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
The Department will support case management redesign efforts in the community by developing a framework to support the change management requirements to ensure successful transition from the current system to implementation of a redesign that mitigates the negative impact on members. The Department will work with Case Management Agencies (CMAs), local area organizations, and stakeholders to plan and prepare for Case Management Redesign (CMRD). It will provide support to CMAs to implement CMRD, transition, change management, strategic and organizational planning, capacity and ensuring member access to a CMA, including developing an infrastructure for a learning collaborative so that CMAs have access to individual resources relevant to their change management needs.
✅ 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
The Department will develop and implement comprehensive training for case management agencies to improve quality and consistency statewide. The Department will develop a robust training program for CMAs, RAEs, and MCOs for all waiver programs and services, as well as behavioral health services, State Plan benefits, benefits counseling, and CFC. All the training will be incorporated into a Learning Management System allowing the Department to assign and monitor training completion. The Department will also update all existing training materials for content updates and upload them to LMS software to establish competency-based performance requirements of case managers. Any changes to program participation requirements will be supported by the submission of a waiver amendment once training documentation is completed.
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.