New Assessment and Person-Centered Support Plan

Pilot Information

The Department 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 and Phase 2

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.

Reports

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

  • The Department contracted with HCBS Strategies to transform its process for assessing individuals in need of publicly-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 lack of consistent collection of all necessary data; and the ability of the current tool to support a person-centered process, to include 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 by Department 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 within the other reports on this website, in meeting minutes, or it has been summarized and included in the new material that is being shared with stakeholders.
     

• Level of Care Pilot Comparative Analysis Report - June 2019
   
  • The Department 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

  • The Department 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). 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 first two phases of the pilot effort collected data necessary to replicate 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
   
  • The Department 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 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
   
  • The Department 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 the Department 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

  • The Department contracted with HCBS Strategies to pilot a new assessment and support planning (A/SP) 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 assessment used for eligibility determinations, the Uniform Long-Term Care (ULTC) 100.2.

  • 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

  • The Department 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.

SB 16-192 and the Testing Experience and Functional Tools (TEFT) Grant

• Senate Bill 16-192

• Senate Bill 16-192 Final Fiscal Note

• Testing Experience and Functional Tools (TEFT) Grant Fact Sheet - May 2016

Contact Us

For more information, contact:

Lori Thompson
Email: Lori.Thompson@state.co.us
U.S. Mail:
Colorado Department of Health Care Policy & Financing
Office of Community Living
1570 Grant Street
Denver, CO 80203