Person-Centered Budget Algorithm (PCBA)

Project Overview

The Department of Health Care Policy & Financing (the Department) is working with Optumas to develop a Person-Centered Budget Algorithm (PCBA) for Health First Colorado Home and Community-Based Services (HCBS) waiver programs.

In collaboration with stakeholders, the Department has developed new processes for eligibility determinations, needs assessments, and support planning for all individuals seeking or receiving Long-Term Services and Supports (LTSS). As part of the new assessment and person-centered support planning process, the PCBA will help identify the right amount of support for members based on assessed need, and together with strengths and preferences identified during the assessment, contribute to a person-centered support plan. The PCBA is an important component of the assessment and support planning process to ensure a consistent method for assigning budgets for all members receiving HCBS.

The Department recognizes that transparency and stakeholder feedback are essential components of the process to develop a PCBA and this website will explain the steps taken in the process of creating the PCBA and will be updated regularly.

Statewide Meetings

The Department and Optumas will be hosting a series of Statewide Meetings over the next year (virtually for now due to COVID-19). These meetings are intended to provide information and gather feedback on the development of the PCBA from a broad range of stakeholders. Morning and afternoon sessions will be held to accommodate as many stakeholders as possible. Both sessions will contain identical content. The Department and Optumas consider stakeholder feedback to be a critical part of the PCBA development and urge stakeholders to attend meetings when possible. Agendas, presentation materials, and summary notes from the Statewide Meetings will be uploaded here as they become available.

Statewide Meetings:

Statewide Meeting 1 - Thursday, September 10, 2020

• Statewide Meeting 1 Presentation
• Statewide Meeting 1 Notes
• Statewide Meeting 1 Webinar Recording

Statewide Meeting 2 - Monday, November 16, 2020

• Statewide Meeting 2 Presentation
• Statewide Meeting 2 Notes
• Statewide Meeting 2 Webinar Recording

NOTE: PCBA work has been paused until fall 2021 to allow for additional data to be collected through the new Assessment and Person-Centered Support Plan process to be launched summer 2021. More meetings will be announced closer to that time.

 

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 first 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 504/ADA  Coordinator hcpf504ada@state.co.us at least one week prior to the meeting to make arrangements.

 

Technical Advisory Group

The Department and Optumas are hosting smaller Technical Advisory Group (TAG) meetings to develop and review the statistical model of the PCBA. Below are the meeting materials and notes from each TAG meeting. The information from the TAG meetings will also be presented at the Statewide Meetings to provide information to and gain additional feedback from a broader range of stakeholders.

Summary notes from the TAG meetings will be uploaded here as they become available.

TAG Meeting 1 - August 25, 2020

• TAG Meeting 1 Presentation
• TAG Meeting 1 Notes
• Person-Centered Budget Algorithm Project Workflow

TAG Meeting 2 - November 3, 2020

• TAG Meeting 2 Presentation
• TAG Meeting 2 Notes
• Person-Centered Budget Algorithm DRAFT Workflow- November 2020

TAG Meeting 3 - January 25, 2021

• TAG Meeting 3 Presentation
• TAG Meeting 3 Notes
• TAG Literature Review Summary
• TAG Literature Review Grid
  • Note: TAG Literature Review sources #5 and #14 contain paywalled content. The Department is unable to rehost or share the entirety/majority of paywalled content in any form. 

FAQs

Will the PCBA be the sole determination of resource need?

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

Is Colorado the first state to develop a Resource Allocation methodology using an assessment?

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

Will the PCBA be developed using data from the Supports Intensity Scale (SIS)?

No, the SIS will not be used in the development of the PCBA. Data from the new LTSS Assessment will be used.

How will the gap between services utilized and services authorized be accounted for?

Optumas will conduct a series of analyses that compare services utilized with services authorized at the member level. 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 is available through the new LTSS Assessment and Support Plan.

Does Optumas have experience in the development of assessment-informed prospective budget methodologies?

Yes, Optumas has developed models like the PCBA in various states.

Will Optumas be using data collected during the COVID-19 pandemic?

No, utilization data that have been influenced by the COVID-19 pandemic will not be used.

How are items from the LTSS Assessment selected for inclusion in the PCBA?

The Department and Optumas will carefully evaluate all items in the LTSS Assessment for appropriateness, consult published literature, conduct a detailed examination of existing assessment-informed, prospective budget methodologies, conduct a wide variety of statistical analyses, and seek feedback from stakeholders.

Will the data used in statistical analysis be made public?

No, the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule prevents the Department 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 are being used?

The Department and Optumas are utilizing LTSS Assessment data as well as corresponding HCBS and State Plan claims from 2018-2019. New data available after implementation of the LTSS Assessment will be used in refining the PCBA.

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

The new LTSS Assessment and Person-Centered Support plan is available here: https://hcpf.colorado.gov/colorados-ltss-assessment-and-support-plan. Additional information surrounding the development of the new LTSS Assessment and Support Plan is also provided.

Will the PCBA be identical for adults and children?

No, adults and children have markedly different needs and will not share identical drivers of resource need. As such, the Department and Optumas expect that the PCBA may utilize a different statistical structure as well as a different set of variables, distributions, and coefficients for adults and children.

Will comorbidities be accounted for?

Yes, the Department 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, the Department 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 PCBA Exceptions Process will include opportunities for stakeholder feedback once the PCBA has been developed and prior to implementation. The PCBA Exception Process will likely differ significantly from the current SIS Support Level Review or Request for Reassessment process.

Will the PCBA only examine ADLs and IADLs for inclusion in the PCBA?

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

Is the Person-Centered Budget Algorithm (PCBA) able to be determined whether the person chooses to complete a Basic Assessment or a Comprehensive Assessment?

All variables that inform the PCBA will be included in both assessment models. The Basic Assessment will be designed to include all required elements that inform the PCBA. The Comprehensive Assessment will be designed with all required items that inform the PCBA, in addition to questions that provide further insight into a person's needs and may benefit support planning, but do not impact the budget.

Common Acronyms

Below are some acronyms that Optumas has used in presentation materials. This list will be updated as new acronyms are used.

A/SP: Assessment and Support Plan

ADRC: Aging and Disability Resource Center

CMS: Centers for Medicare & Medicaid Services

GLM: Generalized Linear Model

HCBS: Home and Community Based Services

HIPAA: Health Insurance Portability and Accountability Act

IDD: Intellectual and Developmental Disabilities

LOC: Level of Care

LTC: Long-Term Care

LTSS: Long-Term Services and Supports

PC: Person Centered

PCBA: Person Centered Budget Algorithm

PHI: Protected Health Information

PHR: Personal Health Record

QI: Quality Improvement

RA: Resource Allocation

RAE: Regional Accountable Entity

SB: Senate Bill

SEP: Single Entry Point

SIS: Supports Intensity Scale

SP: Support Plan

Contact Us

Contact Tasia Sinn for questions, comments or concerns at Tasia.Sinn@state.co.us.

To submit anonymous feedback about the development of Colorado's Person-Centered Budget Algorithm (PCBA), please fill out this form at https://forms.gle/Huuu7R1NnqzAhHbv5

LTSS Assessment and Support Plan Page

Other Long-Term Services and Supports Programs