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Case Management Redesign

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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 is the right number of case management agencies in Colorado, and increasing the quality of case management services.

How does Case Management Redesign benefit me?

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Attention Contractors!

September 8, 2023

The Department is looking for individuals and companies that might be interested in working with Case Management Agencies (CMAs) to assist them as they transition to new roles as part of the Case Management Redesign (CMRD) initiative. Many CMAs are looking for technical assistance across a variety of categories, including:

  • Change management training
  • Communications strategy and planning
  • Facilitation and community planning
  • Legal and corporate structure support
  • Policy support
  • Staffing capacity support
  • Strategic and organizational planning
  • Transition planning and support

If you would like to be included on a list of contractors that will be shared with CMAs for any of this work, please email our vendor, Health Management Associates (HMA) - Jonah LaVigne at JLavigne@healthmanagement.com

Case Management Redesign Timeline

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

Updated May 2023

  • Adjusted Dates for Quality Metric Development & Training and Development (April 2022 Update)
  • Extended Input on Rule & Regulation Draft Updates to June 2023 / Shifted CMA Awardees Notified to June 2023 / Removed July 2023 Public Notice since it will occur beyond the timeline end date (May 2023 Update)
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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 (HCPF) 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 defined service area that is awarded by HCPF through a competitive procurement process.

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

  
Q: Why is CMRD happening NOW?
  

A: In 2014, CMS, HCPF’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, HCPF 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 defined service 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, Complementary and Integrated Health 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 the program. Case Management Redesign will create a simplified system where there is one place to go in each defined service 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 HCPF 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 defined service area. Case Management Agencies will have a process for members to request a new case manager if they are not a good fit.

Exceptions will be made if a person moves across defined service area boundaries and wants to continue being served by their previous agency. The process for this portability allowance and exception is still being formulated and will likely differ by defined service area. (Updated 8/25/22)


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, HCPF 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.” HCPF 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 HCPF 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 defined service areas decided?  

A: HCPF hired a contractor to analyze data, caseloads, the numbers of assessments and support plans, and to look at geographical issues resulting in defined service area recommendations.  

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

Final defined service 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 defined service 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. HCPF will align CHCBS case management with the other waiver case management to meet efforts to simplify and streamline the current siloed system.  All case management agencies will be required to evolve with the changes required in Colorado's system, but HCPF is working closely with CMAs to support the retention of staff into the future case management system. (Updated 8/25/22)

 

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. HCPF, CCBs and CMAs will ensure that case managers are informed, educated and trained on all resources available to HCBS individuals in their defined service areas.

 

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

A: Providers will continue providing the same direct services per rules and regulations. Providers will be notified of any changes in case management agency in each defined service area via provider bulletin, HCPF communications, and communication from local case management agencies.

 

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

A: HCPF is aware of the uncertainty and anxiety that can be created with this level of change. HCPF leadership meets with CCB and SEP leadership groups on a monthly basis to discuss ways to support agencies and their staff through this transition. HCPF has approval to utilize American Rescue Plan Act (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! (Updated 8/25/22)

 

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.

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

As a first step toward achieving the goals of Case Management Redesign, HCPF 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.

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

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

Defined Service Area - Initial plan for proposed defined service 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 (Catchment area refers to what is now named defined service area)

Only Willing and Qualified Provider Exception - Identify provider capacity within the proposed defined service 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.

The Department of Health Care Policy and Financing (HCPF) will update rules and regulations pertaining to Home and Community Based Services (HCBS) waivers and non-waiver programs to come into alignment with new CMRD statute, policy, and language. Rule updates are required to clean up areas in existing rules and waivers that are repetitious, obsolete, or difficult to follow and understand. CMRD also implements changes to the rule structure. The vision behind the structure change is to make the HCBS rules easier to find, read and understand for all stakeholders.

HCPF will host a series of meetings from October 2022 through June 2023 to hear from stakeholders about rule revision topics, ask questions, and receive feedback about navigating HCBS rules to help us make these rule revisions work for all HCBS stakeholders. Rules will go into effect no later than January 1, 2024.

8.7000 HCBS Rule - Final Draft - Updated - Simple Markup - December 22, 2023

8.7000 HCBS Rule - Final Draft - Updated - Full Markup - December 22, 2023

CMRD MSB Stakeholder Feedback Log - December 2023

View Informational Memo IM 22-039

CMRD Rule Revision FAQ - December 2022

Meeting Topics

Visit the OCL Stakeholder Engagement page to view the most current meeting information. (Dates and times are subject to change)

 

Listening Log Documents

Stakeholder engagement, feedback and Department responses will be tracked through listening logs.

Case Management Agency Request for Proposals (RFP) Member Survey Live Response Webinar

  • The Department of Health Care Policy and Financing (HCPF) has developed a survey that allows stakeholders to share involvement in the Case Management Agency selection process while maintaining the integrity of the RFP and state procurement law. The survey will consist of five questions targeting key areas of importance that Long-Term Services and Supports (LTSS) and Home and Community-Based Services (HCBS) stakeholders need most from their Case Management Agency.

    HCPF will host this RFP Member Survey Live Response webinar to answer any questions you may have and help you fill out your surveys.
     

Case Management Redesign (CMRD) Updates

 

Case Management Redesign Training / Educational Sessions:

Case Manager Learning Collaborative Series

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

Culture Change Series

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

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

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 HCPF and case management agencies (CMAs) throughout the CMRD process. All interested stakeholders are welcome.
     
  • Date: Tuesday, April 19, 2022

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, HCPF hosted three opportunities to participate in a member and family-only virtual listening session.

Case Management Redesign Catchment Area Stakeholder Meeting - June 2021

HCPF 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 HCPF. 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.

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.

CMRD Memos

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Memo #Memo TitleIssue DateKeywordsLinks and Attachments
OM 23-056Case Management Redesign: Member Exceptions Process9/6/2023Home and Community-Based Services, HCBS, Case Management Agencies, CMA, Case Management Redesign, CMRD, Member Choice, Member TransitionsNone
IM 23-026Case Manager Retention Payments and Bonus Case Management Redesign9/1/2023Case Management Retention Payments, Case Management Redesign, Recruitment and RetentionNone
IM 23-024Case Management Agency Request for Proposal Status Update8/11/2023Home and Community Based Services (HCBS), Case Management Agencies (CMA), RFP, Request for ProposalNone
OM 23-002Case Management Redesign: Conflict-Free Case Management Waiver1/20/2023Case Management Redesign, CMRD, Conflict-Free Case Management, CFCM, Only Willing and Qualified Provider, OWQPConflict-Free Case Management Waiver Application
IM 22-042Organized Health Care Delivery System (OHCDS) Changes for Case Management12/13/2022Vision, Recreational Fees/Passes, Vehicle Modifications, Assistive Technology, Specialized Medical Equipment and Supplies, Case Management Agency (CMA), Community-Centered Board (CCB), Organized Health Care Delivery System (OHCDS) None
IM 22-039Stakeholder Engagement Opportunity: Office of Community Living Rule Revisions and Waiver Updates11/28/2022Case Management Redesign, Rules and Regulations, Waivers, StakeholderNone
IM 22-026Case Management Redesign Policy Update: Community Centered Board Designation Process7/12/2022Case Management Redesign, Conflict Free Case Management, CFCM, CMRDCommunity Centered Board Designation Application Draft
IM 22-001Case Management Redesign Policy Update: Implementation Timeline1/5/2022Case Management Redesign, Conflict Free Case Management, CFCM, CMRDNone
IM 21-055Case Management Redesign Policy Update: Catchment Area11/30/2021Case Management Redesign, Conflict Free Case Management, CFCM, CMRDNone
IM 21-041Case Management Redesign Member and Family Listening Sessions6/24/2021Case Management Redesign, Conflict Free Case Management, CFCM, CMRDCase Management Redesign Member and Family Listening Session Flyer
IM 21-032Case Management Redesign Catchment Area Stakeholder Survey5/7/2021Case Management Redesign, Conflict Free Case Management, CFCM, CMRDNone
IM 21-014Contractor Kickoff Meeting for Case Management Redesign2/10/2021Case Management Redesign, Conflict Free Case Management, CFCM, CMRDNone
IM 20-050Case Management Redesign Statewide Webinar    10/13/2020  Case Management Redesign, Conflict Free Case Management, CFCM, CMRD, Care and Case Management IT Platform, Long-Term Services and Supports (LTSS) Assessment and Support Plan, Person-Centered Budget Algorithm 

View all memos issued by HCPF

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Contacts

Nicolette.Cordova@state.co.us
Case Management Redesign and Community Liaison
 

Helpful Links

Conflict Free Case Management page
Office of Community Living Stakeholder Engagement page
Long-Term Services and Supports Programs page

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.