✴️ Nurse Assessor and Skilled Care Acuity Assessment

Why Implement a Nurse Assessor?

• HCPF requested funds to implement this initiative through a budget request (R-10) in 2023. 
     
• The nurse assessor will eliminate any conflict of interests that currently exist in the process of accessing skilled care services.
   
• The Nurse Assessor will provide a holistic assessment of the member’s need for skilled care services.
   
• One assessment completed by the Nurse Assessor will decrease the number of assessments for members. For example, when a member is assessed and finds that they do not need Private Duty Nursing (PDN), an additional assessment is not necessary to assess their need for Long-Term Home Health (LTHH). 
   
• The Nurse Assessor will be responsible for educating members about all the available services to meet their skilled care needs, which enables the member to choose the service delivery option(s) that best meet their needs.
   

Who will operate the Nurse Assessor Program in Colorado?

• On March 13, 2025 HCPF announced:
  • A vendor has been selected for Solicitation UHAA 2025-00126 Skilled Nurse Assessor. This selection was made after a HCPF-appointed multidisciplinary evaluation committee reviewed proposals in a competitive Request For Proposal process. 
  • The selected vendor, Telligen, has accepted the award, and the program will be implemented beginning August 1, 2025.
  • Telligen Signed Contract - April 2025
     

Will Telligen be completing a new and independent assessment, or will they use past determinations to make their recommendation?

• The Nurse Assessor will complete a new assessment each year. While they may have prior years' records for review, they will only make a recommendation based on current assessed needs.
   

What is the turnaround time for an assessment and recommendation?

• Telligen is required to complete the intake call within 24 business hours (1 day) and the full assessment within 7 business days. Expedited assessments (e.g., for discharge planning) must be completed within 72 hours.
   

How will a member be fully evaluated with a proper assessment via telehealth?

• The purpose of the Nurse Assessor is to assess and share recommendations for skilled care services. This is different from a physical hands-on assessment that involves a visual and physical examination followed by care planning. This assessment will be completed by trained clinicians at Telligen that will understand how to properly assess a member virtually.
   

Will there be Spanish-speaking nurses, or translation services available?

• Yes, Telligen can provide free interpretation services. If an interpreter is needed, that will be indicated on the referral form prior to the intake call. Additionally, if needed, HCPF will also provide free interpretation services as needed and not limited to Spanish. Efforts will be made to determine and pre-arrange for these needs ahead of the intake call.
   

Do you have to submit a new referral for members that are already receiving services?

• Yes, even if a member is already receiving services, a referral will be needed as they will be required to have a completed assessment. This will be required at the time of their Continued Stay Review (CSR) or at the point when a Prior Authorization Request (PAR) is being requested.
   

If the agency is submitting the referral, is there a place to add attachments? EX: GI notes for G-tube patients, pulmonary notes.

• Yes, there will be an opportunity to upload any relevant documents. It is encouraged that all pertinent documentation be included at this step—such as GI notes for G-tube patients, pulmonary notes, and documentation that demonstrates routine skilled interventions, not just assessments. Additional documentation can also be provided during the assessment.
   

Do Case Managers need to submit that referral to Telligen in a certain amount of time?

• Case managers are expected to submit the referral to the Nurse Assessor in advance of the start of the new support plan year. The referral must be submitted with enough time for the assessment and subsequent service planning process to take place. It is recommended the case manager submit the referral 45-60 days in advance of the Continued Stay Review (CSR).
   

If a current member needs a revision to their Prior Authorization Request (PAR), will the Home Health Agency (HHA) need to submit a referral to the Nurse Assessor?

• If a member is seeking to adjust hours to their currently authorized service plan, they would not need to have a new assessment completed. That would only need to be reviewed for Medical Necessity by Acentra. If a member is seeking a change in services (moving from Long-Term Home Health (LTHH) to Private Duty Nursing (PDN)), a new assessment would be required.
   

Who is sharing the recommendation with the provider agency? The member or Telligen?

• The Recommendation Letter is provided to the various entities involved (Case Management Agency (CMA), Home Health Agency (HHA), Regional Organization (RO), etc.) by Telligen. These letters will be housed in Telligen's IT platform, Qualitrac.
   

What information will be contained in the Recommendation Letter?

• The Recommendation Letter will not include detailed times for skilled care tasks, but will outline the overall recommended time needed for the skilled care needs. The assessment will also be available for review to provide additional information and inform the service planning process.
   

Will there be clear guidelines on what counts as change in condition?

• Yes, clear guidelines on what is considered a change of condition will be provided to Telligen and communicated to stakeholders, including Case Management Agencies (CMAs) and Home Health Agencies (HHAs).
   

Will non-skilled care also be determined by the Nurse Assessor and included in the Recommendation Letter?

• The Nurse Assessor is not required solely for the identification of non-skilled care services such as Homemaker and Personal Care. The case manager is responsible for ensuring that all non-skilled care needs are identified and the appropriate services are authorized. However, if a member is undergoing an assessment by the Nurse Assessor and unskilled care needs are identified during that process, the Nurse Assessor will complete the Direct Care Services Calculator (DCSC) to support recommendations for these services.
   

Will there be a way for members and/or families to access the Recommendation Letter online/email or via a portal in case of loss of physical paperwork?

• Yes, a member can create a member profile in the Telligen system, Qualitrac, that will allow them access to the assessment results and the Recommendation Letter.
   

How does information get submitted to the Nurse Assessor?

• If the information is being submitted to the Nurse Assessor to provide further information for the acuity assessment, the supplemental information would be submitted by the HHA in Qualitrac. If the information is being provided as part of the medical necessity review process with Acentra, it would be provided to Acentra by the HHA at that submission time.

Do we get confirmation that the nurse assessor has completed their part or do we just submit requests on the timeline required and hope for the best?

• Yes, the referral submitter would receive a notification from Qualitrac that the assessment was completed and that the recommendation letter is ready to be downloaded.