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✴️ Nurse Assessor and Skilled Care Acuity Assessment

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

Nurse Assessor     Skilled Care Acuity Assessment     Training     Stakeholder Engagement     Contact Us

Announcement of Delayed Implementation

June 13, 2025

Implementation of the Nurse Assessor and Skilled Care Acuity Assessment (SCAA) has been delayed until August 1, 2025.  It was previously anticipated for July 1, 2025.  The purpose of this announcement is to inform members, advocates, Home Health Agencies (HHA), Case Management Agencies (CMAs) and all interested stakeholders of the delayed implementation of the Nurse Assessor, Skilled Care Acuity Assessment, and Pediatric Long-Term Home Health (LTHH) Prior Authorization Request (PAR) Restart for Registered Nursing (RN), Licensed Practical Nursing (LPN) and Certified Nursing Aide (CNA) services. 

Additionally, the Health Maintenance Activities (HMA) new oversight process will also be delayed until August 1, 2025.

View Operational Memo OM 25-036 for more information.

Nurse Assessor

What is the Nurse Assessor?

  • The nurse assessor is a new process that streamlines the way members are assessed and receive recommendations for skilled care services, including Registered Nurse (RN), Certified Nursing Assistant (CNA), and Health Maintenance Activities (HMA).
     
  • The Department of Health Care Policy and Financing (HCPF) will holistically assess members, using a 3rd party skilled nurse assessor, for the appropriate level of skilled care services across selected service modalities. 
     
  • The skilled nurse assessor will also help educate members about skilled care services and all service delivery options, including self-direction, and ensure members understand the service that will best meet their needs based on their 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.
     

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Skilled Care Acuity Assessment

What is the Skilled Care Acuity Assessment?

  • A clinically reliable and validated tool(s) to determine the appropriate level of care and associated hours for members seeking skilled care services.
     
  • The Skilled Care Acuity Assessment will be completed by a 3rd party Nurse Assessor. 
    • The Request for Proposal (RFP) for the Nurse Assessor includes a requirement for the new vendor to digitize this tool for use.  
       

Why Develop the Skilled Care Acuity Assessment?

  • HCPF and its stakeholders have identified the need for a consistent and reliable tool for assessing members for skilled care services.
     
  • HCPF received funding to implement a LTHH acuity tool in FY 2019-20 through R-9, “Long-Term Home Health/Private Duty Nursing Acuity Tool.” 
    • HCPF used this funding to conduct an environmental scan in FY 2020-21 of other state approaches but was unable to identify an appropriate tool, concluding that HCPF must build one from the ground up. There was not adequate funding to build and implement a tool with the funding from that request.
       
  • The American Rescue Plan Act (ARPA) and associated funding gave HCPF an opportunity to continue to pursue the development of this needed tool.
     
  • ARPA Initiative 6.01 launched in October 2021 and concluded in September 2024.  
     

When will the Skilled Care Acuity Assessment Start Being Used?  

  • HCPF anticipates use of the Skilled Care Acuity Assessment will start with the implementation of the 3rd party Nurse Assessor and resumption of Long-Term Home Health (LTHH) Prior Authorization Requests (PARs) all of which are being phased in starting August 1, 2025. 

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Nurse Assessor Systems Training

Qualitrac Authorized Official User Training

Submitting a Referral Through Qualitrac

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Stakeholder Engagement

Nurse Assessor Listening Log - Updated May 2025 

Nurse Assessor Stakeholder Meeting

Next Meeting:

July 8, 2025 from 10:30 a.m. to 12 p.m.
Join via Google Meet
Join via Phone: 319-346-6054‬ PIN: ‪773 830 666‬#

Meeting Materials

June 10, 2025

May 13, 2025

April 29, 2025 - Health Maintenance Activities and Nurse Assessor Stakeholder Meeting

April 8, 2025

March 11, 2025

February 11, 2025 

    

Contact Us

Email: HomeHealth@state.co.us  

Phone: 303-866-5638

Reasonable accommodations will be provided upon request for persons with disabilities. Auxiliary aids and services for individuals with disabilities and language services for individuals whose primary language is not English may be provided upon request.

Please notify John Barry at 303-866-3173 or John.R.Barry@state.co.us or the Civil Rights Officer at hcpf504ada@state.co.us at least one week prior to the meeting to make arrangements.

 

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