COVID-19 Updates Colorado Department of Health Care Policy & Financing April 10, 2020 1
Overview Colorado Department of Public Health & Environment (CDPHE) Update • Greg S chlosser, Branch Chief Update on COVID-19 status in Colorado • Dr. Lisa Latts, Chief Medical Officer Update from Colorado Cross Disability Coalition (CCDC) • Julie Reiskin, Executive Director Budget Update Progress & Looking Ahead New Department Guidance Issued • Bonnie S ilva, Office of Community Living Director Questions/Feedback • Responses to top question of last week and opportunity for new questions and answers 2
COVID-19 Updates 3
Update • Personal Protective Equipment (PPE) • S tate Emergency Operations Center (S EOC) • S urvey priorities - Immediate j eopardy complaints, infection control related concerns • Medical S urge Concept of Operations • Home health & hospice essential services • S tate and federal waivers • HEMS D COVID-19 Blog 4
Reminder: Personal Protective Equipment • HCPF has Dedicated 8 Staff @ 25 hours/week To report issues in • If you or your organization are experiencing a obtaining PPE please shortage or outage of personal protective notify: equipment (masks, gloves, gowns, etc.) to conduct essential or life saving functions during Sadie Martinez this crisis, please reach out to your local Access and Functional Needs emergency manager or local public health Coordinator department. Office of Emergency Management 720.610.1691 Find Your Local Community Emergency Manager sadie.martinez@ state.co.us Find Your Local Public Health Department 5
COVID-19 in Colorado • 6,202 cases • 1,221 hospitalized • 226 deaths • 56 counties • 58 facilities • US : 467K • Worldwide: 1.62M cases 6
Effect of Social Distancing 7
• S tatewide organization run by and for people with all types of disabilities • We do disability rights advocacy using a social j ustice lens • We have agreed to coordinate communication between our community (not j ust CCDC members but the whole disability community) and HCPF to help with overwhelm. #DoingMyPartCO • Email covid@ ccdconline.org • Website: www.ccdconline.org/ covid-19- resources-links-and-information/ 8
What is a CSC? Protection for workers Resources for critical life/ death Result of crisis overall • PPE • Ventilators • Behavioral When a RES OURCE such as Health • EMS • ICU units in intensive care, • Hospice ventilators, protective equipment, etc., is expected to be INS UFFICIENT to serve everyone… or otherwise prevent us from operating under TYPICAL circumstances the CRIS IS S TANDARD OF CARE dictates a temporary new way of operating. 9
Governor gives Executive Order Crisis Standards Chief of Care – CS C Health Officer aka implements rationing Not enough resources to the j ob 10
Colorado CSC for Intensive Care/Vents Process – by step Is not considered Level 1 Race Ethnicity/ Country Do you need it? Can you be saved? Level 2 Language Ability to pay And ability to survive beyond S core based on age immediate crisis Level 3 Disability S tatus Children Caregivers 11
Who decides? • Triage teams that must be separate from people doing direct care. They will not know the factors that do not matter. • If your disability is not on the tool they will not know you have a disability. They will not know if you are the Governor or j ust got out of j ail. • They will not know if you are a millionaire or on public assist ance. • They will not know your race, religion, or what language you speak. • If they do not follow this they do not have legal protection offered through the CS C. 12
What now? • Hopefully we will not have to implement. • Need to continue to talk about this. • Report problems or concerns. 13
Budget Update 14
Budget Complexities 6.2% CMS Enhanced Authorities Match S tate Federal Budget Legislation Changes S ituation to Funding 15
Progress and Looking Ahead 16
Key Outstanding Federal Approvals Appendix K Disaster S tate Plan Amendment • Staffing Flexibility in Residential S ettings • Sick Time for CDAS S Attendants • Exclusion of Professional Medical Information Page • Enhanced Payments for Nursing Facilities (NF) & (PMIP) at BOTH Annual and Continued S tate Review Intermediate Care Facilities (ICF ) • Retainer Payments for Residential • Waive Level of Care Assessments for NF Transfers • Waive PMIP for Home Health, P ACE, NF , and ICF 1135 Waiver • Enhanced Payments for Community Centered • Waive Signatures for LTS S Eligibility Boards • Enhanced Payments for Fiscal Management Services • Suspend IMD Status (FMS) • Staffing Flexibility for NF , ICF , ACF • ervice Every 30-Day Rule Waive S • Alternative Location Flexibility for ICF • Allow for Bulk Home Meal Delivery • Enhanced Payments for Single Entry Points 17
Implemented Changes Services • Added flexibility to most HCBS benefits for virtual delivery or alternate settings, including certain therapies • Provided guidance on how to implement telemedicine in Nursing, Intermediate Care, and Alternative Care Facilities • Allowed legally responsible person to provide Community Connector service 18
In Process and Exploring Services In Process Exploring • Allow legally responsible person to provide • Allow paid sick time for CDAS S Attendants previously authorized Homemaker and • Expand Home Delivered Meals S upported Community Connector • Add in-home respite for Community Mental • Allow a family member or spouse to Health S ervices waiver provide previously authorized Homemaker and Personal Care • Exceed Y outh Day S ervices limit for Children’s Extensive S upport waiver • Exceed respite limit • Enhance payments 19
Implemented Changes Case Management • Allowed for virtual assessments • Changed 100.2 authorization from 6-months to 1-year authorization for new assessments • Accept eS ignatures or snail mail signatures • Provided guidance on what to do if an agency closes or suspends services • Provided guidance on how to document COVID-19 as critical incident • S uspended PAS RR for 30 days for new admissions 20
In Process and Exploring Case Management In Process Exploring • Additional changes to • Allow flexibility on ULTC 100.2 Professional Medical Information for individuals transferring Page (PMIP) requirements between nursing facilities • Temporary changes to the Notice of Adverse Action (803) process for Case Management Agencies • Enhanced payments for Case Management Agencies 21
Implemented Changes Providers and Workforce • Added flexibility to PAS RR requirements • S uspended Aide supervision requirement for home health agencies • Modified Nursing Facility staffing requirements • Allowed for retainer payments for day programs • Provided guidance for what residential providers should do if they have a suspected or confirmed case of COVID-19 • S uspended in-person inspections of Host Homes 22
In Process and Exploring Providers and Workforce In Process Exploring • Expand eligible providers across HCBS • Enhanced rates for residential, personal waivers and HCA/ Hospice Providers care, and homemaker services • Enhanced rates to Nursing and • Modify Intermediate Care and Intermediate Care Facilities Alternative Care Facilities staffing • Enhanced Financial Management S ervice requirements (FMS ) payments • Retainer payments for prevocational • S uspend IMD status and supported employment • Allow for alternative locations for Nursing and Intermediate Care Facilities 23
Previous Guidance Case Management Agencies HCBS Providers Operational Changes Long-term Care and Congregate S ettings • OM 20-018 (superseded by OM 20-034, next slide) • OM 20-017 • OM 20-019 Day Program S ervice Providers • OM 20-027 • IM 20-017 P AS RR Changes HCBS Therapy S ervices • OM 20-020 • IM 20-015 Guidance for Program Closures Due to COVID-19 • OM 20-030 • OM 20-021 Critical Incident Reporting for COVID-19 Guidance for Class B Providers • OM 20-022 • OM 20-023 Changes to Benefits & S ervices (Table) • OM 20-024 Facilities and P ACE Telemedicine • Temporary Policy Infection Control And Prevention of COVID-19 in Nursing Homes Non-medical Transportation (CMS ) • OM 20-031 • CMS QS O-20-14-NH Telemedicine in Nursing Facilities All COVID-19 relat ed memos can be found here: • OM 20-032 www.colorado.gov/ hcpf/ covid-19-provider-informat ion 24
New Guidance Issued 25
OM 20-034 OM 20-035 New Guidance OM 20-036 Issued OM 20-037 OM 20-038 All COVID-19 relat ed Memos can be f ound here: www.colorado.gov/ hcpf/ covid-19-provider-inf ormat ion 26
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