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✴️ New Colorado Single Assessment (CSA) and Person-Centered Support Plan (PCSP)

✴️ This is a Priority Project for the Office of Community Living
 

Interim Support Level Assessment (ISLA)     FAQs     Historical Information     Contact Us

 

The Department of Health Care Policy and Financing (HCPF), with input from stakeholders, has created a new person-centered process for people who apply for or receive Long-Term Services and Supports (LTSS). This includes:

  • A new eligibility process (called the Level of Care Screen)
  • A single, comprehensive needs assessment called the Colorado Single Assessment (CSA)
  • A Person-Centered Support Plan (PCSP)

Once implemented, these updates are designed to support self-direction, improve service coordination, and work for both adults and children with disabilities. They will also be supported by the new Care and Case Management IT system. 

Visit our Care and Case Management System web page to learn more.

SIS Assessment Retired - Replaced by ISLA

As of July 1, 2025, Colorado will no longer use the Supports Intensity Scale (SIS) assessment. This is because the version of the SIS used in Colorado has been discontinued by its author, the American Association on Intellectual and Developmental Disabilities (AAIDD).

What the SIS was used for:

The SIS was used to assign a Support Level, which is an integral factor in setting the rate providers receive for each Member in certain services for the Developmental Disabilities (DD) and the Supported Living Services (SLS) waivers.

Specifically the Support Level applies to:

  • Day Habilitation (Specialized Habilitation & Supported Community Connections)
  • Prevocational Services
  • Supported Employment (Group)
  • Residential Habilitation Services

It was also used to calculate Service Plan Authorization Limits (SPALs) in the SLS waiver. However, SPALs will be phased out with the launch of Community First Choice (CFC).

Interim Support Level Assessment (ISLA)

HCPF has developed a new tool called the Interim Support Level Assessment (ISLA) to replace the SIS and assign a Support Level for newly enrolling members. The ISLA uses questions from the Colorado Single Assessment (CSA) and applies a new algorithm to assign a Support Level.

For members who are newly enrolling in HCBS-SLS or HCBS-DD, case managers will share the following resources to help members understand what the ISLA is and how to navigate the process. (All of these documents can be found on the LTSS Case Management Forms and Tools page under “ISLA/SIS Resources”, including Spanish versions.)

Background on ISLA

To develop the ISLA: 

  • HCPF worked closely with a group of stakeholders who have been integral to developing the Colorado Single Assessment (CSA) to help develop the ISLA, which is based on the CSA. HCPF and the stakeholders were supported by vendors to replace the SIS and develop the ISLA algorithm to identify Support Levels for newly enrolling members. 
     
  • HCPF ran a pilot of the ISLA from April through June 2025, using trained assessors who work at Case Management Agencies. The pilot:
    • Tested how the ISLA works in real-world settings
    • Ensured the ISLA can accurately capture Members’ support needs
    • Gathered data to develop an algorithm for assigning Support Levels based on Member’s support needs
    • Gathered feedback from assessors, case managers, and stakeholders
    • Helped refine implementation processes before the full rollout
       
  • ISLA implementation began July 1, 2025
     

Resources: 

 

Stay informed: Updates will be posted on this website and shared through OCL Newsletters
 

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Frequently Asked Questions

Who will use the ISLA?

The ISLA will be used for adults with Intellectual and Developmental Disabilities newly enrolling in the DD or SLS waivers who are requesting:

  • Day Habilitation (Specialized Habilitation & Supported Community Connections)
  • Prevocational Services
  • Supported Employment (Group)
  • Residential Habilitation

If a member does not already have a SIS assessment, they will need to complete the ISLA to get a Support Level, before enrolling in an adult IDD waiver.
 

How will the ISLA work for people who already have a Support Level?

The ISLA will only be used with newly enrolling members. Members who already have a SIS-derived Support Level will stay at their established Support Level. If there is a need to re-evaluate a member's Support Level, HCPF has a Support Level Review (SLR) process. 
 

How will new Members learn about and prepare for their ISLA?

Members will work with their Case Manager to schedule an ISLA if they are newly enrolling in the SLS or DD waiver. Their Case Manager will provide them with resources to help them prepare. 
 

ISLA has the word “interim” in it. Why is it interim and what happens next?

At the time the initial ISLA Algorithm was developed, not all ISLA pilot assessments were available for analysis. The additional pilot assessments will be used to review and update the ISLA Support Level Algorithm. The assessments done after ISLA implementation on July 1, 2025, will also be analyzed. The analysis will result in an updated algorithm in September 2025.

The updated ISLA algorithm will be presented to the Medical Services Board in October 2025 and is expected to be adopted in rule effective January 2026.

Further, following a full year of ISLA implementation, HCPF will work with our vendor to analyze the data from these assessments to determine if the ISLA needs to be updated further. This final update will be called the Support Level Algorithm, as it will no longer be considered “Interim”.

The Support Level Algorithm will be a slightly adapted version of the ISLA algorithm to better capture the needs of the IDD population. It will be implemented in conjunction with the rollout of the Colorado Single Assessment. The Support Level Algorithm will be used for newly enrolling members accessing HCBS-CHRP, -SLS, or -DD waivers to identify Support Levels. The Support Level Algorithm will be run annually at each member’s annual reassessment. 
 

Will the Support Level Algorithm be the sole determinant of resource need?

No algorithmic tool can fully capture the resource needs of an individual or population. The Support Level Algorithm is intended for use as one component of a larger person-centered planning process.
 

Is Colorado the only state to use a resource allocation methodology using an assessment?

No, 31 states are currently using some form of an assessment-informed, prospective budget methodology.
 

How will the gap between services utilized and services authorized be accounted for in developing the Support Level Algorithm?

Optumas will conduct a series of analyses that compare services utilized with services authorized at the member level. Colorado Single Assessment data will then be compared to estimated need in terms of services utilized and services authorized. This work also focuses on the impact of natural supports on member utilization. Information on members' natural supports will be available through the new Colorado Single Assessment and Person-Centered Support Plan.
 

Does Optumas, HCPF’s vendor, have experience in the development of assessment-informed prospective budget methodologies?

Yes, Optumas has developed models like the Support Level Algorithm in various states. 
 

How are items from the Colorado Single Assessment (CSA) selected for inclusion in the Support Level Algorithm?
HCPF and Optumas have carefully evaluated all items in the CSA for appropriateness, consulted published literature, conducted a detailed examination of existing assessment-informed, prospective budget methodologies, conducted a wide variety of statistical analyses, and sought extensive feedback from stakeholders. The ISLA was mapped against the SIS-based Support Level Algorithm as an intermediary step as we transition away from/decommissioning the SIS and move toward implementation of the CSA.
 

Will the data used in statistical analysis be made public?

No, the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule prevents HCPF and Optumas from sharing Protected Health Information (PHI). Appropriately de-identified and summarized data may be used. Sample data may also be shared.
 

What data is being used?

HCPF and Optumas are utilizing 2019-2020 CSA Pilot data as well as corresponding HCBS and State Plan claims data.  New data available from the April-June 2025 ISLA Pilot, data after full implementation of the ISLA and then eventually the CSA, will be used in refining the Support Level Algorithm.
 

Where can I view the new Colorado Single Assessment and Person-Centered Support Plan?

See the Historical Information for CSA & PCSP Development section of this page for information about the development of the new Assessment and Support Plan.
 

Will comorbidities be accounted for?

Yes, HCPF and Optumas intend to conduct statistical analyses in a manner that accounts for comorbidities. This may include variable transformation and/or the development of composite scales. All methodological processes of this nature will be shared with stakeholders during stakeholder meetings.
 

Will there be an exceptions process?

Yes, HCPF and Optumas will be working with stakeholders to build an exceptions process with the understanding that no algorithmic tool can fully capture the resource needs of every individual. The development of the Resource Allocation Exceptions Process will include opportunities for stakeholder feedback once the Resource Allocation Algorithm (RAA) has been developed and prior to implementation.
 

Will the Support Level Algorithm only examine Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) for inclusion in the Algorithm?

No, a wide variety of Assessment items are being considered for inclusion in the SLA.
 

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Historical Information for CSA & PCSP Development

Assessment Tools, Manuals, and Support Plan

2019-2020 CSA Pilot Information

HCPF piloted the process with participants seeking or receiving LTSS, and case managers from across the state to test the assessment content and automation of the new LTSS Assessment and Support Plan. These pilots occurred in two primary phases.

Pilot Phase 1

The first component of this phase, the level of care (LOC) pilot, has been completed. During the LOC pilot case managers assessed participants using both the current LOC eligibility assessment, the ULTC 100.2 and the new LOC pilot screening tool. The purpose of the pilot was to compare responses in current and new items. The comparative analysis of these items can be found Stakeholder Meetings and Regional Forums section below.

The second component of this phase, the Nursing Facility (NF) Hospital (H) LOC and Reliability Pilot (NF/H-LOC & Reliability Pilot), is ongoing. This pilot will collect data necessary for the Department to fulfill the following functions:

  • Replicate the current Nursing Facility-LOC thresholds for adults using the new assessment items
  • Establish a more objective Nursing Facility-LOC criteria for children
  • Establish objective and prospective Hospital-LOC for Colorado's relevant HCBS Waivers
  • Test reliability, including the inter-rater reliability, of selected items in the new assessment potentially to be used for NF-LOC, H-LOC and individualized budgets.

Pilot Phase 2

The second phase assessed the workflow of the assessment process using the automation that is intended to be used in the field. During this pilot, a smaller group of case managers conducted the comprehensive assessment and Support Plan. The data from this phase was analyzed and feedback sessions were conducted with case managers and participants. The assessment and support plan was updated based on these results and the changes were incorporated in the automation. Case managers were trained on the updates and began assessing participants as part of the Time Survey pilot. This pilot collected data to understand how long the new process takes. Additional feedback sessions with participants and case managers were conducted during this phase.

This pilot concluded in April 2020.

These reports, authored by HCBS Strategies, represent the work done in collaboration with the Assessment and Support Plan (A/SP) Stakeholder Advisory Group from 2019-2020 and provide the historical context for the piloting of the Level of Care (LOC) Screen, the new Needs Assessment and the Person-Centered Support Plan.  The first two phases of piloting were used to establish reliability and develop LOC Screen criteria. The later three phases helped to streamline the LOC and A/SP process and establish how long the process took, through time-studies.
 
For current information related to the Care and Case Management (IT) system development which will house the new Colorado Single Assessment (CSA) and Person-Centered Support Plan please visit the Care and Case Management System web page.
 

  • Colorado Assessment Process Development Final Report - March 2017
    • HCPF contracted with HCBS Strategies to transform its process for assessing individuals in need of publicly-funded long-term services and supports (LTSS). HCPF undertook this effort because of concerns about the reliability and validity of the items in the current tool used for eligibility determinations; the lack of consistent collection of all necessary data; and the ability of the current tool to support a person-centered process, including developing a Support Plan. The new assessment is described as a process because it incorporates several workflows that support key design decisions as opposed to a standalone tool or form.  

      Extensive input from HCPF staff and stakeholders shaped the development of this process.  If successfully implemented, the new process could be the keystone of a more person-centered system that uses workflows and data to improve rule compliance; allows for a fairer and efficient allocation of resources; and provides better information about the quality and effectiveness of the supports provided.
    • Note: This document references an archived website created and maintained by HCBS Strategies during the contract period referenced as the “blog.” The information found within the blog can now be found in the other reports on this website, in meeting minutes, or it has been summarized and included in the new material shared with stakeholders.
       
  • Level of Care Pilot Comparative Analysis Report - June 2019
     
    • HCPF contracted with HCBS Strategies to pilot its new assessment and support planning process for Medicaid-funded long-term services and supports (LTSS). The Department undertook this effort because of concerns about the reliability and validity of the items in the current tool used for eligibility determinations, the Uniform Long-Term Care (ULTC) 100.2, the lack of consistent collection of all necessary data, and the ability of the current tool to support a person-centered process, including the development of a person-centered Support Plan.
       
    • This report compares individual ULTC 100.2 items and matching items in the new process. The findings highlight the fundamental flaws of the ULTC 100.2 and reinforce the need to change this tool.

       
  • Colorado Assessment Reliability Analyses - March 2020
    • HCPF contracted with HCBS Strategies to pilot its new process for eligibility determinations, needs assessment, and support planning for Medicaid-funded long-term services and supports (LTSS). HCPF undertook this effort because of concerns about the reliability and validity of the items in the current tool used for eligibility determinations, the Uniform Long-Term Care (ULTC) 100.2 assessment.
    • The first two phases of the pilot effort collected data necessary to replicate the current level of care (LOC) criteria used for establishing eligibility for Medicaid home and community-based services (HCBS) waivers and create objective criteria where none exist. To assess inter-rater reliability (IRR), 107 of the 413 pilot participants were assessed by two case managers who scored the assessment independently.
       
  • New Assessment Hospital Level of Care Report - May 2020
     
    • HCPF contracted with HCBS Strategies to pilot its new assessment and support planning process for Medicaid-funded long-term services and supports (LTSS). HCPF undertook this effort because of concerns about the reliability and validity of the items in the current tool used for eligibility determinations, the Uniform Long-Term Care (ULTC) 100.2 assessment.
       
    • This report compares UTLC 100.2 items and by classifying high-cost individuals as meeting H-LOC and comparing their costs to average hospital costs (which are substantially higher), the State can meet budget neutrality for the remaining participants who only meet NF-LOC.

       
  • New Assessment and Support Plan Time Survey Report - June 2020
     
    • HCPF contracted with HCBS Strategies to pilot its new assessment and support planning process for Medicaid-funded long-term services and supports (LTSS). The Department undertook this effort because of concerns about the reliability and validity of the items in the current tool used for eligibility determinations, the Uniform Long-Term Care (ULTC) 100.2.
       
    • This report includes findings culminated in the pilot process of the Time Study pilot. The Time Study pilot provided HCPF with data on the average time it takes case managers familiar with the assessment and support planning (A/SP) process and automation to complete the process. The findings were intended to allow assessors to become familiar with both the A/SP process and the flow of the process in the Aerial Case Management IT platform.

       
  • Comprehensive Assessment and Support Plan Summary Report - June 2020
    • HCPF contracted with HCBS Strategies to pilot a new assessment and support planning (A/SP) process for Medicaid-funded long-term services and supports (LTSS). HCPF undertook this effort because of concerns about the reliability and validity of the items in the current assessment used for eligibility determinations, the Uniform Long-Term Care (ULTC) 100.2 Assessment.
    • The new A/SP process was piloted in five phases with 648 participants: Level of Care Pilot (March-May 2019), NF/H-LOC and Reliability Pilot (May 2019-Jan 2020), Comprehensive Assessment Pilot (Jan-Feb 2020), and Support Plan Pilot (Feb-Mar 2020). Throughout the pilot process, HCBS Strategies engaged three primary groups outside of the Department to obtain feedback on the draft A/SP process and input on the proposed changes: stakeholder advisory group, case managers, and individuals seeking or receiving services and their representatives who participated in the pilots. 
       
  • LTSS Assessment and Support Plan Pilot Final Report - July 2020
    • HCPF contracted with HCBS Strategies to pilot its new assessment and support planning (A/SP) process for Medicaid-funded long-term services and supports (LTSS). The pilot served the following purposes to establish the validity and reliability of the items used in the process and rectify or remove items that were found to be problematic, to replicate the current nursing facility level of care (NF-LOC) criteria, which is used for determining eligibility for most of Colorado’s home and community-based services (HCBS) waivers as well as nursing facilities. The pilot then worked to establish new hospital level of care (H-LOC) criteria that are used for establishing eligibility for one Home and Community Based Services (HCBS) waiver and meeting federal budget neutrality requirements for several other waivers. Finally, the pilot was intended to streamline the process and eliminate unnecessary items as well as to obtain time estimates for how long the new process would take.

Stakeholder Meetings and Regional Forums

Below is documentation of stakeholder involvement in the development of these new processes.

Contact Us

For more information, contact:

Email: HCPF_HCBS_Questions@state.co.us
U.S. Mail:
Colorado Department of Health Care Policy & Financing
Office of Community Living
303 E. 17th Avenue, Suite 1100
Denver, CO 80203

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