- Read More about 6.05 - Member Tech Literacy
Project Achievements and/or Activities:
Like HCBS providers, many HCBS-enrolled members could benefit from greater use of electronic systems. Every day we are all expected to adopt new technologies that improve our lives and help us to access the things we need, including our healthcare. This includes accessing doctor's portals, utilizing email and text messaging reminder systems for appointments, or receiving services through expanding telehealth and telemedicine options.
Under this project, HCPF contracted with the Center for Inclusive Design and Engineering (CIDE) to understand the technology literacy landscape for members served through Long Term Services and Supports (LTSS) and identify best practices for effective instruction in achieving desired outcomes including increased digital literacy and use among LTSS members. The outcome of this work is the development of a Digital Literacy Pilot, which included 29 members and 18 coaches, aimed at improving the digital literacy skills of Colorado Medicaid recipients so they may better access online health information and services. During this project, the team is proud to have accomplished the following:
- Conducted stakeholder engagement through a community survey, small group feedback sessions, and subject matter experts to inform the development of the digital literacy curriculum for people with disabilities. Report
- Conducted a scholarly literature review of the technology literacy landscape for people with disabilities.
- Developed a comprehensive Digital Literacy Coach Facilitation Guidebook.
- Developed two interactive digital literacy curriculums accessible via learning modules, one for coaches and another for learners.
- Conducted a pilot with 29 volunteer learners (HCBS recipients) and 18 coaches (service providers, family members, and friends) to evaluate the effectiveness of the curricula and learning modules.
- Evaluated the learning experience and shared results in a final report.
- Published the full curriculum and modules online for anyone in the general public to access through Moodle.
Summary / Project Outcome:
This project developed a learning experience to aid members in developing digital literacy skills including how to access health information online utilizing a coach and learner structure. The learning plans include lessons on foundational skills, online healthcare, cybersecurity, and digital equity. The pilot participants shared their satisfaction with the learning experience in the evaluation process.Moving forward, the developed content and learning management system will be available publicly for anyone to access, free of charge. Additionally, the team from the University of Colorado - Center for Inclusive Design & Engineering (CDIE), in partnership with the Colorado Office of Employment First (COEF), plans to continue to look for future funding opportunities to expand the curriculum.
External Facing Reports/Websites:
✅Initiative 6.11. - Centers of Excellence in Pain Management - Completed
Project Achievements and/or Activities:
- Developed an accredited training program (live and on-demand) for providers to educate about pain management treatment options.
- Established a process to offer consultations with a pain management specialist for members’ primary care providers.
- Developed an extensive outreach effort to engage providers and other stakeholders from around the state.
Summary / Project Outcome:
This project established a new program, the Chronic Pain Centers of Excellence (CoE), designed to address gaps in care experienced by people with chronic pain enrolled in Health First Colorado (Colorado’s Medicaid program.) To support Primary Care providers in managing chronic pain, the program offers accredited provider education, consults for complex pain cases, and connection to multidisciplinary care modalities for people who live with chronic pain through our referral coordinator and locally available resources within each region.
The program has offered live and on-demand educational sessions to over 100 Medicaid enrolled providers, completed complex pain consultations with a double board certified pain specialist and/ or pharmacist, provided support to RAE Representatives, and connected dozens of people who live with chronic pain to appropriate resources and options for individualized care.
External Facing Reports/Websites:
✅Initiative 6.13. - Connect CMAs to ADT Data - Completed
(previously named Connect Case Management Agencies to CORHIO)
Key Project Achievements and/or Activities:
The following details the key achievements and activities resulting from the Connect Case Management Agencies (CMAs) to Admission, Discharge, Transfer (ADT) pilot project:
- HCPF was able to regularly deliver and distribute readable and user-friendly daily ADT data to each of the CMA participants.
- Policy and process recommendations were submitted as Case and Care Management (CCM) system change requests to add event notifications and a work queue for ADT data.
- The CMA pilot participants were able to learn how to use ADT data for identifying and following up on Critical Incidents Reports.
- The participants were able to identify potential areas of collaboration with their Regional Accountable Entities (RAEs) as a result of this project.
- HCPF was able to successfully gather and implement stakeholder feedback through monthly meetings and surveys.
- Connect Case Management Agencies (CMAs) to Admission, Discharge, and Transfer (ADT) Data Pilot Summary of Findings and Recommendations report was completed by the HCPF.
Summary / Project Outcome:
The 6.13 Case Management Agencies (CMAs) to Admission, Discharge, Transfer (ADT) Data pilot project began in January 2023 and concluded in December 2023. The pilot consisted of seven participating CMAs who received daily ADT hospital data files via a secure site from HCPF. The CMAs used the ADT data to identify members associated with their agency who had visited the hospital, alerting them to possible changes in functional needs and services and supports, as well as possible critical incidents. All of which made CMAs more effective at case management while enhancing member experience. The HCPF staff utilized feedback received from monthly participant meetings and monthly participant survey responses to determine the results and outcomes from the pilot project. Multiple positive outcomes were identified as a result. The feedback from participants resulted in the submission of a system change request to generate ADT notifications and a work queue in the Case and Care Management (CCM) system. As a result of having access to the ADT data, participants reported improved outreach and increased communication between case managers and their members thus enhancing member experience. Participants also stated feeling empowered to conduct more effective and comprehensive follow up with their members and identified increased opportunities for the coordination of discharge planning, in turn leading to a more seamless continuity of care. It was determined that both members and case managers benefited from connecting CMAs to ADT hospital data. Case managers were able to better coordinate care and participate in discharge planning with access to this vital information. Overall, this improved health outcomes and the quality of care for members.
Project Metrics:
Seven grants were issued to Case Management Agencies (CMAs) with a focus on diversity. 85.7% of grantees were designated with a diversity classification and were identified as small businesses. Pilot participants completed 12 monthly surveys which included an average of 10 questions across three different categories: Quality of Admission, Discharge, Transfer (ADT) data, Critical Incident Reporting, and Regional Accountable Entity (RAE) and CMA Coordination. The respondents were also asked to upload examples of ADT follow-up activities. Pilot participants engaged in 12 monthly meetings with HCPF staff to discuss and review outcomes related to the quality of ADT data, progress of Critical Incident Reporting, and communication with the RAEs. HCPF project leads spent 30+ hours gathering, documenting, and organizing stakeholder feedback for the ADT project. HCPF distributed 290 days of ADT data to pilot participants between January 26, 2023 and December 31, 2023, despite a brief interruption due to a nationwide data outage during the months of June and July 2023. An analysis demonstrated that the distribution of the ADT data impacted an average of 704 members per month.
External Facing Reports/Websites:
✅Initiative 6.15. - Interface with Trails - Completed
Key Project Achievements and/or Activities:
The Department of Health Care Policy and Financing (HCPF) partnered with Colorado Department of Human Services (CDHS) to improve eligibility determinations and case management for children and youth in Child Welfare enrolled in Medicaid. The project’s multi-phase approach included training and a system change in Trails, the state’s child welfare system. By reducing the number of duplicate cases in the system, the project aided in reducing double capitation payments to our vendors.
Summary / Project Outcome:
Training: Operational memos were issued to county human services departments in December of 2022. Memos provided guidance on data integrity checks, client searches, and case merging.
Case managers were directed to bring questions and/or concerns to the Medicaid Working Sessions.
Systems Change: Prior to the system change, authorized users of the Trails system did not have the ability to look up a member’s Medicaid or CHP+ eligibility information in the interChange system. Thus, the Trails user could not determine whether a member had an active State ID before creating a new ID for the member. The interface has been added to allow county child welfare workers to see if there is a case already open for the member. This will allow them to make a decision related to using the same State ID number, merging cases, or to make a request to close one case while they are opening another.
✅ Initiative 6.02. - Specialty Search in Provider Specialty Tool - Completed
Key Project Activities and/or Achievements:
- Identified related service types
- Web page to help guide prospective providers
- Provider notification memo
A web page has been deployed to help prospective HCBS providers select the right specialty in advance of enrolling with Gainwell or starting the licensure process with the Colorado Department for Public Health & Environment. This will save prospective providers time, reduce the amount of applications returned, and increase the number of available HCBS providers.
✅Initiative 6.14. - Data Sharing with the State Unit on Aging - Completed
Key Project Achievements and/or Activities:
HCPF worked with a vendor to determine future data-sharing capabilities with the Office of Aging and Adult Services (SUA) within the Department of Human Services (DHS), as well as address gaps, opportunities, and barriers to data-sharing in Colorado and reporting on best practices used in other states. The vendor designed a system map of program and IT systems to determine a mechanism to share data and other information across offices. The goal was to implement a technology solution to access the Area Agencies on Aging (AAAs) data to identify and better track Medicaid (Long Term Services and Supports) LTSS members who are receiving services post-ARPA. Current efforts are underway through Colorado’s Health IT Roadmap led by the Office of eHealth Innovation to accelerate the sharing of information and establish infrastructure, governance, and policy that enable the broader health IT ecosystem and State agencies to support care delivery and quality measurement.
Summary / Project Outcome:
Through meeting with representatives from Colorado Case Management Agencies (CMAs), Area Agencies on Aging (AAAs), Aging and Disability Resource Centers (ADRCs), and Health Care Policy and Financing (HCPF), the vendor was able to identify key barriers to cross-agency data sharing that ultimately result in members missing out on certain benefits or supports. The vendor also completed thorough analyses on data sharing allowances related to Medicaid-centric agencies as supported by statutes and regulations, and on opportunities to improve data-sharing through Department initiatives. To point to a feasible path toward data-sharing improvements, the vendor completed a study on data-sharing best practices in other states, and the various systems used by CMAs, AAAs, and ADRCs, and also highlighted allowances in HIPAA regulations.