Case Management Redesign

CASE MANAGEMENT FOR LONG TERM SERVICES & SUPPORTS IS CHANGING IN COLORADO

The Current Landscape

Health First Colorado is Colorado’s Medicaid program. Health First Colorado offers a benefit called home and community-based services (HCBS) and the case management for these services.

Individuals and families who receive or wish to receive these important services should know about important changes that are coming to the case management system.

These HCBS services are typically called Medicaid Waivers. In the current system in Colorado, entities called Single Entry Points (SEPs) - of which there are 26 that cover the state - provide case management for the following Medicaid waivers: Brain Injury waiver; Community Mental Health Supports waiver; Elderly, Blind and Disabled waiver; Spinal Cord Injury waiver; Children’s Home and Community Services waiver; and Children with Life Limiting Illness waiver. Jefferson County currently serves as the Single Entry Point (SEP) agency for Jefferson County.

 

There are 20 entities across the state called Community Centered Boards (CCBs). Generally, CCBs provide both case management and direct services for another set of Medicaid waivers: Developmental Disabilities waiver; Supported Living Services waiver; Children’s Extensive Support waiver; and Children’s Habilitation Residential Program waiver. Developmental Disabilities Resource Center (DDRC) currently serves as the CCB for Jefferson, Clear Creek, Gilpin and Summit Counties.

The information contained within this communication is specific to the changes in Jefferson and Clear Creek counties. Additional information related to the changes in Summit and Gilpin counties is forthcoming.

 

What is Changing and Why?

In 2014, the federal agency that oversees Medicaid issued a rule that addressed what was recognized as a potential conflict: that an entity providing case management services for any of these waivers that also provided services, had a conflict. This has come to be known as ‘conflict-free case management.’

 

To come into compliance with the requirement to be conflict free for the delivery of case management and waiver services to families, the state of Colorado passed legislation to implement case management redesign (CMRD).

The legislation provides that, no later than July 2024, a newly created single Case Management Agency (CMA) must be selected for each state catchment area so that individuals in need of long- term supports and services can access case management services in one place without a conflict, essentially combining the case management of all waivers from Single Entry Points and Community Centered Boards into one Case Management Agency.

This means that agencies such as DDRC cannot provide both case management services and direct services for Health First Colorado (Medicaid) waiver members. DDRC has provided both case management and Home and Community Based Services for nearly 60 years. DDRC will no longer be providing case management services but will continue to provide their direct services (HCBS Waiver Services, Early Intervention, Behavioral Health, Recreation, etc.). Jefferson County’s SEP only provides case management so historically has experienced no conflict.

 

DDRC & Jefferson County Working Together

Jefferson County Human Services (JCHS) and DDRC began working together about 2 ½ years ago, knowing that both entities, the individuals and families we serve, our staff and community would be impacted by this change. Working together, the leadership of both organizations analyzed all options, and ultimately decided that Jefferson County should apply, in partnership with DDRC, to be the new CMA for Jefferson and Clear Creek counties. After a lengthy process and many hours of planning, Jefferson County was notified by the State Department of Health Care Policy & Financing (the Medicaid state agency) on June 12 of a Notice of Intent to Award (NOIA) the contract to Jefferson County. The Jefferson County Board of Commissioners formally approved JCHS to accept the NOIA on July 11.

 

Who This Impacts

Individuals and families who receive their case management and resource coordination from DDRC for all Intellectual and Developmental Disabilities HCBS Waivers, State Supported Living Services and Family Support Services will be the most impacted by this change. Case management for these services will move to Jefferson County. Additionally, DDRC will be transferring the functions of Quality Assurance and Family Support.

Most individuals and families currently served by Jefferson County’s Single Entry Point should experience little change.

 

Jefferson County intends to work with the DDRC staff impacted, holding hiring events and other activities. The new CMA anticipates most DDRC staff impacted by this change will be hired as part of the new Jeffco CMA.