Complex Supportive Services is designed to support members and families experiencing complex health situations and provide a process for collaboration across entities.
Complex Service Solutions
Complex Service Solutions (CSS) helps Health First Colorado (Colorado's Medicaid Program) members who are adults ages 18 years and older to address issues with community placement and other complex health needs or situations.
Who can make a CSS Support Request? The Regional Accountable Entity (RAE), Case Management Agency (CMA), and other relevant participants (member, family, caregiver, providers, etc.) must first work together to find a resolution. If additional assistance is needed from the Department of Health Care Policy and Financing (HCPF), the RAE or CMA must complete a CSS Support Request.
HCPF can help provide oversight, problem-solving, facilitate connections, monitor providers, monitor regulation compliance, and uphold the integrity of services.
Creative Solutions
Creative Solutions (CS) helps Health First Colorado members who are children and youth ages 17 years and younger and their families navigate complex health situations and crises.
Who can make a CS request? Families, providers, advocates, RAE, CMA, Child Welfare
RAEs work with HCPF and the Colorado Department of Human Services (CDHS) to facilitate meetings with the team.
Common solutions are using fee-for-service benefits, Early and Periodic Screening, Diagnostic and Treatment (EPSDT) or enrolling in children's home and community based services (HCBS) waivers like Children's Extensive Support (CES) or Children's Habilitation Residential Program (CHRP).
Hospital Discharge Support
When a Hospital encounters barriers to discharging a member who no longer meets medical necessity for an inpatient stay or requires more acute/specialized support than the Hospital can provide, it must collaborate with the member's RAE and CMA (when applicable), as well as other community support partners, to find solutions that will lead to a safe discharge.
Who can make a request? If the Hospital requires additional support after exhaustive collaboration with the member's RAE, CMA, and community support team, the Hospital may ask the RAE to submit a discharge escalation support request.
Request CSS Support Process
For Adults ages 18 years and older
After exhaustive collaboration with the member's community support team, the Regional Accountable Entity (RAE) or the Case Management Agency (CMA) may request CSS support from HCPF.
Step 1: The RAE or CMA will request Complex Solutions Support (CSS) using the Complex Solutions Referral Form.
- If the CSS request is time-sensitive, involves a crisis event, the member is on an M1 hold, or has similar escalating factors, follow up with an email to HCPF after submitting the Complex Solutions Referral Formand include any additional information that may help HCPF expedite its support.
Step 2: HCPF will review the CSS request and determine the most appropriate and practical next steps for assisting.
- HCPF may need additional information to understand the member's needs better.
- The review process takes time; some reviews will take longer than others, but we try to respond as quickly as possible.
Step 3: HCPF will email the contact who submitted the CSS request to guide the RAE or CMA through the next steps.
- These next steps may include but are not limited to HCPF providing support through email, attending a complex call, or requesting further information.
- HCPF recognizes that complex support needs are often time-sensitive and will make every effort to respond promptly.
Step 4: If HCPF determines a complex call is needed, it requests that the RAE or CMA send an invite to the next one.
- Invitations should be for the week(s) following HCPF's response.
- HCPF will attend complex calls subject to availability.
- HCPF may allow and prioritize emergency meetings and time-sensitive requests at its discretion.
Step 5: During the complex call, HCPF will gather information and provide technical assistance when appropriate.
- HCPF's approach is solutions-oriented and may include recommendations the team has already tried or considered.
- HCPF may need to consult with other staff specializing in particular areas, including benefits, case management, and eligibility.
Step 6: HCPF will continue to provide CSS support through email and complex calls until it has determined that the member's support team no longer needs active assistance.
- HCPF may request to be kept on email chains and receive regular updates
- RAEs and CMAs are encouraged to contact HCPF after CSS support has ended when the member's support team believes there is a risk of further complex support needs that the team cannot navigate without assistance.
Request Creative Solutions Support Process
For Children and Youth ages 17 years and younger
Creative Solutions (CS) process is appropriate when the member needs assistance beyond the Regional Accountable Entity's (RAE's) ability to provide support. At that point various parties may request Creative Solutions support including families, providers, advocates, child welfare agencies and Case Management Agencies (CMA).
Step 1: Make a request directly to the member's Regional Accountable Entity (RAE)
- All parties seeking Creative Solutions support must begin by collaborating directly with the RAE to resolve escalated member needs.
Step 2: If that request is unsuccessful or the member's needs exceed the RAE's abilities, complete the EPSDT Screening Referral Form
- Include any additional information that may help HCPF expedite its support.
- If the referral involves HCBS Waivers (existing or needed), or County involvement, please note this in the "Reasons for Request" section of the form.
Step 3: Email the EPSDT Screening Referral Form to HCPF_EPSDT@state.co.us
- This email will be viewed by Gina Robinson, Senior Policy Advisor and EPSDT Program Administrator, who will then create a Creative Solutions ticket.
- HCPF will notify the RAE of the CS Ticket and request the RAE schedule a CS call.
Step 4: During the CS call, HCPF will gather information and provide technical assistance when appropriate.
- HCPF's approach is solutions-oriented and may include recommendations the team has already tried or considered.
- HCPF may need to consult with other staff specializing in particular areas, including benefits, case management, and eligibility.
Step 5: HCPF will continue to provide CS support through email and calls until it has determined that the member's support team no longer needs active State assistance.
- HCPF may request to be kept on email chains and receive regular updates.
- RAEs are encouraged to contact HCPF when the member's support team believes there is a risk of further complex needs that the team can only navigate with assistance
Request Hospital Discharge Support Process
Step 1: The RAE will submit a request using the Hospital Discharge Issue Reporting form.
Step 2: HCPF will review the request and determine the most appropriate and practical next steps for assisting.
- When the request is for a child/youth 17 years and younger, HCPF will follow the Creative Solutions process and guidelines.
- When the request is for a youth/adult 18 years and older, HCPF will follow the Complex Solutions process and guidelines.
- The support team should exhaust all solutions or resources in advance of HCPF's attendance in a call.
Step 3: During the discharge support call, HCPF will gather information and provide technical assistance when appropriate.
- HCPF's approach is solutions-orientated and may include recommendations the team has already tried or considered.
- HCPF may need to consult with other staff specializing in particular areas, including benefits, case management, and eligibility.
Step 4: HCPF will continue to provide discharge support through email and complex calls until it has determined that the member's support team no longer needs active assistance.
- HCPF may request to be kept on email chains and receive regular updates
- RAEs and CMAs are encouraged to contact HCPF after CSS support has ended when the Member's support team believes there is a risk of further complex support needs that the team cannot navigate without assistance.