Joint Budget Committee Office of Community Living Kim Bimestefer, Executive Director; Josh Block, Budget Director; Bonnie Silva, Interim Office of Community Living Director December 19, 2018 https://www.colorado.gov/hcpf/legislator-resource-center
Our Mission Improving health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources 2
Office of Community Living Redesign all aspects of long-term services and supports delivery system to support Coloradans with Goal* disabilities and older Coloradans to be able to live in the home of their choosing with the supports they need and participate in communities that value their contributions • Provide services in a timely manner with respect and dignity Guiding • Strengthen consumer choice in service provision • Incorporate best practices in service delivery Principles • Encourage integrated HCBS delivery • Involve stakeholders in planning and processes • Incorporate supportive housing NOTE: Goal and guiding principles were set by Executive Order D 2012-027, which established the Office of Community Living. 3
Continuum of Care 4
Long Term Services and Supports System Case Direct Management Services • Community • At home Centered • In community Boards (CCBs) • In facilities • Single Entry Member Points (SEPs) NOTE: CCBs also provide direct services. 5
Who Receives Long Term Services and Supports? 7% 44% 49% Children & Adolescents Adults Older Adults ages 20 & younger ages 21-64 ages 65 or older & qualifying former foster care youth SOURCE: FY17-18 data; Data represent percentage of people receiving Medicaid LTSS in various age groups. 6
Understanding Members’ Unique Needs 80% of members receiving Long Term Services and Supports have one or more chronic condition ➢ Compared to 36% of members not receiving LTSS 47% of members in intellectual and developmental disabilities waivers also have a physical disability NOTE: The rates are based on whether Colorado Medicaid paid a claim with a diagnosis listed in FY 17-18. If the member is untreated for the condition or only Medicare paid the claim, we do not have those data. Intellectual and developmental disabilities (IDD) refers to those receiving services under the three IDD waivers in Colorado. 7
Long Term Services and Supports Programs Certain federal Medicaid rules can be waived to provide services for eligible members to live in the community. Children’s Children’s Home Children with Children’s Habilitation and Community- Brain Injury Life Limiting Extensive Residential Based Services Waiver Illness Waiver Support Waiver Home and Program Waiver Waiver 521 179 1,972 Community- 39 1,673 Based Services Persons with (HCBS) Community Elderly, Blind, Developmental Spinal Cord Supported Living Mental Health and Disabled Waivers Disabilities Injury Waiver Services Waiver Support Waiver Waiver Waiver* 129 5,359 3,793 26,610 5,631 State- Supported Living Family Support Services Funded Services (SLS) Program (FSSP) Only 588 3,562 Programs Home and Community- Program of All-Inclusive Nursing Homes and State-Funded Only Based Services Care for the Elderly Intermediate Care Programs (HCBS) Waivers (PACE) Facilities 4,150 45,938 4,899 15,044 SOURCE: FY 2017-18; based on claims in MMIS. * There is a waiting list for the HCBS-DD waiver. As of September 2018, there were 3,059 people registered as waiting for enrollment into the HCBS- DD waiver with a timeline of “As Soon As Available.” 8
LTSS Scorecard: Colorado is a Leader • Scorecard measures state- level long term services and supports (LTSS) system performance from the viewpoint of users of services and their families • Colorado ranks 8 th in the nation overall on the LTSS Scorecard SOURCE: 2017 Long-Term Services and Support State Scorecard can be found at: http://www.longtermscorecard.org/. 9
2019 HCPF Budget Requests • R6 | Local Administration Transformation • R7 | Primary Care Alternative Payment Models • R8 | Benefits and Technology Advisory Committee • R9 | Long Term Home Health and Private Duty Nursing Acuity Tool • R10 |Transform Customer Experience • R11 | All-Payer Claims Database Financing • R12 | Medicaid Enterprise Operations • R13 | Provider Rate Adjustments • R14 | Office of Community Living Governance • R15 | Operational Compliance and Program Oversight • R16 | Employment First Initiatives and State Programs for People with Intellectual and Developmental Disabilities 10
Conflict Free Case Management Question 1 11
Conflict Free Case Management Timeline 2015 March 2014 2017 and 2018 FY 2021-2022 2 nd and 3 rd Quarter HB 15-1318 CMS released final Department By June 30, 2021, at 2019 passed requiring HCBS rule, which working with case least 25% of individuals Department engages Department to required management are receiving conflict- develop a CFCM stakeholders and separation of case agencies on rural free case management, implements choice implementation management from exceptions and and by June 30, 2022, plan (submitted in case management service provision business continuity all individuals for IDD waivers July 1, 2016) plans (BCPs) Conflict Free Case Management (CFCM) 2017 June 2020 FY 2015-16 July 2019 HB 17-1343 passed, Case 6 meetings with CCBs Department redefining case management 15 Town Hall Meetings completes management in Colorado agencies 4 Regional Forums analysis of and requiring the complete 1 statewide webinar BCPs Department to implement required changes CFCM by June 30,2022 12
Community Centered Board Audit Question 2 13
CCB Performance Audit: Department Actions In year 3 of a 5-year plan to revise the State Supported Living Services (SLS) allocation methodology Developing State SLS specific regulations and improving contractual requirements Enhanced Benefits Utilization System (BUS) to create additional customized reports for CCBs Recovered all Targeted Case Management (TCM) overpayments in July 2018, found no additional instances of overpayment Developing written clarification to better define reasonable billing practices Working to review payments for service claims without prior authorization and make recoveries 14
Developmental Disabilities Waiver Waitlist Questions 3-7 15
HCBS-DD Waiting List • 3,059 individuals waiting for HCBS-DD waiver services ➢ 81% of individuals on the waiting list are receiving other services , including some HCBS • Eliminating the waiting list for HCBS-DD services would take: ➢ Estimated annual total of $204,153,367 ➢ Four years NOTE: Waiting list numbers are as of September 30, 2018. The Department’s calculations for eliminating the waiting list are b ased on the methodology from its FY 2017-18 R-I- 1 request “Elimination of the HCBS - DD Waiting List,” updated to reflect current waiting list numbers, per capita costs, and various administrative cost. 16
Employment First and Additional Question Questions 8-11 17
Thank You 18
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