CO HCPF Home and Community-Based Services (HCBS) for Persons with Intellectual and/or Developmental Disabilities Waiver Programs & Targeted Case Management for HCBS Waiver Programs — Program Overview: Home and Community-Based Services (HCBS)

TheHomeandCommunity-BasedServices(HCBS)waiverprogramsprovideHealthFirstColorado(Colorado'sMedicaidprogram)Memberswhomeetspecialeligibilitycriteriaaccesstoadditionalservicesintheirhomesandcommunitiesasanalternativetoinstitutionalcare.TheHomeandCommunity-BasedServicesprogramsforpersonswithintellectualand/ordevelopmentaldisabilitiesinclude:

HomeandCommunity-BasedServicesforPersonswithIntellectualand/orDevelopmentalDisabilitiesWaiver(HCBS-DD)

HCBS-SupportedLivingServices(HCBS-SLS)

HCBS-Children'sExtensiveSupport(HCBS-CES)

LevelofcaredeterminationsaremadeannuallybyContractedCaseManagementAgencies.Membersmustmeetfinancialandmedicaleligibility,aswellasprogram-specificcriteriatoaccessservicesunderawaiver.Theapplicantmustbeatriskoftransitiontoanursingfacility,hospital,orIntermediateCareFacilityforIndividualswithIntellectualDisabilities(ICF/IID).Toaccesswaiverbenefits,Membersmustbewillingtoreceiveservicesintheirhomesorcommunities.AMemberwhoreceivesservicesthroughawaiverisalsoeligibleforallbasicHealthFirstColoradocoveredservicesexceptnursingfacility,ICF/IID,andlong-termhospitalcare.WhenaMemberchoosestoreceiveservicesunderawaiver,theservicesmustbeprovidedbycertifiedHealthFirstColoradoProviderAgencies.

Applicantsmayapplyformorethanone(1)waiverbutmayonlyreceiveservicesthroughone(1)waiveratatime.

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TheHCBS-DDWaiverprovidespersonswithintellectualand/ordevelopmentaldisabilitiesaccesstoservicesandsupports24hoursadaytoallowthemtolivesafelyandparticipateintheircommunity.Servicesinclude:

ResidentialHabilitation

SpecializedHabilitation

SupportedCommunityConnections

PrevocationalServices

SupportedEmploymentServices

BenefitsPlanning

Non-MedicalTransportationServices

BehavioralServices(forindividuals21yearsofageandolder)

SpecializedMedicalEquipmentandSupplies

DentalServices(forindividuals21yearsofageandolder)

VisionServices(forindividuals21yearsofageandolder)

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TheHCBS-SLSWaiverprovidesservicesandsupportstoassistpersonswithintellectualand/ordevelopmentaldisabilitiestoliveintheperson'sownhome,apartment,familyhome,orrentalunitthatqualifiesasanSLSsetting.Servicesinclude:

ExtraordinaryCleaning

Mentorship

SpecializedHabilitation

SupportedCommunityConnections

PrevocationalServices

SupportedEmploymentServices

Non-MedicalTransportation

BehavioralServices(forindividuals21yearsofageandolder)

Hippotherapy

MovementTherapy

MassageTherapy

HomeAccessibilityAdaptations

VehicleModifications

AssistiveTechnology

DentalServices(forindividuals21yearsofageandolder)

VisionServices(forindividuals21yearsofageandolder)

SpecializedMedicalEquipmentandSupplies

LifeSkillsTraining

PeerMentorship

BenefitsPlanning

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TheHCBS-CESWaiverisforchildrenagesbirthto18withintellectualand/ordevelopmentaldisabilitiesorforchildrenagesfour(4)andunderwhoareatriskofadevelopmentaldelay.Servicesinclude:

Respite

ExtraordinaryCleaning

CommunityConnector

MovementTherapy

MassageTherapy

SpecializedMedicalEquipmentandSupplies

AdaptedTherapeuticRecreationalEquipmentandFees

HomeAccessibilityAdaptations

VehicleModifications

AssistiveTechnology

CaregiverEducation

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TargetedCaseManagement(TCM)isanoptionalHealthFirstColoradobenefitforMemberswhohavebeendeterminedbyaContractedCaseManagementAgencytomeeteligibilitycriteriaandareactivelyenrolledinone(1)oftheprogramslistedbelow.MembereligibilityforthisbenefitisdependentonwhethertheMemberisreceivingcasemanagementfromone(1)oftheDepartmentofHealthCarePolicy&Financing's(theDepartment)ContractedCaseManagementAgencies.

Members,byWaiver,eligibleforTCMwhenbilledbyaContractedCaseManagementAgency:

BrainInjuryWaiver(HCBS-BI)

Children'sExtensiveSupport(HCBS-CES)Waiver

ChildrenwithComplexHealthNeeds(CwCHN)Waiver

Children'sResidentialHabilitationProgram(HCBS-CHRP)Waiver

CommunityMentalHealthSupportsWaiver(HCBS-CMHS)

ComplementaryandIntegrativeHealthWaiver(HCBS-CIH)

PersonswithIntellectualand/orDevelopmentalDisabilities(HCBS-DD)Waiver

Elderly,Blind,andDisabledWaiver(HCBS-EBD)

SupportedLivingServices(HCBS-SLS)Waiver

TCM-Administrativecasemanagementservices

AcomponentofTCMispaidonamonthlybasisforeachmemberandrequiresthatContractedCaseManagementAgenciesmustdocumenttheprovisionofabillableactivityintheCareandCaseManagement(CCM)Systemwithin10businessdaysoftheprovisionofthatservice,ensuringthedateofcontactisenteredcorrectly.Billableactivitiesinclude,butarenotlimitedto,thefollowing:

DevelopmentandimplementationofaPerson-CenteredSupportPlan

PriorAuthorizationofservicesidentifiedthroughassessmentandserviceplanningprocess

DevelopmentandrevisionasneededofaPerson-CenteredServicePlan

ReferralandrelatedactivitiestohelpaMemberobtainneededservices

Monitoringandmonitoringfollow-upactivitiesthatarenecessarytoensurethePerson-CenteredServicePlanisimplementedandadequatelyaddressesthemember'sneeds

ExclusionsforTCMincludeadministrativetaskssuchasmassphysicalorelectronicmailings,aswellasautomatedtelephonecalls

BillingforTCMactivitiesthatarepaidforbycontractualpaymentsareconsideredduplicativeandshouldbeexcluded

ActivitiesthatarenotdocumentedwithintherequiredtimeframesaboveshouldnotbebilledasTCM

TCM-MonitoringVisits

AseparatecomponentofTCMencompassesface-to-faceandremotemonitoringthequalityofservicestoensuretheMemberisreceivingservicesinaccordancewiththeserviceplan,ensureMembersatisfactionwithservices,andtoensurethehealth,safety,andwelfareoftheMember.Ruraltraveladd-onsmayonlybebilledwithone(1)oftherequired,quarterlyface-to-facevisitsifperformedinperson.Ruraltraveladd-onsmaybebilledforMembersresidingincountiesdesignatedasruralorfrontier.Ruraladd-onmaynotbebilledinconjunctionwithtelephone/virtualmonitoring.Thisworkincludesmonitoringtheeffectiveandefficientprovisionofservicesacrossmultiplefundingsources.

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