The Need
The transformation of Colorado’s case management system is underway, requiring a complete reorganization of a decades-old system. Colorado is the second fastest-growing state for older adults, which is driving increased demand for HCBS services. This, in combination with the fact that 84% of HCBS members have a chronic condition, 31% of whom have 5 or more chronic conditions, is having a measurable impact on state budgets and program demands. As the case management system adapts and transforms in preparation, growing pains could be better addressed if case management agencies were better prepared. To assist with expected organizational and system changes, the 18 | Colorado HCBS Spending Plan Department proposes providing capacity-building funds, change management expertise, and evolving systems support for agencies, members, and their families.
✅Initiative 5.01. - Case Management Capacity Building - Completed
Case Management Redesign (CMRD) refers to several initiatives that will help make accessing long-term services and supports easier by changing case management agencies (CMAs) to serve all Home and Community Based Services (HCBS) waivers so people have one place to go, making sure there is the right number of case management agencies in Colorado, and increasing the quality of case management services. While the long-term effects are necessary and invaluable, there were substantial changes in those processes. This project provided resources to help limit disruptions to members during the CMRD transition process.
CMA Start Up and Transition Costs
Technical Assistance & Coaching
HCPF contracted with a vendor to support CMAs, stakeholders, and HCPF to plan, prepare, and implement CMRD transitions. The needs of each agency varied through the phased CMRD transitions, and support included implementation of CMRD policy changes, transition case management services, change management, and capacity building to ensure members have access to a CMA.
A total of 2,981 hours of coaching was provided to CMAs between June 2023 and September 2024. Nineteen CMAs received technical assistance (TA) over the three phases of CMRD, with over $1.9M dispersed to support TA and stabilization activities. The most requested TA included legal and corporate structure support, transition planning and support, policy and community planning support, and change management support.
One grantee reported, “The coaching team was really great. It was very helpful to learn about the differences for the IDD world and teaching us and encouraging us to work together. [Our organization} would not have progressed as successfully through the transition without the coaching support.”
Additionally, the vendor collaborated with HCPF to develop and facilitate a total of 45 Learning Collaborative training sessions for Case Management staff between April 2022 and August 2024. Topics were focused on change management and navigating through the CMRD transitions. View the Learning Collaborative series.
One participant reported, “The peer learning collaboratives were useful in terms of recognizing that [our agency] was not alone with some of the struggles and actually were able to offer helpful ideas to other CMAs at times. That feeling of community was helpful during this large of a change.”
CMA Start-Up Grant
HCPF developed the CMA Start-Up Grant to support the transition of designated CMAs to provide case management HBCS services. The project team collaborated with the project teams from ARPA 6.06 (Dollars to Digitize) and 6.08 (Care and Case Management System Investments) to provide a streamlined application process and single point of contact. Eligible funds were available for three areas of need: the purchase of Care and Case Management (CCM) System compatible devices (6.08), upgrading or adopting a new Electronic Health Record (EHR) (6.06), and/or costs to support new agency start-up (5.01).
With approximately 38,000 members served, 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.
Grantees 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.”
“It was so nice to have my own workspace ... I feel spoiled and appreciated...”
CMA Longevity and Retention Bonuses
HCPF developed the CMA Retention Grant in an effort to strengthen CMRD and maintain local case management expertise and knowledge. Three phases of funding were dispersed from February 2023 to August 2024, totaling over $4.3M and benefiting 4,392 staff. Outcomes of the grant include:
31 CMAs retained 90% or more of staff that received a retention bonus in Phase 3
82.5 % of staff not new to case management indicated that the sign-on bonus motivated their decision to stay in Case Management
65% of staff new to case management indicated that the sign-on bonus motivated their decision to start work with their CMA
One grantee reported, “Personnel retention grants allowed us to reward staff for their ongoing dedication during a challenging transition period. The sign-on bonuses were also a valuable tool in attracting new hires, enhancing our workforce stability.”
CMA Care and Case Management Stabilization Support
Care and Case Management (CCM) Stabilization Grant
The CCM Stabilization Grant provided support to CMAs for unexpected costs outside of previous funding opportunities or existing reimbursement structures to implement CMRD, to support staff retention, assist with data clean-up in the CCM, digitization and/or storage of documents and other unexpected demands. Funding was dispersed between March and September 2024, totaling over $3.2M. Grantees provided the following feedback on the funding’s impact:
“96% of the case management staff who were provided with stabilization retention payments are still employed by the organization 5 months later, providing stability and consistency to Members.”
“CM Stabilization was not just valuable, but a necessity given the challenges with the system.”
Assessment Tool Quality Assurance and Quality Improvement
CMAs are responsible for completing the Supports Intensity Scale (SIS) Assessment, which is utilized by HCPF to determine a Member’s Support Level before enrollment in HCBS-Developmental Disability (DD) or HCBS-Supported Living Services (SLS) waivers. The Assessment must be conducted by a certified SIS Interviewer, and includes the person being assessed as well as the people who know them well. With the introduction of the new Interim Support Level Assessment tool and the retirement of the SIS-A tool SIS Online platform, the SIS-A assessment tool can no longer be used.
HCPF contracted with the developer of the SIS-A to evaluate the quality and effectiveness of the Assessment and its administration in Colorado in preparation for the transition to the Interim Support Level Assessment and eventual Colorado Single Assessment (CSA). The following activities were included in the evaluation:
SIS-A Interviewer Reviews
SIS-A Record Reviews
SIS- A Community of Practice Training
The findings and insights of the evaluation informed a set of recommendations to support the successful implementation of the Interim Support Level Assessment tool and eventual implementation of the new CSA tool. Recommendations include focused training and development, strengthened communication strategies, enhanced data and feedback mechanisms, strategic planning for future integration, and continuous stakeholder engagement.
✅ Initiative 5.03. - Case Management Rates - Completed
Key Project Activities and/or Achievements:
- Case management time study and analysis
- Comprehensive rate workbook for case management activities
- Case Management Recommendation Report for case management activities
A newly developed case management workbook for rate development is to be utilized moving forward. Existing rates were deemed sufficient with the exception of the ongoing targeted case management rate. A budget request has been implemented to increase the case management appropriation for this task. HCPF will continue to use the developed rate workbook when determining any future rate changes for case management activities. This initiative will continue to be led by the Office of Community Living.
✅Initiative 5.04. - Case Management Best Practices - Completed
Key Project Achievements and/or Activities:
Person-centered case management and care coordination requires adapting outreach strategies and support services to the needs of the population and of individuals, which may be different depending on the disability. The Department of Health Care Policy & Financing (HCPF) researched national best practices for Colorado’s Regional Accountable Entity (RAE)/ Case Management Agency (CMA) system to better meet the needs of a variety of member profiles such as complex care coordination for those with dual or poly diagnoses. HCPF developed a training plan, which included appropriate materials for CMA and RAE staff on their various roles and responsibilities, collaborative roles between the systems, and effective care collaboration across the continuum of care, especially for Members with complex needs. The Department also provided funding to CMAs to incentivize the implementation of identified best practices.
CMAs and RAEs were supported in implementing select best practices, the results of which have increased CMA/RAE collaboration and communication in serving shared Medicaid Members.
By better defining roles and responsibilities; adopting accepted business practices; creating training materials; establishing clear communication channels and standards; sharing information; and leveraging technology for data exchange, the RAEs and CMAs have enhanced their ability to
work together more efficiently and have improved the overall member experience.
Summary / Project Outcome:
CMAs and RAEs have established data sharing agreements, standardized standing meetings and policies and procedures around serving their shared Members. CMAs and RAEs now meet together monthly at a Cross Agency Forum co-chaired by a CMA and RAE representative designed to further their collaboration and communication going forward.
✅Initiative 5.05. - Case Management Agency Training Program - Completed
Key Project Achievements and/or Activities:
HCPF developed a comprehensive training curriculum to equip Colorado’s case managers with the necessary knowledge to provide person-centered case management to help members feel heard and in control of their decisions. The training was informed by HCPF subject matter experts and external stakeholders and designed to be interactive and empowering. In addition to training development, HCPF provided funding to case management agencies to support training implementation for staff.
Summary / Project Outcome:
The comprehensive training curriculum includes 53 web-based trainings, 6 virtual instructor-led training (VILT) presentations, and 9 certification exams. The training covers new processes developed by HCPF for eligibility determinations, needs assessments, and support planning for individuals seeking or receiving long-term services and supports (LTSS). These new processes are person-centered, enhance self-direction, and facilitate greater coordination of services. The training will be incorporated into a Learning Management System (LMS), allowing HCPF to assign and monitor training completion.
Stakeholders provided the following feedback regarding the training curriculum:
“Grateful to see the state offering this resource to CMAs across the state (especially those that cannot afford internal training staff due to their size).”
“The diversity/cultural parts were not part of my training 8 years ago when I was hired, so well done.”
“I really appreciate the training informing case managers that they can be involved in any part of the process, including helping applicants with the application process. This may be new territory for our incoming Single Entry Point (SEP) case managers.”
“The Member Spotlights were my favorite part of the training. The interactive questions were really helpful and reinforced the knowledge introduced throughout the course.”
Though the majority of training development under this project is complete, one component is still ongoing due to delays with the Care and Case Management (CCM) system rollout. HCPF intended to complete the training for the new Colorado Single Assessment (CSA), which was scheduled to replace the Support Intensity Scale (SIS) assessment, and the Person Centered Support Plan, during the ARPA period. The SIS assessment is being decommissioned by July 1, 2025 and the CSA was planned to be implemented at the same time. However, due to the delays of the CCM system, HCPF has had to delay the implementation of the CSA and pivot to an interim solution to replace the SIS called the Interim Support Level Assessment (ISLA). Case managers and other assessors will be required to be trained on the new interim tool in the spring of 2025 and on the CSA later in 2025.
HCPF will maintain strong oversight of the ISLA and CSA training until activities are completed.
External Facing Reports/Websites:
Initiative 5.02. - Improve and Expedite Long-Term Care Eligibility Processes
Under this project, the Department will work with stakeholders to identify solutions to barriers to long-term care eligibility, both from a physical eligibility and financial eligibility perspective. Any changes will result in the need for system enhancements as well as training to counties, Medical Assistance sites, and case managers on eligibility requirements for waiver programs and other long-term care programs.
The Department will research and determine appropriate solutions for expedited eligibility processes and manage projects. These changes will require extensive stakeholder feedback and engagement.