History: Case management redesign (CMRD) refers to several initiatives aimed at simplifying access to long-term services and supports, creating stability for the case management system, increasing and standardizing quality requirements, requiring accountability, and achieving federal compliance.
Stakeholder Involvement: The Department conferred with stakeholders, which includes case management agencies (CMAs), advocacy partners, and members to garner feedback and ensure pertinent information was included in the timeline.
Purpose: This timeline addresses the key policy framework required to implement CMRD in compliance with HB 21-1187 but does not include all details regarding system changes (i.e. Care and Case Management System, new Assessment and Support Plan, etc.). The Department will keep this timeline up to date on the website as we continue to work through policy requirements with stakeholders. The timeline includes but is not limited to the following: Case management (CM) Rates Analysis, Case Management Agency (CMA) Quality Metric Development, CMA training and development, Federal Approvals, Rule and Regulation Changes, new CMA contracts and Member updates.
CMA = Case Management Agency
CMS = Centers for Medicare & Medicaid Services
Dept. = Department = Department of Health Care Policy & Financing
eClearance = Electronic Clearance (State internal document review and approval process)
HCPF = Department of Health Care Policy & Financing
MSB = Medical Services Board
RFP = Request for Proposals (State contracting process)
SPA = State Plan Amendment
Updated December 2021
Date Range of Event - Name of Event [Responsible Party/Parties]
Case Management Rate Analysis
January 2022 - April 2022 - Case Management Rate Analysis [Case Management Agency/Department Contactor]
May 2022 - September 2022 - Finalize Case Management Rate Analysis [Department Contractor]
May 2022 - June 2023 - Review Rate Structure [Department of Health Care Policy & Financing / Case Management Agencies]
Case Management Agency Quality Metric Development
January 2022 - Draft Case Management Metrics for Case Management Agencies [Department of Health Care Policy & Financing]
February 2022 - March 2022 - Case Management Engagement on Case Management Metrics [Department of Health Care Policy & Financing / Case Management Agencies]
April 2022 - August 2022 - Review Case Management Data Relevant to Case Management Metrics [Department of Health Care Policy & Financing]
June 2022 - July 2022 - Case Management Input on Case Management Metrics & Revised Contract Language [Department of Health Care Policy & Financing / Case Management Agencies]
Case Management Agency Training & Development
January 2022 - Case Management Learning Management System Development [Department of Health Care Policy & Financing/
February 2022 - April 2022 - Care & Case Management Tool Training [Case Management Agencies]
June 2023 - July 2023 - Begin New Case Management Training Support [Department of Health Care Policy & Financing / Case Management Agencies]
July 2022 - October 10, 2022 - Determine Waiver & State Plan Changes Needed [Department of Health Care Policy & Financing]
Milestone: October 10, 2022 - All Decisions for State Plan Amendment/Waivers Must be Made
November 2022 - December 2022 - Waiver & State Plan Amendment Public Comment [Stakeholders]
January 2023 - February 2023 - Final Approval of Waivers / State Plan Amendment [Department of Health Care Policy & Financing]
March 2023 - June 2023 - Centers for Medicare & Medicaid Services Review & Approval of Waivers & State Plan Amendment [Centers for Medicare & Medicaid Services / Department of Health Care Policy & Financing]
Milestone: July 1, 2023 - State Plan Amendment/Waivers Effective
Rule & Regulation Updates
January 2022 - June 2022 - Case Management / Waiver Rule & Regulation Draft Updates [Department of Health Care Policy & Financing]
June 2022 - September 2022 - Input on Rule & Regulation Draft Updates [Department of Health Care Policy & Financing / Stakeholders]
November 2022 - December 2022 - Public Comment [Stakeholders]
January 2023 - February 2023 - Revised Rules Drafted [Department of Health Care Policy & Financing]
March 2023 - April 2023 - Medical Services Board Review & Approval [Medical Services Board]
Milestone: July 1, 2023 - Rules Effective
New Case Management Contracts
January 2022 - August 15, 2022 - Draft New Case Management Contracts & RFP [Department of Health Care Policy & Financing]
Milestone: August 15, 2022 - Draft Request for Proposals Complete
September 2022 - December 2022 - RFP In eClearance [Department of Health Care Policy & Financing]
January 2023 - February 2023 - RFP Open for Case Management Responses [Case Management Agencies]
May 2023 - Case Management Awardees Notified [Department of Health Care Policy & Financing]
July 2023 - Case Management Transition Begins [Department of Health Care Policy & Financing / Case Management Agencies]
March 2022 - Quarterly Webinar [Department of Health Care Policy & Financing]
June 2022 - Quarterly Webinar [Department of Health Care Policy & Financing]
September 2022 - Quarterly Webinar [Department of Health Care Policy & Financing]
December 2022 - Quarterly Webinar [Department of Health Care Policy & Financing]
March 2023 - Quarterly Webinar [Department of Health Care Policy & Financing]
June 2023 - Quarterly Webinar [Department of Health Care Policy & Financing]
Case Management Agency Transitions
July 2023 - June 2024 - Phase 1 Transitions [Case Management Agencies / Department of Health Care Policy & Financing]
November 2023 - June 2024 - Phase 2 Transitions [Case Management Agencies / Department of Health Care Policy & Financing]
February 2024 - June 2024 - Phase 3 Transitions [Case Management Agencies / Department of Health Care Policy & Financing]
Case Management Rates Analysis;
The Department will contract with a vendor in 2022 to develop recommendations for a case management rate setting methodology based on case management requirements and national best practices. It is anticipated that engagement with Case Management Agencies will begin January 2022 and go through April 2022. The contractor will then utilize the information provided by the Department and stakeholders to complete the rate analysis from May 2022 to August 2022. Any rate methodology changes will be subject to federal approval and, if necessary, a legislative appropriation.
Case Management Agency Quality Metric Development
The Department will create quality metrics for case management agencies that will leverage data within in the new Care and Case Management System. The Department will work closely with stakeholders through ongoing communities of practice and through member/advocate meetings to develop language for quality measures and remediation processes that will be implemented in the contracts for new case management agencies no later than July 1, 2024. The Department will use this stakeholder process to develop scorecards for case management agencies in CMRD.
Case Management Agency Training and Development
The Department is in process of developing the training learning management system (LMS) for case management agencies to prepare for the Case Management Agency transitions in 2024. The Department’s existing training is available to case managers on the Department's website, but additional trainings will be available through the new LMS.
With the creation of case management agencies who serve all 10 waivers, training and support will be necessary for new case management agencies who are awarded the CMA contract no later than July 1, 2024. The Department will provide training support to CMAs for the purposes of smooth transitions for members in each catchment area and access to training(s) in the LMS will begin February 2022.
The Centers for Medicare and Medicaid Services (CMS) require approval for any change to the state plan or 1915(c) home and community-based services (HCBS) waivers. The Department will determine the necessary waiver and state plan changes during July 2022 to October 2022. The Department will publish the waiver and state plan amendment (SPA) for public comment November 2022 to end of December 2022 with final approvals at the Department happening no later than February 2023. The Department is partnering closely with CMS representatives now and will obtain official approvals through biannual waiver and state plan amendment (SPA) processes in early 2023. CMS is required to review and approve the changes to waiver and state plan to ensure Colorado is in compliance with federal and state requirements for CMRD.
Rule and Regulation Changes
The Department will work with stakeholders to outline the proposed framework for the rules and regulations needing updated language required for CMRD compliance and to come into alignment with the future state of case management in Colorado in July of 2024. These updates will take place in calendar year 2022 with official stakeholder input and comment period set for November to December of 2022. Rules will be effective July 1, 2024.
New Case Management Agency Contracts
The Department will develop a Request for Proposal (RFP) for interested parties to respond to for CMA work. The Department anticipates potential Offerors will have 8 calendar weeks between RFP posting and the proposal submission deadline. Procurement law requires a formal inquiry period as part of the RFP process, which is included in the 8-week timeline for RFP responses. Details of these timelines will be outlined in the RFP when it is released in December 2022. Contracts for agencies that are selected to serve as a CMA via the RFP process will be executed no later than July 1, 2024.
The Department is committed to transparency and member communication throughout the CMRD process. The Department intends to update statewide stakeholders quarterly between January 2022 and July of 2024 of progress with CMRD. Once CMA contractors are chosen, members will receive direct communication from outgoing and incoming agencies, in addition to communication from the Department. Members will be informed of the changes taking place along with how those changes impact them personally and how to get their needs met for necessary service provision.
Case Management Agency Transitions
The Department will work collaboratively with each catchment area community and its current and future agencies to facilitate a thoughtful transition to the new CMA contract with minimal impact to members and their services. Department staff will work with agencies in each catchment area to assess readiness for transition based on areas such as: Targeted Case Management provider enrollment status, conflict free status, and local preparedness. Once the readiness assessment is complete, the Department will assign agencies into three transition cohorts. This will allow Phase 1 Transitions to begin July 2023, Phase 2 will begin November 2023 and Phase 3 will begin February 2024 with all transitions complete July 1, 2024.
Incoming and outgoing CMAs in each catchment area will be closely supported by Department staff throughout the transition process to ensure a smooth transition. Before, during, and after CMA transitions, members will be notified of whom to contact in order to get their needs met for waiver case management services. Portability guidelines and expectations for members wanting to be served by agencies outside their catchment areas will be developed in collaboration with advocates and members and will be communicated by the Department prior to the CMA contract execution.