Case Management Redesign

#FFFFFF

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)
#FFFFFF

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. 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 catchment 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 catchment 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, 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 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 the Department 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. 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 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.

#FFFFFF

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.

The Department 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 rule 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.

Rules must be in effect no later than November 1, 2023, at which point the first cohort of new Case Management Agencies under CMRD will transition.  

The Department will host a series of meetings from October 2022 through April 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.

View Informational Memo IM 22-039

Meeting Topics

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

  • October 25, 2022 - Kick off meeting - project overview and process for stakeholder feedback and Dept. responses
  • November 8, 2022 - HCBS Waiver Amendments and Applications
  • November 22, 2022 - HCBS Waiver Program Eligibility Rules - Pages 1-16
  • December 6, 2022, 9-11 a.m. MT: HCBS Waiver Program Eligibility Rules - Pages 17-26
  • January 3, 2023, 9-11 a.m. MT: MEETING CANCELED
     
  • January 17, 2023, 9-11 a.m. MT: Case Manger Agency Requirements
     
  • January 31, 2023, 9-11 a.m. MT: Case Manger Requirements & Client Rights and Responsibilities
     
  • February 14, 2023, 9-11 a.m. MT: Case Management rules/Follow-up Session, Halfway Point Check-in
     
  • February 28, 2023, 9-11 a.m. MT: HCBS Benefits and Services Rules, Part 1
     
  • March 14, 2023, 9-11 a.m. MT: HCBS Benefits and Services Rules, Part 2
     
  • March 28, 2023, 9-11 a.m. MT: HCBS Benefits and Services Rules, Part 3
     
  • April 11, 2023, 9-11 a.m. MT: HCBS Provider Requirement Rules
     
  • April 25, 2023, 9-11 a.m. MT: Wrap-up and Follow-up and Next Steps in Process
Listening Log Documents

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

Case Management Redesign (CMRD) Updates

 

Case Management Redesign Training / Educational Sessions:

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

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.

CMRD Memos

#FFFFFF

 

Memo # Memo Title Issue Date Audience Keywords Links and Attachments
IM 22-039 Stakeholder Engagement Opportunity: Office of Community Living Rule Revisions and Waiver Updates 11/28/2022 Stakeholders Case Management Redesign, Rules and Regulations, Waivers, Stakeholder  
IM 22-026 Case Management Redesign Policy Update: Community Centered Board Designation Process 7/12/2022 Stakeholders Case Management Redesign, Conflict Free Case Management, CFCM, CMRD Community Centered Board Designation Application Draft
IM 22-001 Case Management Redesign Policy Update: Implementation Timeline 1/5/2022 Stakeholders Case Management Redesign, Conflict Free Case Management, CFCM, CMRD None
IM 21-055 Case Management Redesign Policy Update: Catchment Area 11/30/2021 Stakeholders Case Management Redesign, Conflict Free Case Management, CFCM, CMRD None
IM 21-041 Case Management Redesign Member and Family Listening Sessions 6/24/2021 Stakeholders Case Management Redesign, Conflict Free Case Management, CFCM, CMRD Case Management Redesign Member and Family Listening Session Flyer
IM 21-032 Case Management Redesign Catchment Area Stakeholder Survey 5/7/2021 Stakeholders Case Management Redesign, Conflict Free Case Management, CFCM, CMRD None
IM 21-014 Contractor Kickoff Meeting for Case Management Redesign 2/10/2021 Stakeholders Case Management Redesign, Conflict Free Case Management, CFCM, CMRD None
IM 20-050 Case Management Redesign Statewide Webinar     10/13/2020   Stakeholders 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  

To view all Memos issued by the Department visit the Memo Series page

#FFFFFF

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.