9 Colo. Code Regs. § 2503-5-3.570

Current through Register Vol. 47, No. 20, October 25, 2024

Section 9 CCR 2503-5-3.570 - HOME CARE ALLOWANCE AND BURIAL

3.570.1HOME CARE ALLOWANCE

3.570.11 PURPOSE OF PROGRAM

A. Home Care Allowance (HCA) is a special cash payment made to a client, five (5) years of age or older for the purpose of securing in-home, personal care services.

1. HCA is a non-entitlement program;

2. Clients must be evaluated for Home and Community Based Services through Health First Colorado (Medicaid) before the HCA program can be considered.

a. At application, if the client is functionally eligible for Home and Community Based Services (HCBS) through Health First Colorado (Medicaid), the client is not eligible for HCA.

b. At reassessment on or after 05/01/2022, clients must be evaluated for Home and Community Based Services through Health First Colorado (Medicaid) and if functionally eligible, the clients are no longer eligible for the HCA program. Clients who are determined eligible for HCBS through Health First Colorado at reassessment may remain on HCA for up to three (3) months while they transition to HCBS if the delay in transition is not within the client's control.

c. HCA cannot be received while receiving Home and Community Based Services; and,

3. HCA is designed to serve clients with the lowest functional abilities and the greatest need for paid care.

B. Effective September 1, 2018, the HCA grant standard maximums are as follows:

1. Tier 1 - $330.00

2. Tier 2 - $472.00

3. Tier 3 - $605.00

C. The tier grant standard maximums shall be lower for certain clients with special circumstances, as defined in Section 3.570.13, D.

D. The HCA grant is not taxable income to the client. The payment made to the care provider using the HCA grant received by the client is income to the care provider and subject to taxation under State and Federal laws.

E. The HCA grant standards shall be adjusted to stay within available appropriations. Appeals shall not be granted for these adjustments.

F. In addition to the regular monthly HCA grant payments, supplemental payments necessary to comply with the Federal Maintenance of Effort (MOE) requirements, as incorporated in Section 3.531.D, may be provided. These payments are supplements to regular grant payments, are not entitlements, and do not affect grant standards. Appeals shall not be allowed for MOE payment adjustments.

3.570.12DEFINITIONS

"Activities of daily living" (ADL) mean physical transfers, bladder care, bowel care, mobility, dressing, bathing, hygiene, and eating.

"Authorized representative" means an individual or organization designated by the client, or by the parent or guardian of the client, if appropriate, to assist in acquiring or utilizing Home Care Allowance (HCA). The extent of the authorized representative's involvement shall be determined upon designation.

"Care planning" means identifying client goals and choices for the care needed, services needed, appropriate service providers, and knowledge of the client and of community resources. The care plan shall be documented on the State Department prescribed care plan tool.

"Case management" means the assessment of a client's long-term care needs, development and implementation of a care plan, coordination and monitoring of the long-term care service delivery, evaluation of service effectiveness, and periodic reassessment of client needs.

"Functional assessment" means the comprehensive evaluation of the client's ability to manage his or her activities of daily living and to determine the level of assistance the client requires to complete his or her activities of daily living.

"Home" means a non-facility residence. A home cannot include a homeless shelter or other temporary setting.

"Intake/screening/referral" means the initial contact with clients by the Single Entry Point (SEP) and shall include, but not be limited to, a preliminary screening of: the client's need for long term care services, the client's need for referral to other programs or services, eligibility for financial and program assistance, and the need for a comprehensive assessment.

"Medical leave" means the absence of the client from their home for more than twenty-four (24) hours due to admittance to a hospital or other facility, upon physician's order with the presumption on the part of the physician that the client will be returning to their home. Medical leave may be planned or unplanned.

"Non-medical leave" means the absence of the client from their home for more than twenty-four (24) hours for non-medical reasons that are not part of a client's care plan. Non-medical leave may be planned or unplanned.

"Non-skilled care" means care provided by licensed and unlicensed non-medical personnel, including caregivers who assist or help the individual with daily tasks such as bathing, eating, cleaning the home, and preparing meals.

"Ongoing case management" means the evaluation of the effectiveness and appropriateness of services, on an ongoing basis, through contacts with the client, appropriate collateral contacts, and service providers.

"Reassessment" means a comprehensive re-evaluation by the case manager with the client and appropriate collaterals (such as family members, friends and/or caregivers) to determine the client's level of functioning, service needs, available resources, potential funding resources, and necessity for paid care. The reassessment of functional need shall be documented on the State Department prescribed assessment tool.

"Single Entry Point ("SEP") agency" means the agency selected by HCPF to provide case management functions for persons in need of long term care services within specific demographic areas, pursuant to Section 25.5-6-106, C.R.S.

"Skilled personal care" means some exceptions to personal care for activities of daily living that, because of the severe or complex nature of the client's need, requires a person with specialized training and skill to complete the task. Skilled personal care is not a paid service of the Home Care Allowance (HCA) program. See Section 8.489.30 (10 C.C.R. 2505-10) of the HCPF rules for the definitions of personal care and the skilled exceptions to personal care.

3.570.13ELIGIBILITY

A. Eligibility for HCA shall be based on both financial need and the client's functional needs. The client shall meet eligibility for both financial and functional requirements to be approved for an HCA payment.

B. To be financially eligible, the client shall:

1. Be approved for Supplemental Security Income (SSI) benefits; or,

2. Meet all eligibility criteria required for Aid to the Needy Disabled - State Only (AND-SO) program; or,

3. Have been receiving both Old Age Pension (OAP) grant payments and HCA as of December 31, 2013 and remain continuously eligible for both benefits.

C. To be functionally eligible, the client shall have an HCA eligible functional assessment score. The functional assessment score is calculated by determining the client's functional capacity score and need for paid care score, as follows:

1. Functional Capacity: determined by assessing the client's ability to complete all activities of daily living (ADLs) and applying a score to his or her ability to complete the ADLs using the functional impairment scale; and,

2. Need for Paid Care: determined by identifying the unmet need for paid care and applying a score to the unmet need using the need for paid care scale, as outlined in Section 3.570.14; and,

3. Combining the functional capacity score and the need for paid care score to determine whether the client meets the minimum scores for eligibility and, if eligible, the tier of grant payments to be approved, as follows:

Tier	Capacity Score	Need for Paid Care Score
1	21 or Higher	1 to 23
2	21 or Higher	24 to 37
3	21 or Higher	38 to 51

D. The SEP shall not approve the maximum authorized HCA amount for the tier if:

1. The client's needs can be fully or partially met through other paid or unpaid sources (excluding family and friends); or,

2. The HCA provider is able to provide the authorized services for less than the maximum authorized amount; or,

3. The client is unwilling or unable to use the maximum authorized amount.

E. Each client who meets the minimum functional assessment scoring requirements for the HCA program shall be functionally eligible for an HCA grant.

1. The authorization by the SEP shall be forwarded to the county department to determine financial eligibility.

2. Clients shall not be approved for HCA if financially ineligible, even if the client is functionally eligible.

3. Clients shall not be approved for HCA if functionally ineligible, even if the client is financially eligible.

F. If financially and functionally eligible for HCA, the HCA grant payment shall begin on the first day of the month following the month in which the HCA is approved or the payment effective date from the State approved form completed by the SEP, whichever date is later. There shall be no retroactive HCA payments.

G. If a client is assessed and does not meet the functional assessment scoring requirements, the county department and SEP shall refer the client to other agencies or services available in the community, such as Area Agencies on Aging (AAA), Aging and Disability Resources for Colorado (ADRC), Centers for Independent Living, and/or other local community resources to help with any identified needs.

3.570.14FUNCTIONAL ASSESSMENT SCORING

A. The need for skilled personal care shall not be included in the scoring of the need for paid care.

B. In order to be eligible for the Home Care Allowance program, each client shall score a minimum of twenty one (21) points when assessed for the ability to complete the ADL using the following functional impairment scale:

1. Independent: score zero (0) if the client is physically able to perform all essential components of the ADL, with or without an assistive device.

2. Low: score one (1) if the client requires occasional or intermittent supervision or stand-by assistance in a limited number of the components of the activity such as he or she is able to perform all essential components of the function, but impairment of function exists even with an assistive device.

a. Occasional or intermittent means the client does not need assistance daily, but may need assistance a few times a month or up to two (2) times per week.

b. Supervision means verbal prompting, cueing, and reminders to help the client if he or she needs assistance up to two (2) times per week.

c. Stand-by assistance means assistance or monitoring to help the client if he or she needs physical assistance up to two (2) times per week.

3. Moderate: score two (2) if the client is unable to perform the majority of the essential components of the function even with an assistive device, and the client requires hands-on and frequent assistance to accomplish the activity.

a. Frequent means the client needs assistance at least three (3) times per week and up to daily.

b. Hands-on assistance means the care provider must physically assist the client in completing the task.

4. Severe: score three (3) if the client is totally unable to perform the function and requires someone to perform the task, or the client requires constant supervision for the task.

C. The need for paid care score shall be based on the frequency of the client's unmet need for paid care and shall be modified by the following factors:

1. Need for paid care shall be scored as zero (0) when those services are provided through another program, agency, or individual.

2. For clients living with others, the need for paid care shall be scored only on the client's needs that are greater than and differentiated from typical household routine and the typical expectation of assistance by family members living in the home.

D. For children age five (5) through eighteen (18) years, functional capacity and need for paid care shall be scored according to age appropriate criteria. Children under the age of 5 shall not be scored and are not eligible to receive Home Care Allowance.

E. The need for paid care scale is as follows:

Score	Frequency	Definition Of Frequency
0	None	Client's needs are met. No need for paid care.
1	Weekly	Client needs paid care up to and including once a week.
2	Daily	Client needs paid care more than once a week and up to once a day, seven days a week.
3	Twice Daily	Client needs paid care two or more times per day at least five days per week.

F. The functional assessment shall be scored on the State Department prescribed form, which shall list each activity of daily living, the functional capacity score and the need for paid care score for each ADL.

3.570.15ACTIVITIES OF DAILY LIVING

A. Activities of daily living (ADL) shall be scored using the functional capacity impairment scale and the need for paid care scale.

B. The activities of daily living are:

1. Critical ADL

a. Transfers: the ability to move between surfaces, such as getting in and out of bed; transferring from a bed to a chair, wheelchair, or walker; moving from a chair or wheelchair to a walker or to a standing position; and the ability to use assistive devices, including prosthetics.

b. Bladder care: the extent to which the client has control of his OR her bladder functions and the ability of the client to accomplish the tasks of toileting, including catheterizing, getting on and off the toilet, changing incontinence products, and cleaning him/herself.

c. Bowel care: the extent to which the client has control of his OR her bowel functions and the ability of the client to accomplish the tasks of toileting, including getting on and off the toilet, changing incontinence products, and cleaning him/herself.

2. Basic ADL

a. Mobility: the ability of the client to ambulate around the home and around essential places outside the home, with or without assistive devices.

b. Dressing: the ability of the client to accomplish all phases of the activities of dressing and undressing, including getting, putting on, fastening, and taking off all items of clothing, braces, and artificial limbs.

c. Bathing: the ability of the client to safely accomplish the task of washing body parts including getting into bathing waters, with or without assistive devices or whether the client requires stand by or hands-on assistance from another person.

d. Hygiene: the ability of the client to maintain personal hygiene other than bathing, including combing hair, brushing teeth, and clipping nails.

e. Eating: the ability to cut food into manageable size pieces, chew, and swallow food, with or without assistive devices.

3. Instrumental ADL

a. Meals: the ability to safely prepare food to meet the basic nutritional requirements of the client, including cutting food, transferring food to cooking vessels and/or dishes, utilizing utensils, using a stove or microwave, and implementing special dietary needs. A child age 5 to 18 years shall not be scored for meals.

b. Housekeeping: the ability to maintain the interior of the client's residence for the purpose of health and safety, such as wiping surfaces, cleaning floors, making a bed, and cleaning dishes. A child age 5 to 18 years shall not be scored for housekeeping.

c. Laundry: the ability to gather and wash soiled clothing and linens; use washing machines and dryers; hang, fold, and put away clean clothing and linens. A child age 5 to 18 years shall not be scored for laundry.

d. Shopping: the ability to purchase goods that are necessary for health and safety. Activities include the ability to make needs known, to make a list, reach for the needed items at the store, ability to estimate or determine the cost of the item, and to move items into the home and put them away. A child age 5 to 18 years shall not be scored for shopping.

4. Supportive ADL

a. Medicine: the ability to manage medications, including knowing the name of the medication, knowing the amount, frequency, and how to take the medicine, understanding the reason for taking it, and understanding possible side effects. A child age 5 to 14 years shall not be scored for medicine.

b. Appointment: the ability to schedule or make an appointment for essential activities, such as doctor visits, meetings with caseworkers, and transportation. A child age 5 to 18 years shall not be scored for appointments.

c. Money: the ability to manage money, such as balancing a check book, writing checks or paying a bill electronically, and ability to understand financial decisions. A child age 5 to 18 years shall not be scored for money.

d. Access: the ability to access resources or services in the community, such as locating the resource/service and completing the process necessary to receive the resource or service. A child age 5 to 18 years shall not be scored for access.

e. Telephone: the ability to use the telephone to communicate essential needs, such as answering the phone in a reasonable time, speaking clearly and loudly enough to be understood, dialing the phone, initiating a conversation, hearing the caller, and placing a call in an emergency. A child age 5 to 12 years shall not be scored for telephone.

3.570.16CARE PLANNING AND CASE MANAGEMENT

A. Home Care Allowance may be used to purchase:

1. Non-skilled assistance with activities of daily living, as defined in Section 3.570.15; and;

2. Electronic monitoring, such as an emergency alert button; and,

3. One-time deep cleaning if a referral is initiated by Adult Protective Services and determined necessary by the SEP.

B. The SEP shall develop a care plan on the State Department prescribed form within ten (10) working days after program eligibility has been determined and prior to the arrangement for services.

1. The care plan shall be:

a. Signed by the client, SEP, and the service provider; and,

b. Reviewed and updated at least once every twelve months; and,

c. Reviewed sooner if there is a change in the client's needs; and,

d. Provided to all parties.

2. Care planning shall include, but not be limited to, the following tasks:

a. Identifying and documenting care plan goals and client choices.

b. Identifying and documenting services, including type, duration and frequency.

c. Arranging for services through a service provider, family member, or other provider of the client's choosing.

1) Providers shall be at least eighteen (18) years of age or older and have the ability to provide appropriate services.

2) The SEP shall negotiate with the client and care provider to arrive at the total number of paid care hours to be provided monthly.

3) The HCA payments shall be made directly to the client or authorized representative who shall pay the provider the agreed upon, authorized amount monthly.

4) No portion of the authorized HCA amount shall be withheld by the client for personal use. The entire HCA authorized amount shall be spent for HCA allowable services.

d. Coordinating service delivery, negotiating with the service provider and the client regarding service provision, and formalizing the provider agreement.

e. Completing program requirements for the authorization of services.

f. Referring the client to community resources, as needed, and attempting to develop resources for the client if a resource is not available within the client's community.

g. Explaining the complaint procedures to the client, as listed on the care plan document.

h. Explaining the client's right to appeal any decision.

3. The SEP shall meet the client's needs, with consideration of the client's choices, using the most cost effective methods available.

a. When services are available to the client at no cost from family, friends, volunteers, or others, these services shall be utilized before the purchase of services, providing these services adequately meet the client's needs.

b. When public dollars must be used to purchase services, the SEP shall assist the client in comparing the cost of services.

c. The SEP shall ensure there is no duplication in services provided by any other public or privately funded services.

d. The SEP shall discuss with the client if other waivers and/or services are more appropriate or beneficial to the client and assess as needed.

C. The SEP shall provide ongoing case management, as follows:

1. Monitoring the quality of care provided to the client.

2. Contacting service providers concerning service coordination, effectiveness, and appropriateness.

3. Reviewing the client's assessment, care plan, and service agreements to include changes in client functioning, service effectiveness, appropriateness, and cost-effectiveness that may require a reassessment or a change in the care plan.

4. Making changes in care plans as appropriate to client needs and/or referring the client to community resources, if appropriate.

5. Providing conflict resolution and/or crisis intervention, as needed.

6. Identifying and contacting appropriate individuals, and resolving any problems or complaints raised by the client or others regarding service delivery.

7. Notifying the appropriate law enforcement and/or child/Adult Protective Services agency of suspected abuse, neglect or exploitation, as required by Sections 18-6.5 108, 19-3-304 and 26-3.1-102, C.R.S.

D. The SEP shall complete a review of the client's current assessment or reassessment and the care plan with the client six months following the assessment or reassessment.

1. The review shall be conducted by telephone, at the client's place of residence, at the place of service, or other appropriate setting as determined by the client's needs.

2. An in-person home visit shall be completed when significant changes in the client's condition are identified.

E. The SEP shall complete an in-person functional reassessment within twelve (12) months of the initial functional assessment and every twelve months thereafter. A reassessment shall be completed sooner if the client's condition changes.

F. Reassessment shall include the following tasks:

1. Reviewing the care plan, service agreement, and provider contract or agreement.

2. Evaluating service effectiveness, quality of care, and appropriateness of services.

3. Verifying continuing financial and program eligibility.

4. Annually, or more often if indicated, completing a new care plan and service agreement.

5. Referring the client to community resources, as needed; and

6. Discussing with the client if a HCPF waiver and/or service is more appropriate or beneficial and assess as needed.

G. The SEP shall update the information provided at the previous assessment or reassessment, utilizing the State Department prescribed form and the HCPF prescribed system. When a new functional assessment is completed a copy shall be sent to the county department within ten (10) working days of the reassessment.

3.570.17DENIALS, DISCONTINUATIONS, AND CASE TRANSFERS

A. The responsibility of the SEP is to determine the functional eligibility of the client. The SEP shall deny or discontinue the client from the HCA program if he or she is determined functionally ineligible and provide timely or adequate notice as required by Section 3.554 .

1. The client shall be informed of his or her appeal rights as outlined in Section 3.587.

2. The client shall be provided appropriate referrals to other community resources within one (1) working day of discontinuation or denial.

3. If the discontinuation or denial is due to functional eligibility, the SEP shall notify the client that he or she must notify the providers on the care plan within one (1) working day of receiving notice from the county department.

4. If the discontinuation or denial is due to financial eligibility, the SEP shall notify the client that he or she must notify all providers on the care plan within one (1) working day of receiving notice from the county department.

5. The SEP shall notify the county department within FIVE (5) working days of discontinuation.

6. The SEP shall prepare for and defend at the state level fair hearing any appeal related to functional denial or discontinuation. The SEP may request assistance and/or testimony from the county department.

B. The responsibility of the county department is to determine the financial eligibility of the client. The county department shall deny or discontinue the client from the HCA program if he or she is determined financially ineligible and provide timely or adequate notice as required by Section 3.554.

1. The client shall be informed of his or her appeal rights as outlined in Section 3.587.

2. The client shall be provided appropriate referrals to other community resources within one (1) working day of discontinuation or denial.

3. The county department shall notify the SEP within FIVE (5) working days of discontinuation.

4. The county department shall prepare for and defend at the state level fair hearing any appeal related to financial denial or discontinuation. The county department may request assistance and/or testimony from the SEP.

C. Following the notice procedures outlined in Section 3.554, denial and/or discontinuation from the HCA program shall occur for the following reasons:

1. Financial and Functional Eligibility: The SEP or county department shall deny or discontinue a client if the client is not financially eligible and/or is not functionally eligible for HCA.

2. Level of Care: The SEP shall deny or discontinue when the client:

a. Does not meet functional capacity score minimum requirements; or,

b. Does not meet need for paid care score criteria.

3. Receipt of Services: The SEP or county department shall deny or discontinue when the client:

a. Has not received services for one month;

b. Has twice refused to schedule an appointment for an initial assessment, six (6)-month review, or reassessment within a thirty (30) consecutive DAY period;

c. Has failed to keep three (3) scheduled appointments within a thirty (30) consecutive day period;

d. Has refused to schedule an appointment for a required visit after the client's case has been transferred to a new SEP or county department;

e. Refuses to use the HCA payment to pay for services or uses the payment for services not identified in the service agreement;

f. Refuses to sign the intake form, care plan, or other documents and forms required to receive services.

4. Facility Status: The SEP or county department shall deny or discontinue when the client:

a. Is a resident of a nursing facility, hospital, or any other long-term care facility; or,

b. Enters a hospital or other long-term care facility for treatment, hospitalization, or rehabilitation that continues for thirty (30) calendar days or more.

5. Service Limitations Related to Safety: The SEP or county department shall deny or discontinue when the client cannot be safely served given the type and/or amount of services available. Evidence of safety concerns include, but are not limited to:

a. The results of an Adult Protective Services assessment that substantiates ongoing risk.

b. A statement from the client's physician attesting to diminished cognitive capacity, debilitating mental health concerns, or ongoing risk.

c. Lack of available and/or appropriate service providers.

d. A functional assessment score indicating a level of need for services in excess of those available under the HCA program.

e. Other available information or evidence that will support the determination that the client's safety is at risk.

6. Service Limitations Related to Cost Effectiveness: The SEP or county department shall deny or discontinue when other more cost effective alternatives are available to meet the client's needs.

7. Living Arrangements: The SEP or county department shall deny or discontinue when the client is residing anywhere other than his OR her home.

a. The SEP may continue to authorize services while a resident is on medical or non-medical leave.

b. Combined leave shall not exceed a total of forty-two (42) days in a twelve (12) month period beginning with the date the client was approved for the HCA program.

8. Move Out of State: The SEP or county department shall deny or discontinue when the client has moved out of state.

a. Discontinuation shall be effective the day after the date of the move.

b. Clients who leave the State on a temporary basis with the intent to return to Colorado within thirty (30) calendar days shall not be discontinued. If the client fails to return to Colorado the client shall be discontinued on day thirty one (31).

9. Voluntary Withdrawal from the Program: The SEP or county shall deny or discontinue when the client requests withdrawal from the HCA program.

10. Death: The SEP or county shall discontinue the HCA program effective the day after the client's date of death. No notice of discontinuation shall be sent.

D. The SEP shall complete the following procedures to transfer an HCA client to a new county department:

1. The SEP shall notify the county department of the client's plans to relocate to another county and the date of transfer.

2. If the client's current service providers do not provide services in the area where the client is relocating, the SEP shall make arrangements, in consultation with the client, for new service providers.

E. The SEP shall complete the following procedures to transfer an HCA client to a new SEP:

1. The transferring SEP shall contact the receiving SEP by telephone or email to give notification that the client is planning to transfer, to negotiate a transfer date, and to provide information.

2. The transferring SEP shall forward copies of the client's case records, including forms required for the HCA program, to the receiving SEP prior to the relocation, if possible, but in no case later than five (5) working days after the client's relocation.

3. The receiving SEP shall complete an in-person meeting with the client and an assessment and case summary update within ten (10) working days after notification of the client's relocation.

4. The receiving SEP shall review the care plan and the assessment tool, revise as necessary, and coordinate services and providers.

3.570.18COUNTY DEPARTMENT AND SINGLE ENTRY POINT (SEP) REQUIREMENTS AND RESPONSIBILITIES

A. The county department shall:

1. Ensure all requirements of the county department are implemented, as appropriate for the HCA program, related to:

a. General requirements, as outlined in Section 3.520; and,

b. Old Age Pension, as outlined in Section 3.530; and,

c. Aid to the Needy Disabled State Only and Colorado Supplement, as outlined in Section 3.540 and 3.546; and,

d. Financial redetermination, as outlined in Section 3.550.

2. Determine financial eligibility for HCA in the statewide automated system and update any changes in the case record.

3. Notify the SEP in writing:

a. Within five (5) working days of determining HCA eligibility.

b. Within five (5) working days after the eligibility worker determines that the client is no longer financially eligible for HCA.

c. Within one (1) working day when the client has filed a written appeal with the county department.

d. Within one (1) working day when the client has withdrawn the appeal or a final agency decision has been entered.

4. Respond to requests for information from the SEP within ten (10) working days.

B. The SEP shall:

1. Provide intake, screening, and referral activities, as follows:

a. Determine the appropriateness of a referral for a client assessment.

1) If appropriate, complete intake activities within two (2) working days of the referral.

2) Obtain the client's or client's authorized representative's signature on the intake form.

3) Complete the HCA functional assessment within thirty (30) calendar days of referral.

b. Provide the client information and referral to other agencies, as needed.

2. Identify potential payment source(s), including the availability of private funding:

a. Refer the client to the county department to complete an application; or,

b. Refer the client to another community resource that can assist in completing the application; or,

c. Verify the client's ability to private pay for services.

3. Complete a functional assessment when the county department provides written notification that the client has requested HCA and is receiving or has submitted an application for Old Age Pension (OAP), Aid to the Needy Disabled Colorado Supplement (AND-CS), Aid to the Needy Disabled State Only (AND-SO), or the client is receiving Supplemental Security Income (SSI).

a. If the client is being discharged from a hospital or nursing facility, the SEP shall complete the functional assessment regardless of whether an application date for State assistance or Medicaid has been provided by the county department.

b. The SEP shall complete the functional assessment within two (2) working days after notification when a client is being transferred from a hospital to the HCA program.

c. The SEP shall complete the functional assessment within five (5) working days after notification when a client is being transferred from a nursing facility to the HCA program.

d. The SEP shall complete the functional assessment within ten (10) working days after notification for all other clients. However, the SEP shall have a procedure for prioritizing urgent referrals.

4. Document all case information.

a. Documentation of contacts and case management activities shall be entered into the HCPF prescribed system within five (5) working days of the contact or activity.

b. All information related to intake, assessment, and care planning shall be thoroughly documented within ten (10) working days of the intake, assessment or care planning using State Department prescribed forms and the HCPF prescribed system.

c. Additional documentation that cannot be entered into the HCPF prescribed system shall be maintained in the case file.

5. Notify clients of their program status using the State Department prescribed form at the time of initial eligibility, when there is a significant change in the client's payment or services, when an adverse action is taken, or at the time of discontinuation.

6. Notify the county department in writing:

a. Within five (5) working days of determining HCA functional eligibility.

b. Within five (5) working days after the SEP determines that the client is no longer functionally eligible for HCA.

c. Within one (1) working day when the client has filed a written appeal with the SEP.

d. Within one (1) working day when the client has withdrawn the appeal or a final agency decision has been entered.

7. Respond to requests for information from the county department within ten (10) working days.

8. Notify the client, at the time of his or her application and at the time of reassessment or discontinuation of the right to request a state level fair hearing before an Administrative Law Judge as outlined in Section 3.587, and to appeal adverse actions of the SEP or county department.

9. Inform the client's Adult Protective Services caseworker, if applicable, of the client's status. The case manager shall participate in mutual staffing of the client's case.

10. Immediately report to the Colorado Department of Public Health and Environment any congregate facility, with three (3) or more residents, that is not licensed.

11. Immediately report to the county department any information that indicates an overpayment, incorrect payment, or misuse of any HCA benefit, and shall cooperate with the county department in any subsequent recovery process.

12. Be subject to routine quality control, program monitoring, and contract management to minimally include:

a. Targeted review of the HCPF prescribed system documentation;

b. Case file review;

c. Targeted program review conducted via phone, email, or survey;

d. Onsite program review;

e. A performance improvement plan to correct areas of identified non-compliance; and,

f. Contract sanctions when the SEP fails to implement a performance improvement plan.

3.570.4BURIAL ASSISTANCE PROGRAM

3.570.41PURPOSE OF PROGRAM

Burial benefits are available to eligible clients to cover reasonable and necessary costs for burial services.

3.570.42DEFINITIONS

"Burial benefit" means the State Department program to pay all or a portion of the cost of funeral, burial, or cremation services for certain deceased clients.

"Burial funds" means the funds authorized by the county department under the burial benefit.

"Burial plot" means the client's final resting place, whether a cemetery plot, vault, or crematorium niche.

"Burial services" means those services provided as part of funeral, burial, or cremation services, including:

A. Transportation of the body from the place of death to a funeral home or other storage facility, and/or from the funeral home to the funeral/memorial site, and/or to the burial plot;

B. Storage of the body prior to final disposition and/or storage of the cremated remains for no more than one hundred twenty (120) days, in those cases where the remains are not buried and are not claimed by the client's family or friends;

C. Embalming, where necessary for preservation of the body and/or preparation of the body for the casket or for cremation;

D. Purchase of a casket or of an urn or other receptacle for the cremated remains;

E. Purchase of a gravesite, vault, vault liner, or crematorium niche;

F. Purchase and placement of the grave marker and/or of perpetual care of the gravesite, vault, or crematorium niche;

G. Funeral or memorial service;

H. Cremation of the body;

I. Burial or internment of the body or cremated remains in a burial plot, vault, or crematorium niche;

J. Any other items that are incidental to burial services.

"Contributions" means any monetary payment or donation made directly to the service provider(s) by a non-responsible person to defray the expenses of a deceased public assistance or medical assistance recipient's funeral, cremation, or burial, or any combination thereof.

"Legally responsible person(s)" means a person who is the decedent's spouse or the decedent's parent if the decedent is an unemancipated minor who is under the age of eighteen; and bears legal responsibility for the charges associated with the decedent's funeral, cremation, or burial expenses.

"Nonresponsible person" means one of the following who makes a contribution to the charges for burial services:

A. A relative of the decedent who is not a legally responsible person; or,

B. Any other person or party.

3.570.43ELIGIBILITY AND DETERMINATION FOR BURIAL ASSISTANCE

A. A burial benefit shall be available to cover all or part of reasonable and necessary costs for burial services when:

1. A deceased client was receiving Old Age Pension (OAP), Aid to the Needy Disabled (AND-SO OR AND-CS), Home Care Allowance, and/or Colorado Medicaid assistance at the time of death; and,

2. The deceased client's estate is insufficient to pay all or part of the burial services; and,

3. The resources of the legally responsible person(s) for the support of the deceased client are insufficient, even with contributions from the client's estate, to enable the legally responsible person(s) to pay all or part of such expenses; and,

4. The total cost for all burial services does not total more than two thousand five hundred dollars ($2,500), except that the cost of a burial plot shall not be included in the $2,500 maximum cost limit when:

a. The client has a prepaid burial plot valued at two thousand dollars ($2,000) or less at the time of purchase; or,

b. A burial plot was purchased by someone other than the deceased client and donated to the deceased client; and,

B. The total burial benefit shall not exceed the current burial benefit rate.

1. Effective March 1, 2020, the burial benefit shall not exceed one thousand five hundred dollars ($1,500).

2. The reimbursement rate shall be adjusted by the State Department as needed to stay within the available appropriations. There shall be no appeal granted for this adjustment.

C. When assistance for funeral, burial, or cremation services is requested within thirty (30) days from the date of death on behalf of a deceased client as described in Section 3.570.43.A, by any interested party; an application requesting a burial benefit shall be completed and submitted to the county department for eligibility determination. Requests made after 30 days shall be evaluated by the county department and an extension may be given if good cause exists, not to exceed one (1) year from the date of death. Good cause shall exist for any application filed within one year of the date of death of the client, if the client's date of death preceded the effective date of this rule. The client's family or friends, or the county department when there are no known family or friends, shall make arrangements for disposition of the client's body in a reasonable, dignified manner which approximates the wishes and the religious and cultural preferences of the client or family, to the extent possible within the burial benefit rules and burial grant payment funds.

1. The county department shall ensure that a choice of disposition by the client is made in writing. The choice of disposition may be made on the client's most recent application for benefits, in the client's will, or by any other document which the county department deems credible. If there are conflicting documents expressing the client's choice of disposition, the county department shall utilize the most recent document containing the client's choice. If the client has not expressed a choice of disposition, the client's disposition shall be determined respectively by the client's spouse, adult children, parents, or siblings.

2. The county department shall coordinate with the client's family or interested parties to explain the burial benefit rules, including:

a. Options in the event the client's or family's burial preferences cannot be met within the limitations of the burial rules or burial grant payment maximum; and,

b. If the family's burial preference is in opposition to the client's preference, as noted on the client's most recent application for benefits or other documentation, the burial grant payment shall be used to meet the client's preference, unless all options for meeting that preference have been exhausted within the limitations of the burial grant payment; and,

c. The legally responsible person's responsibility to pay the cost of burial services that exceed the approved burial grant payment; and,

d. That voluntary contributions from family, friends, or other interested parties, may be used to cover some or all of the legally responsible person's costs that exceed the approved burial grant payment up to the maximum cost limit.

3. The county department shall use the following procedures when the deceased client's burial preferences are unknown and a family member cannot be located:

a. If a family member has not been located within twenty-four hours after the client dies, the county department shall have the body refrigerated or embalmed.

b. If a family member has not been located within seven (7) days, the county department shall make the determination to bury or cremate the body based on the best option available.

c. The county department shall complete and send written authorization to the appropriate funeral home or crematorium.

D. The county department shall reduce the burial grant payment by applying the following monies toward the full burial costs in the order listed:

1. First, subtract monies due from any insurance policy of the deceased client to a legally responsible person or any other person who makes a contribution to burial services and is named as beneficiary or a joint beneficiary; then if costs remain,

2. Subtract the value of the deceased client's estate as of the date of death that are available, including any cash or property of any kind which the deceased client owned or proportionate share of resources held in joint ownership at the time of death; then if costs remain,

3. Subtract monies from the legally responsible person(s) for the client, as follows:

a. Social Security lump sum death benefits payable to a legally responsible person shall be exempt.

b. If the legally responsible person(s) has resources below the SSI resource limit of $2,000 for an individual or $3,000 for a couple any resources would not be used to reduce the burial grant payment. These limits are consistent with the provisions of Federal Regulations found at 20 CFR 416.1205 (2019), which are herein incorporated by reference. This rule does not contain any later amendments or editions. These regulations are available for no cost at https://www.ecfr.gov/. These regulations are also available for public inspection and copying at the Colorado Department of Human Services, Director of the Employment and Benefits Division, 1575 Sherman Street, Denver, Colorado, 80203, or at any State publications library during regular business hours.

1) If the legally responsible person is the widow(er), the individual resource limit shall apply.

2) The legally responsible person(s) may voluntarily contribute monies toward the cost of the burial services.

c. If the legally responsible person(s) has resources over the SSI limit, the amount of resources over the limit shall be used to reduce the burial grant payment; then if costs remain,

4. The county department shall issue a written authorization for the amount of the burial grant payment, up to the burial grant payment limit, as set forth in Section 3.570.43.B.1.

E. Once the application and choice of burial services is determined, the family or county department shall contact the appropriate provider(s) to obtain a written estimate of the provider's proposed charges for burial services. If more than one provider is involved, a separate written estimate from each provider shall be obtained.

F. Once the proposal(s) from the provider(s) is received, the county department shall determine if a burial grant payment is appropriate.

1. If the combined charges from the provider(s) exceed two thousand five hundred dollars ($2,500), no burial grant payment shall be paid.

2. The county department shall allow the provider(s) to resubmit a written estimate within ten (10) calendar days of notification that the charges exceeded the burial grant payment maximum.

G. All payments from a decedent's estate, payments from legally responsible persons, and contributions from any other person persons who make a contribution to burial services shall be paid directly to the provider(s) of services. After the provision of all services, the providers shall bill the county department directly for reimbursement for appropriate costs that have not been covered by the resources from or contributions made by the decedent's estate, legally responsible persons, or any other person persons who make a contribution to burial services. The county department shall reimburse the appropriate providers directly, based upon the statement of agreement.

H. The county department of residence of the deceased client shall authorize the approved burial grant payment through the statewide automated system. The burial grant payment shall be paid directly to the provider(s). The burial application must be processed as soon as possible but no later than thirty (30) days from submission.

I. The county department shall have a statement of agreement between the providers, which ensures that the distribution of burial grant payment is proportional to burial services provided or as the providers otherwise determine. The agreement shall be signed by all provider(s) and shall be approved and signed by the county department before the burial grant payment is authorized in the statewide automated system.

J. The county department will seek recovery of resources if:

1. The resource was reported to the funeral director after the deadline date, and the funeral director does not collect from them.

2. The resource becomes available only after the county department has paid for burial services.

3.570.5SUPPORTIVE PAYMENTS (Effective 7/1/2022)

3.570.51PURPOSE

A. The purpose of the disaster assistance payment is to provide disaster assistance to eligible clients to mitigate needs and/or expenses due to a county, Governor, or federally declared disaster. The payment shall not exceed two thousand dollars ($2,000) per client, per disaster.

B. The disaster assistance payment period begins when :

1. A county, and/or;

2. Governor, and/or;

3. Federal government declares a disaster.

C. The disaster assistance payment period ends when there is no longer:

1. A county, and/or;

2. Governor, and/or;

3. Federally declared disaster.

D. In cases where the effects of the disaster appear after the disaster declaration has been rescinded, the client may petition for disaster assistance which may be granted at the county director's or director designee's discretion.

3.570.52ELIGIBILITY

In order to be eligible for disaster assistance, the client must:

A. Be approved for or receiving a grant payment during the time of the county, Governor, or federally declared disaster.

B. Have an emergent need related to the disaster that could include, but is not limited to: a threat to health or safety, lack of food, clothing, shelter, transportation, personal care or medical care, or other unmet expenses.

C. Request disaster assistance either verbally or in writing to the county department. Counties have the option to utilize a state prescribed form for a disaster assistance request.

D. Nothing precludes the county from making additional payments to the client for the disaster through a general assistance program or other resources. This payment shall also not preclude an individual from accessing additional resources that are unrelated to the disaster.

3.750.53COUNTY DEPARTMENT RESPONSIBILITIES

When the county receives the disaster assistance request they shall:

A. Review the disaster assistance request and determine what the client may potentially be eligible for based on the request.

B. Only request verification related to the client's request for disaster assistance if the county considers the request questionable.

C. Assess the client's needs related to the disaster assistance request and make additional referrals to the client and inform them of other potential assistance that may be available.

D. Not request documentation to verify how the client has used their disaster assistance payment.

E. Make a determination of eligibility for disaster assistance the same day as the determination of eligibility for adult financial grant payment if the client is pending for adult financial assistance at the time of the request for disaster assistance.

F. Make a determination of disaster assistance eligibility within five business days if already active on adult financial assistance.

G. Notify the client of approval or denial of disaster assistance in writing through the statewide automated system.

9 CCR 2503-5-3.570

37 CR 13, July 10, 2014, effective 8/1/2014

37 CR 17, September 10, 2014, effective 10/1/2014

38 CR 04, February 25, 2015, effective 3/20/2015

38 CR 04, February 25, 2015, effective 4/1/2015

38 CR 09, May 10, 2015, effective 6/1/2015

38 CR 15, August 10, 2015, effective 9/1/2015

38 CR 23, December 10, 2015, effective 1/1/2016

39 CR 17, September 10, 2016, effective 10/1/2016

40 CR 03, February 10, 2017, effective 2/14/2017

41 CR 05, March 10, 2018, effective 4/1/2018

41 CR 15, August 10, 2018, effective 9/1/2018

41 CR 19, October 10, 2018, effective 11/1/2018

42 CR 01, January 10, 2019, effective 2/1/2019

43 CR 01, January 10, 2020, effective 1/1/2020

43 CR 03, February 10, 2020, effective 3/1/2020

43 CR 11, June 10, 2020, effective 7/1/2020

43 CR 23, December 10, 2020, effective 1/1/2021

44 CR 03, February 10, 2021, effective 3/2/2021

44 CR 13, July 10, 2021, effective 8/1/2021

45 CR 03, February 10, 2022, effective 3/2/2022

45 CR 05, March 10, 2022, effective 4/1/2022

45 CR 13, July 10, 2022, effective 7/1/2022

45 CR 15, August 10, 2022, effective 8/10/2022

45 CR 15, August 10, 2022, effective 8/30/2022

46 CR 01, January 10, 2023, effective 12/10/2022

46 CR 01, January 10, 2023, effective 1/1/2023

46 CR 03, February 10, 2022, effective 3/2/2023