February 29, 2024
Background:
In tandem with the increased workload associated with the end of the Public Health Emergency, HCPF implemented the new Care and Case Management (CCM) system, and also transitioned Case Management Agencies (CMAs), as required by the federal mandate for conflict free case management commenced in July 2023. While HCPF did not intend for these three workstream implementations to overlap (the CCM tool was two years late in delivery and the end of the PHE was not known when the other two projects were initiated), the work associated with these three, once-in-a-generation system concurrent changes has created instability for HCPF’s contracted Case Management Agencies (CMAs).
In February 2024 a system change was made to consolidate HCBS waivers in the CBMS system into one waiver. This was done to align and allow the CCM to manage the various waivers. Based on outstanding level of care (LOC) assessments not being entered timely or not completed yet, members were terminated as of 2/29/2024 for missing LOCs.
Solutions:
Understanding that the LOC is only one component of the eligibility determination process, the Department has identified all LTSS members who were terminated regardless of the termination reason and will be reinstating coverage. This reinstatement entails the following:
- Reinstate all terminated LTSS members who were terminated effective 2/29/2024.
- This will be applied to ALL members who were terminated for any reason (not just missing Level of Care).
- This will be completed by COB on 2/29/2024 to allow the systems to update and mitigate a gap in coverage and services for Friday, March 1, 2024. This means that the PEAK website, Health First Mobile app, and the Interchange will all show active coverage as of 3/1/2024 again once the change has been made.
- An approval letter will be generated and sent out to all impacted members.
- The Department will be working on the operational details to ensure these cases are updated appropriately with LOCs as well as any other missing information.
Resources for members, providers and advocates
For Member Eligibility Concerns: HCPF’s county escalation process is available to any member or provider who has attempted to work with their county and is still facing challenges. Upon completion of our Member Escalation webform, which collects the necessary background information to escalate the case, the member is provided a Salesforce tracking number. Once submitted, the County Escalations team triages the request and prioritizes access to care issues. Once triaged, the team coordinates with the county to prioritize resolution of the issue. The member is then notified by the county and the escalations team of the outcome. The cases escalated tend to be the most complex cases and resolution can take policy research and is not immediate. Members and providers can access this form by visiting healthfirstcolorado.com/county feedback or by scanning a QR code on public postings available in all county lobbies. For additional information, you can contact hcpf_membercomplaints@state.co.us.