Case Management Redesign

Case Management Redesign refers to several initiatives that will help make accessing long-term services and supports easier by changing case management agencies to serve all HCBS waivers so people have one place to go, making sure there are the right number of case management agencies in Colorado, and increasing the quality of case management services.

Case Management Redesign Timeline

This timeline gives you a high level view of projected dates for the Case Management Redesign process.

Case Management Redesign Timeline Image

Case Management Quality Survey - Open through October, 15 2021

As part of the case management redesign initiatives for HCBS waivers, the Department would like to gather information and feedback from stakeholders on current and future definitions of quality case management.

Take Case Management Quality Survey - English

Take Case Management Quality Survey - Spanish

The survey will be open to all stakeholders until October 15, 2021

Stakeholder Engagement Plan - FY 2021-22

Please continue to look for broader engagement on Case Management Redesign, as we intend to reach all interested stakeholders before implementing any changes.

State Fiscal Year 2021-2022

The Department continued its partnership with HCBS Strategies to research final policy decisions for the Department to finalize the design and plan for implementing the Case Management Redesign (CMRD) initiative in Colorado.

The Department recognizes the importance of ensuring stakeholders help shape the Case Management Redesign process and will host member and family listening sessions to better understand what quality case management looks like, listening sessions for case managers, and a statewide stakeholder meeting.  All materials are posted on this page. In addition, the Department has a survey for all interested stakeholders to obtain feedback on quality case management.

Based on this work, the Department will make decisions on the following topics for the future of Case Management Redesign:

  • Children's Home and Community Based Services (CHCBS) - Analyze the current case management and benefits structure of Children’s Home and Community Based Services (CHCBS) and make recommendations to the Department on how to integrate into Case Management Redesign.
     
  • Community Centered Board Designation - Conduct analysis of Colorado’s current Community Centered Board (CCB) designation to identify how it will change with Case Management Redesign.
     
  • Regulation and Waiver Crosswalk
     
  • Case Management Implementation Timeline - House Bill HB 21-1187, Long-term Services and Supports Case Management Redesign, requires the Department to work with stakeholders to develop a timeline for implementation of Case Management Redesign no later than December 31, 2021.
     
  • Human Rights Committee research 
Stakeholder Engagement Plan - FY 2020-21

As a first step toward achieving the goals of Case Management Redesign, the Department partnered with HCBS Strategies and Single Entry Point agencies (SEPs), Community Centered Boards (CCBs), and other stakeholders to design the plan for implementing the Case Management Redesign (CMRD) initiative in Colorado.

The Department recognized the importance of ensuring stakeholders help shape the Case Management Redesign process, and hosted a kickoff meeting, smaller targeted focus group meetings, and a statewide stakeholder meeting.  All materials were posted on this page.

In addition, the Department sent multiple surveys to all interested stakeholders to obtain feedback on the topic areas listed below.

Based on this work, the Department identified decisions on the following topics for the future of Case Management Redesign: 

Catchment Areas - Initial plan for proposed catchment area maps for the consolidated SEP and CCB regions and rationale for the proposed approach.

Only Willing and Qualified Provider Exception - Identify provider capacity within the proposed catchment areas and where only willing and qualified provider exceptions may need to be made.

Organized Health Care Delivery System (OHCDS) - Discuss results of our research and interviews with other states around OHCDS.

Frequently Asked Questions

Q: What is Case Management Redesign (CMRD)?  

  • A: Case Management Redesign refers to several initiatives that will help make accessing long-term services and supports (LTSS) easier by changing case management agencies to serve all Home and Community-Based Service (HCBS) waivers so people have one place to go, making sure there are the right number of case management agencies in Colorado, and increasing the quality of case management services.   

Q: Why is CMRD happening?  

  • A: Single Entry Points (SEPs), Community Centered Boards (CCBs) and private Case Management Agencies currently provide case management for individuals with disabilities in the Colorado Department of Health Care Policy and Financing’s (the Department) ten Home and Community-Based Services (HCBS) waiver programs, with each serving different waiver programs.   

    In addition to case management services, many CMAs also provide direct services to program recipients, creating a conflict of interest which is no longer allowable by the Centers for Medicare and Medicaid Services (CMS).  

    Individuals who are seeking or receiving LTSS often qualify for multiple programs and end up navigating between systems that are siloed by program, making the system difficult for members.   

    CMRD is intended to simplify access and remove silos so members will be able to more easily navigate and find the right programs and services that work for them. It will require one case management agency to provide case management services for all waiver programs in each catchment area that is awarded by the Department through a competitive procurement process. 

    Further, these changes will meet the federal Conflict-Free Case Management requirement and allow the Department to ensure quality case management services for members across the state.  

Q: Why is CMRD happening NOW?  

  • A: In 2014, the Centers for Medicare and Medicaid (CMS), the Department’s federal partners, released as the requirements for the “Final HCBS Settings Rule.” It included many requirements for providers to make changes to their processes to increase person centeredness.   

    This rule also included a requirement for case management agencies to be “conflict free,” which means that they cannot provide services to the same person they are providing case management services to. Colorado must come into compliance with these rules by July 1, 2024.  

Q: What if we don’t implement CMRD?  

  • A: If Colorado does not come into compliance with conflict free case management, the risk is losing federal funding, which is 50% of home and community-based services.  This would be detrimental to people in Colorado being able to access these vital services in the future.  

Q: What does “conflict free” mean?  

  • A: Conflict free means a case management agency will not provide both case management services and direct services to an individual, because this creates a conflict of interest.

    CMS defines conflict free case management as: “Providers of HCBS for the individual, or those who have an interest in or are employed by a provider of HCBS for the individual must not provide case management or develop the person-centered service plan, except when the State demonstrates that the only willing and qualified entity to provide case management and/or develop person-centered service plans in a geographic area also provides HCBS. In these cases, the State must devise conflict of interest protections including separation of entity and provider functions within provider entities, which must be approved by CMS.” 

Q: Will there be exceptions to conflict free case management?

  • A: Yes, the Department will create a process for exceptions to conflict free case management in areas where the approved case management agency is also the only willing and qualified provider in a catchment area to ensure access to services and supports statewide. 

Q: How will CMRD benefit members?  

  • A: Currently, Single Entry Points (SEPs) provide case management services for individuals on the following waivers: Brain Injury waiver, Community Mental Health Supports waiver, Elderly, Blind and Disabled waiver, Spinal Cord Injury waiver, Children’s Home and Community Services waiver, and Children with Life Limiting Illness waiver. The Community Centered Boards (CCBs) provide case management services to members who have intellectual or developmental disabilities (IDD) on the following waivers: Developmental Disabilities waiver, Supported Living Services waiver, Children’s Extensive Support waiver, and Children’s Habilitation Residential Program waiver. Private Case Management agencies provide case management services to people on the Children’s Home and Community Based Services waiver.  

    Individuals seeking or receiving long term services and supports often qualify for multiple programs and end up navigating  systems that are siloed by program. Case Management Redesign will create a simplified system where there is one place to go in each catchment area for case management for all waivers. Case Management Redesign will create consistency in the quality, accountability and stability of the case management services people receive across the state. It will allow the Department to provide oversight and support to ensure high performing case management system statewide.   

Q: Will members still have a choice of agency?  

  • A: Members will receive case management services from the agency who holds the contract in their catchment area except for in cases where both the individual and agency agree to other terms.  

    If a person wants to be served by another agency in an adjacent catchment area, if both the individual and the agency agree, this will be allowable.   

Q: What if I want to keep being served by my current agency but they don’t get awarded the contract?  

  • A: In the event there is a transition, the department works closely with both incoming and outgoing agencies to ensure there is very minimal impact to members.  In our experience majority of staff transition and individuals are able to retain their case manager if they so choose. 

Q: What will the impact be if a person moves from being served by a SEP or CCB to being served by a case management agency?   

  • A: The impact on members should be minimal if a transition does occur in your area. Most of the transition process will be business processes, contracts, materials, and files which are done “behind the scenes.” The Department works with both incoming and outgoing agencies to ensure a smooth transition for members. Members can expect to experience outreach and communication regarding a change in their case management agency from both the Department and the awarded case management agency. 

    During previous transitions between agencies, case management staff experience and expertise are highly valued and new agencies seek to retain case managers whenever possible. Unless case managers choose to leave, members can expect to continue with their current case manager through transitions whenever that is possible.  

Q: How are catchment areas decided?  

  • A: The Department hired a contractor to analyze data, look at geographical issues, caseloads, and numbers of assessment and support plans and made recommendations.  

    Stakeholders provided feedback on the proposed maps and the contractor adjusted recommendations to the Department based on webinars and survey responses.   

    Final catchment areas (the areas that the case management agencies service) will be decided based on all this feedback by November 2021.

Meeting Information and Materials

Meeting materials will be posted following each meeting.

Case Management Redesign Member and Family Listening Sessions - July 2021

To ensure members and families are at the center of the final decision-making process, the Department will host three opportunities to participate in a member and family only virtual listening session.  Please attend ONE of the following sessions:

Tuesday, July 27, 2021 from 12:30-2:30 p.m.
or
Tuesday, July 27, 2021 from 5:00-7:00 p.m. 
or
Wednesday, July 28, 2021 from 10:00 a.m.-12:00 p.m.

During each meeting members and families will view a brief video outlining the Department's efforts to redesign the case management system, then members and families will participate in small group discussions based on their geographic locations. The feedback received during these listening sessions will be collated into themes and used by the Department in their decision making on key policy areas for Case Management Redesign.

Catchment Area Stakeholder Meeting - June 2021

Case Management Redesign Catchment Area Stakeholder Meeting - June 16, 2021
 
The Department hosted a statewide Case Management Redesign stakeholder meeting to provide an overview of the feedback received on draft defined service areas, or catchment areas, for new case management agencies. This was an opportunity for stakeholders to learn more about the project and provide feedback to the Department. All interested stakeholders were welcome.

Further information about the meeting and a related stakeholder survey are found in Informational Memo 21-032 which can be found on the Department's 2021 Memo Series Communication web page.

Stakeholder Kickoff Meeting - February 2021

Stakeholder Kickoff Meeting for Case Management Redesign - February 24, 2021

The initial kickoff meeting was open to all stakeholders and laid out the objectives and proposed approach for the project and obtain stakeholder input.

Contacts

Tiffani.Domokos@state.co.us
Case Management Redesign Policy Advisor

Katy.Barnett@state.co.us
Community Liaison

Helpful Links


Reasonable accommodations will be provided upon request for persons with disabilities. Auxiliary aids and services for individuals with disabilities and language services for individuals whose first language is not English may be provided upon request. Please notify John Barry at 303-866-3173 or John.R.Barry@state.co.us or the 504/ADA Coordinator at hcpf504ada@state.co.us at least one week prior to the meeting to make arrangements.