Joint Budget Committee Hearing:

Office of Community Living

January 5, 2017

1

Susan E. Birch, MBA, BSN, RN, Executive Director

Our Mission

Improving health care access and

outcomes for the people we serve

while demonstrating sound

stewardship of financial resources

2

Medicaid Waivers

• Certain federal rules for the Medicaid State Plan

can be waived.

3

Brain Injury Waiver

Children with Autism Waiver

Children with Life Limiting Illness Waiver

Children’s Habilitation Residential

Program Waiver

Children’s Home and Community-Based Services

Waiver

Community Mental Health Support Waiver

Elderly, Blind, and Disabled

Waiver

Spinal Cord Injury Waiver

Children’s Extensive

Support Waiver

Persons with Developmental

Disabilities Waiver

Supported Living Services Waiver

History

4

Office of Community Living Highlights

Moving

Forward: Implementing

CLIP to redesign

LTSS system to

be more person-

centered

2014• CLAG submitted final recommendations to

redesign LTSS system

• HB 14-1252 and HB 14-1051: Eliminated

the HCBS-Supported Living Services waiver

waiting list and asked for a plan to eliminate

HCBS-Persons with Developmental

Disabilities waiver waiting list

• HB 14-1338: Created Regional Center Task

Force (RCTF)

2012Gov. Hickenlooper issued Executive Order

establishing Office of Community Living

(OCL) and Community Living Advisory

Group (CLAG)

2013• HB 13-1314: Transfer

administration of

services for persons

with I/DD from DHS

to HCPF to create

OCL

• SB 13-230:

Eliminated waiting

list for Home and

Community Based

Services Children’s

Extensive Supports

(HCBS-CES) waiver

2015• RCTF submitted final recommendations

• HB 15-1318: Developed plan for CFCM and

created single waiver for adults with I/DD

• HB 15-1368: Cross-system crisis response

and stabilization services pilot created for

individuals with co-occurring I/DD and

behavioral health conditions

2016Developed

Community Living

Implementation

Plan to encompass

all work related

to enhancing

person-

centeredness and

community living

Looking

Back: Colorado has a

strong history of

providing services

for people in the

community

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Community Living Implementation Plan

(CLIP)

Community Living Advisory

Group Rec’s

Colorado’s Community Living Plan

Community Living Implementation Plan

Streamline Access to LTSS

e.g. No Wrong Door

Restructure Case

Management

e.g. Conflict-Free Case

Management

Develop New Assessment Tool

and Support Plan

e.g. New functional

assessment tool

Strengthen Choice for Self-

Directed Services

e.g. Consumer directed services

expansion

Enhance Community

Supports

e.g. Colorado Choice

Transitions

Redesign HCBS Benefits

e.g. Community First Choice

Monitoring and Evaluation | Quality Improvement

Workforce Training and Development | Statutes and Regulation Changes

Office of Community Living

Services Expenditures

6

15%

5%

1%

79%

Long Term Services and Supports Homeand Community Based Waivers, Class INursing Facilities, Class II NursingFacilities and Program of All InclusiveCare for the Elderly, $1.3 billion

Home and Community Based Services forPersons with Intellectual andDevelopmental Disabilities, $457 million

Regional Centers, $49 million

Remaining Services, $6.7 billion

FY 2016-17 Projected Long Term Care Services Expenditure as a Proportion of Total Services ($8.5 billion)

Individuals with Intellectual and

Development Disabilities Waivers

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• Current Enrollment: 1,587

• Average Cost Per Enrollment: $17,562

Children's Extensive Support Waiver

• Current Enrollment: 4,608

• Average Cost Per Enrollment: $13,675

Adult Supported Living Services Waiver

• Current Enrollment: 5,058

• Average Cost Per Enrollment: $68,340

Adult Persons with Developmental Disabilities Waiver

Source: Community Contract Management System, September 30, 2016

Intellectual and Developmental

Disability Waivers General

Questions 1-7

8

Intellectual and Developmental

Disability Waivers Waiting List

Questions 8-9

9

Individuals with Intellectual and

Development Disabilities Waivers

10

Current Wait List: 0

Children's Extensive Support Waiver

Current Wait List: 0

Adult Supported Living Services Waiver

Current Wait List: 2,684

Adult Persons with Developmental Disabilities Waiver

Source: Community Contract Management System, September 30, 2016

88% on the wait list are

getting services such as

physician care, dental services,

medical transportation &

prescription drug coverage

72% on wait list are getting

services from other waivers

Intellectual and Developmental

Disability Waivers Caseload and

Provider Availability

Questions 10-11

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Conflict-Free Case Management

Questions 12-16

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History of Colorado Conflict-Free Case Management (CFCM)

13

Community Engagement

State

Federal

2007University of

Southern Maine

study, gathered

stakeholder input

2010Conflict of Interest (COI)

Task Force based on the

Office of the State

Auditor audit findings

2014COI Task Group

initiated by the

Department

2015-166 meetings with CCBs

15 Town Hall Meetings

4 Regional Forums

1 statewide webinar

2007University of

Southern Maine

Report

2009Office of State

Auditor’s Audit

2010Convened COI

Task Force

2014Convened CFCM

Task Group

2015-2016HB 15-1318 passed, contracted with

Navigant to develop a CFCM

implementation plan

Pre-2007

CMS inquired about

potential COI and

expressed concern

2009

CMS initiated rule-making

process, which included

person-centered planning rules

2014

CMS released final rule, which added

separation of case management from

service provision

14

Colorado Conflict-Free Case Management

(CFCM) Implementation Plan

Source: Colorado Conflict-Free Case Management for Home and Community Based Services Implementation Plan (HB 15-

1318), Navigant Consulting, July 1, 2016.

• Conduct specific analyses to inform key decisions identified in this report

• Assess which statutes, regulations, waiver amendments and other policies must change in order to implement the proposed plan

• Initiate collaborations with stakeholders to move forward with implementation

• CCBs will decide which of the four options they will take to transition to CFCM and develop business continuity plans

Phase 1: Planning

1-2 years

• Develop and submit revisions to existing statutes, regulations, waiver amendments and other policies governing case management

• Set specific requirements for compliance with CFCM based on revisions to statutes, the Medicaid State Plan and waivers

• CCBs will begin implementing components of their business continuity plans, including any applicable divestment

Phase 2:

Design

1-2 years

• Regulatory and policy changes

• Provider development and outreach

• Communication priorities

• Quality and evaluation

Phase 3: Implementation

1 year

Joint Questions with Human

Services and Health Care

Policy & Financing

Regional Centers and R10

Questions 17-19

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Thank You

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