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.

Updated April 2022

  • Adjusted Dates for Quality Metric Development & Training and Development (April 2022)

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 HCBS waiver programs, with each serving different waiver programs.  

In addition to case management services, many Case Management Agencies (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, CMS, the Department’s federal partner, released the requirements for the “HCBS Settings Final 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 the budget for 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, 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 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 that 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 on members. In our experience,  the majority of staff transition to the new agency, 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, caseloads, the numbers of assessments and support plans, and to look at geographical issues resulting in catchment area recommendations.  

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

Final catchment areas (the areas that the new case management agencies will service) were decided based on feedback in November 2021.

View Informational Memo IM 21-055 - CMRD Policy Update: Catchment Areas - November 2021

 

Q: Will contracts for Case Management go to the lowest bidder through the RFP process?

A: No. The rates for case management are set for all administrative and targeted activities. The RFP process will not evaluate costs but will evaluate best fit to serve the specific catchment area each agency applies for.

 

Q: How will CMRD impact Children’s-Home and Community Based Services (CHCBS)?

A: CHCBS members will continue to receive In Home Support Services (IHSS) and case management services. The Department will continue stakeholder outreach about the possibility of aligning CHCBS case management with the other waivers and allow for new services for this waiver population.

 

Q: How will CMRD impact CCBs and mill levy?

A: The definition of CCBs will be amended but will ensure the continuity of local mill levy dollars as it pertains to HCBS recipients to be shared with local CMAs. The Department, CCBs and CMAs will ensure that case managers are informed, educated and trained on all resources available to HCBS individuals in their catchment areas.

 

Q: How will CMRD impact providers or available services for members?

A: Providers will continue providing the same direct services per rule and regulation. Providers will be notified of any changes in case management agency in each catchment area via provider bulletin, Department communication and communication from local case management agencies.

 

Q: What is the Department doing to ensure stability among case managers at current CCBs and SEPs?

A: The Department is aware of the uncertainty and anxiety that can be created with this level of change. Department leadership meets with CCB and SEP leadership groups on a monthly basis to discuss ways to support agencies and their staff through this transition. The Department has approval to utilize ARPA funds to identify strategies to address these important concerns in our case management system. This work will be ongoing between now and July 2024. Check out the ARPA website for more information about this project! (insert ARPA website)

 

Q: I want to participate in upcoming stakeholder engagement efforts for Case Management Redesign. How do I get involved?

A: We are so glad you want to get involved! Please sign up for our twice weekly OCL Email Newsletter and our ARPA Project Pulse Newsletter to keep informed of opportunities! You can also Email John Barry for more information.

Catchment Area, Organized Health Care Delivery System (OHCDS), and Rural Exceptions

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. View Informational Memo IM 21-055 - CMRD Policy Update: Catchment Areas - November 2021

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.

Meeting materials will be posted following each meeting.

Case Management Redesign Training / Educational Sessions:

  • Change Management and Case Management Redesign
    • This session will help participants define change management as it related to CMRD and garner feedback about what our stakeholders need from the Department and case management agencies (CMAs) throughout the CMRD process. All interested stakeholders are welcome.
       
    • Date: Tuesday, April 19, 2022
      Time: 1:00 - 2:30 p.m. MT​​​​​​
       
    • Presentation - April 19, 2022
  • Grant Writing 101
    • Funding and other resources are available from public agencies and private foundations but grant application processes can be daunting and time-consuming.

      This Learning Collaborative will teach participants about how to identify the right funding opportunities, evaluate go/no go decisions, determine resources needed to write and collect information for applications, and how to design measures to track success and evaluate outcomes. It is designed for a broad audience, especially those who are unfamiliar with federal/state/foundation grants and those who want to brush up on writing good grant applications.

      All interested members of the public and long-term services and supports (LTSS) stakeholders are welcome.

    • Date: Tuesday, May 24, 2022

    • Time: 1:00 - 2:30 p.m. MT

    • Grant Writing 101 Meeting Recording - May 24, 2022
    • Presentation - May 24, 2022
    • Application Guide Template - May 24, 2022
    • Possible Funding Research Grid Template - May 24, 2022
       
  • Culture Change Series

This three-part series to listen and learn from the people whose lives are most affected by case management services. 

  • Part 1 - Learning from People with Disabilities
    • Part 1 focuses on listening and learning directly from the individuals whose lives are most impacted by case management services.  People with disabilities and their advocates will give their insights and talk about what Case Management Agencies (CMAs) will need to know about working with people with disabilities.

      This webinar is open to the public but will be most helpful for staff and leaders from CMAs not currently serving people with disabilities.

      Interested stakeholders will include case managers, people with disabilities, families, and other members of the public.
       
    • Date: Tuesday, May 10, 2022
      Time: 1:00 - 2:30 p.m. MT
       
    • Presentation - May 10, 2022
  • Part 2 - Learning from Older Adults
    • Part 2 focuses on listening and learning directly from the individuals whose lives are most impacted by case management services. It will feature older adults and their advocates talking about what they believe is most important for Case Management Agencies to know about serving them.

      This webinar is open to the public but will be most helpful for staff and leaders from CMAs not currently serving older adults.

      Interested stakeholders will include members of the public, case managers, older adults and families.
       
    • Date: Tuesday, June 21, 2022
      Time: 1:00 - 2:30 p.m. MT
      Meeting Recording
  • Part 3 - Balancing Equity and Unique Needs
    • Part 3 focuses on listening and learning directly from the individuals whose lives are most impacted by case management services. It will feature national experts in person-centered thinking and equitable approaches to working with different populations.

      This webinar is open to the public and is designed for anyone interested in learning more about how to balance the unique needs of individuals being served with an overall approach to equity.

      Interested stakeholders will include long-term services and supports (LTSS) stakeholders and members of the public.
       
    • Date: Tuesday, July 26, 2022
      Time: 1:00 - 2:30 p.m. MT
      Register Now
      Meeting ID: 999 0109 2024   Passcode: 434937
      Join by Phone: 1-253-215-8782 or (Toll-free) 1-877-853-5257
       
  • Myths and Facts about Changes to Case Management 
    • Major changes to a system can mean major confusion. Let’s help put some of the rumors to rest! This Learning Collaborative will help anyone interested in sorting through facts vs. fiction about changes to case management as a result of the Colorado Case Management Redesign work. It is open to the public and will be most helpful for individuals and their families who are being served by a Case Management Agency today, as well as individual case managers and providers seeking to understand this important reform.

      Interested stakeholders will include long-term services and supports (LTSS) stakeholders and members of the public.

    • Date: Tuesday, August 23, 2022
      Time: 1:00 - 2:30 p.m. MT
      Register Now
      Meeting ID: 953 1233 0628, Passcode: 838502
      Join by Phone: 1-253-215-8782 or (Toll-free) 1-877-853-5257

  • Collaborative Consumer Engagement: Supporting Members and Families to Support Design, Implementation, and Oversight 
    • People who receive long-term services and supports (LTSS) and their families, as well as beneficiary and community advocates, offer important perspectives in the design, implementation, and oversight of public programs, including case management. Both HCPF and the Centers for Medicare & Medicaid Services (CMS) encourage both informal and formal stakeholder engagement in LTSS programs. This Learning Collaborative will focus on best practices in consumer engagement, member advisories, and ensuring program design, implementation and oversight are informed by the views of members. This webinar is open to the public and is designed for organizations seeking to improve consumer engagement and for members, families, and advocates who want to contribute to great case management in the new structure.

      Interested stakeholders will include long-term services and supports (LTSS) stakeholders and members of the public.

    • Date: Tuesday, September 20, 2022
      Time: 1:00 - 2:30 p.m. MT
      Register Now
      Meeting ID: 925 3305 5093, Passcode: 978859
      Join by Phone: 1-346-248-7799 or (Toll-free) 1-877-853-5257

Accessibility Accommodations: 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.

 

Case Management Redesign Member and Family Listening Sessions - July 2021

Meeting Purpose: To ensure members and families are at the center of the final decision-making process, the Department hosted three opportunities to participate in a member and family only virtual listening session.

Case Management Redesign Catchment Area Stakeholder Meeting - June 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.

View Informational Memo 21-032 for further information about the meeting.

Stakeholder Kickoff Meeting for Case Management Redesign - February 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.

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

Contacts

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

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.