2018-2019 Waiver Renewal Children’ s Habilitation Residential Program (CHRP) Presented by: Sarah Hoerle December 2018 1
Our Mission Improving health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources 2
Housekeeping 3
Ground Rules During the meeting: - We have a lot to cover, so please hold questions until breaks in the presentation. - Please do not speak over the presenter, or other participants. During the engagement process: - Questions about this stakeholder engagement process can be sent to: hcbswaivers@ state.co.us - If you have a formal comment/ suggestion on the waiver(s), please submit them to: ltss.publiccomment@ state.co.us 4
• Inform S takeholders of the Waiver Renewal Process • Explain the content of Meeting the CHRP waiver application Purpose • Discuss updates to the CHRP waiver for this renewal • S takeholder feedback 5
Major Changes to the CHRP Waiver Removal of requirement that the child be in foster care. Transfer of administration of the CHRP waiver from the CDHS to the Department. Transfer of case management from child welfare agencies to Case Management Agencies (specifically Community Centered Boards- CCBs). Addition of two services to the waiver to mitigate the need for an out of home placement and facilitate returns to the home once stabilized. 6
Home and Community- Based Services Overview 7
HCBS waiver authority permits the state to offer home and community-based services to individuals on the CHRP waiver who: • Are under the age of 20 • In out-of-home care who have been determined to have a developmental disability • The waiver serves as an alternative to placement in an Intermediate Care Facility of Individuals with Intellectual Disabilities 8
Waiver Application Process • S tates must submit initial waiver application to the Centers for Medicare and Medicaid • Initial approval period is 3 years • After initial period renewal occurs every 5 years • The CHRP waiver requires a renewal by June 30, 2019 9
Renewal Process • The Children’ s Habilitation residential Program (CHRP) Waiver expires on June 30, 2019 • The S tate must respond to Evidentiary Reports and other CMS Guidance • Waiver Application must be submitted at least 90 days in advance of expiration 10
S cope Things that can change: - Correct grammatical or technical language errors - Legislative updates Things we cannot change: - Changes or additions not authorized by legislation - Changes that would cause a fiscal impact 11
Intended Timeline Important Dates: Public Comment Period from 1/ 28/ 2019 through 2/ 28/ 2019 The Department will submit the renewal to CMS before 3/ 31/ 2019 Renewal will go into effect on 7/ 1/ 2019 12
Centers for Medicare and Medicaid Services The Centers for Medicare and Medicaid Services (CMS) has several requirements States must meet when administering a waiver 13
CMS Requirements Appendix A: Waiver Administration & Operation Appendix B: Participant Access and Eligibility Appendix C: Participant Services 14
CMS Requirements Appendix D: Participant-Centered Planning and Service Delivery Appendix E: Participant Direction of Services Appendix F: Participant Rights 15
CMS Requirements Appendix G: Participant Safeguards Appendix H: Systems Improvement Appendix I: Financial Accountability Appendix J: Cost Neutrality Demonstration 16
W ai aiver r Adm inist rat rat ion on A: an and Operat rat ion on “What entities are involved in the operation of the waiver?” 17
The S tate agency responsibilities for day to day administration and operation of the Appendix A waiver and contracted or local/ regional Identifies entities with operational functions 18
Waiver Administration A: and Operation • Currently, the waiver states that it is operated by a separate state agency: The Colorado Department of Human S ervices, Division of Child Welfare S ervices • At renewal, the S tate will update this to the S tate Medicaid Agency per HB 18-1328 19
A: Contracted Entities Currently there are no contracted entities that perform waiver operational and administrative functions on behalf of the Medicaid agency and/ or the operating agency. At renewal we will: • Add Case Management Agencies (CMAs) as contracted entities to provide targeted case management services • Add Memorandum of Understanding (MOU) with DHS for monitoring/ licensing of residential services • Add DPHE Interagency Agreement to conduct surveys of certain services 20
A: Roles • Currently, a local/ regional non-state public agencies, the County Departments of Human/ S ocial services, perform waiver operational and administrative functions for clients enrolled in the CHRP waiver. • At renewal, local/ regional non-governmental non- state entities, the Community Center Board’ s (CCB), will perform waiver operational and administrative functions for clients enrolled in the CHRP waiver. 21
A: Responsibility • Currently, the responsibility of assessing the performance of County Departments of Human/ S ocial S ervices in conducting waiver operational and administrative functions is DHS , under the oversight of HCPF. • At renewal, HCPF is responsible for assessing the performance of the Community Centered Boards (CCB) in conducting waiver operational and administrative functions. 22
A: Assessment Methods Currently, methods to assess performance of Contracted non-state entities include: • An administrative tool is used by the waiver administrator for all enrollments • Oversight and monitoring of the case management agencies is provided by the DHS waiver administrator. • HCPF and DHS review all plans of correction and necessary remediations. • HCPF provides oversight to the DHS waiver administrator. 23
A: Assessment Methods At renewal, the CHRP waiver will be updated to include: • An Interagency Agreement with DPHE on complaints to be investigated • Annual monitoring for each CCB • Administrative evaluation to monitor compliance with agency requirements • Programmatic evaluation that consists of a desk audit on client files • Oversee the fiscal agency operating the MMIS • Oversight of the Quality Improvement Organization and Post Payment Review contractor 24
Operational and A: Administrative Functions Currently the assessment of performance of contracted non-state entities is DHS , under the oversight of HCPF, for the County Departments of Human/ S ocial S ervices in conducting waiver operational and administrative functions. At renewal, HCPF will be responsible for the assessment of performance for Community Centered Boards (CCB). 25
A: Quality Improvement HCPF will update the Performance Measures in Appendix A to provide CMS with the assurance that HCPF retains ultimate administrative authority over the CHRP waiver through the tracking and monitoring of deliverables provided by the contracted entities. 26
Part art icipan ant Access an and B: B: Eligibilit y “Who receives waiver services?” 27
Target group(s) and Medicaid eligibility groups, Level of Care Appendix B (LOC) & Evaluation procedures, Freedom of Identifies Choice, and the Application Process for entrance into the waiver 28
B: Specific Target Groups Currently CHRP serves individuals 0 – 20 with a Developmental Disability. At renewal, we will update the definition of intellectual and developmental disability to read: "Int ellect ual and development al disabilit y" means a disabilit y t hat manifest s before t he person reaches t went y-t wo years of age, t hat const it ut es a subst ant ial disabilit y t o t he affect ed person, and t hat is at t ribut able t o an int ellect ual and development al disabilit y or relat ed condit ions, including Prader-Willi syndrome, cerebral palsy, epilepsy, aut ism, or ot her neurological condit ions when t he condit ion or condit ions result in impairment of general int ellect ual funct ioning or adapt ive behavior similar t o t hat of a person wit h an int ellect ual and development al disabilit y. Unless ot herwise specifically st at ed, t he federal definit ion of "development al disabilit y" found at C.R.S . 25.5-10-202 29
Selection of Entrants into the Waiver Children/ youth age birth (0) through twenty (20) who have a determination of developmental disability by a Community Centered Board. As well as; meet the level of care criteria for Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF-IID) as defined in 42 CFR §440.150, and have with extraordinary support needs as defined in 10 CCR 2505-10 8.500, and are at risk of, or in need of, out of home placement. 30
B: # of Participants CHRP The State does not limit the number of participants it serves at any point in time during a waiver year. 31
B: Medicaid Eligibility Group §1634 State with Miller Trust Medicaid Eligibility Groups Served include: S S I recipients 32
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