8.508.20DEFINITIONSA. Abuse: As defined at § 16-22-102(9) C.R.S., § 19-1-103, C.R.S., § 25.5-10-202(1) (a) -(c), C.R.S., and § 26.3.1-101 C.R.S.B. Adverse Action: A denial, reduction, termination, or suspension from a Long-Term Services and Supports (LTSS) program or service.C. Applicant: A child or youth who is seeking a Long-Term Care eligibility determination and who has not affirmatively declined to apply for Medicaid or participate in an assessment.D. Assessment: As defined in Section 8.390.1 DEFINITIONS.E. Caretaker: As defined at Section 25.5-10-202 (1.6)(a)-(c), C.R.S.F. Caretaker neglect: As defined at Section 25.5-10-202 (1.8)(a)-(c), C.R.S.G. Case Management Agency (CMA): A public or private not-for-profit for-profit agency that meets all applicable state and federal requirements and is certified by the Department to provide case management services for Home and Community-based Services waivers pursuant to sections 25.5-10-209.5 C.R.S. and pursuant to a provider participation agreement with the state department.H. Child Placement Agency: As defined at 12 CCR 2509-8; Section 7.701.2 (F).I. Client: A child or youth who meets long-term services and supports eligibility requirements and has been approved for and agreed to receive Home and Community-based Services (HCBS)J. Client Representative: A person who is designated to act on the Client's behalf. A Client Representative may be: (a) a legal representative including, but not limited to a court-appointed guardian, or a parent of a minor child; or (b) an individual, family member or friend selected by the Client to speak for an/or act on the Client's behalf.K. Community Centered Board: A private corporation, for-profit or not-for-profit that is designated pursuant to Section 25.5-10-209, C.R.S., responsible for, but not limited to conducting Developmental Disability determinations, waiting list management Level of Care Evaluations for Home and Community-based Service waivers specific to individuals with intellectual and developmental disabilities, and management of state funded programs for individuals with intellectual and developmental disabilities.L. Complex Behavior: Behavior that occurs related to a diagnosis by a licensed physician, psychiatrist, or psychologist that includes one or more substantial disorders of the cognitive, volitional or emotional process that grossly impairs judgment or capacity to recognize reality or to control behavior.M. Complex Medical Needs: Needs that occur as a result of a chronic medical condition as diagnosed by a licensed physician that has lasted or is expected to last at least twelve (12) months, requires skilled care, and that without intervention may result in a severely life altering condition.N. Cost Containment: Limiting the cost of providing care in the community to less than or equal to the cost of providing care in an institutional setting based on the average aggregate amount. The cost of providing care in the community shall include the cost of providing Home and Community-based Services, and Medicaid State Plan benefits including long- term home health services and targeted case management.O. Criminal Activity: A criminal offense that is committed by a person; a violation of parole or probation; and any criminal offense that is committed by a person receiving services that results in immediate incarceration.P. Crisis: An event, series of events, and/or state of being greater than normal severity for the Client and/or family that becomes outside the manageable range for the Client and/or their family and poses a danger to self, family, and/or the community. Crisis may be self-identified, family identified, and/or identified by an outside party.Q. Critical Incident: Incidents of Mistreatment; Abuse; Neglect; Exploitation, Criminal Activity; Damage to Client's Property/Theft; Death unexpected or expected; Injury/Illness to Client; Medication Mismanagement; Missing Person; Unsafe Housing/Displacement; and/or Other Serious Issues.R. Department: The Colorado Department of Health Care Policy and Financing the single state Medicaid agency.S. Damage to Client's Property/Theft: Deliberate damage, destruction, theft or use a Client's belongings or money. If the incident involves Mistreatment by a Caretaker that results in damage tor Client's property or theft in the incident shall be listed as Mistreatment. Developmental Delay: A child who is:
1. Birth up to age five (5) and has a developmental delay defined as the existence of at least one of the following measurements:i. Equivalence of twenty-five percent (25%) or greater delay in one (1) or more of the five domains of development when compared with chronological age;ii. Equivalence of 1.5 standard deviations or more below the mean in one (1) or more of the five domains of development;iii. Has an established condition defined as a diagnosed physical or mental condition that, as determined by a qualified health professional utilizing appropriate diagnostic methods and procedures, has a high probability of resulting in significant delays in development, or2. Birth up to age three (3) who lives with a parent who has been determined to have a developmental disability by a CCB.T. Early and Periodic Screening Diagnosis and Treatment (EPSDT): As defined in Section 8.280.1.U. Exploitation: As defined in Sections 25.5-10-202 (15.5)(a)-(d) and 26.3.1-101 C.R.S.V. Extraordinary Needs: A level of care due to Complex Behavior and/or Medical Support Needs that is provided in a residential child care facility or that is provided through community-based programs, and without such care, would place a child at risk of unwarranted child welfare involvement or other system involvement.W. Family: As defined at Section 25.5-10-202(16)(a)(I) -(IV)(b), C.R.S.X. Foster Care Home: A family care home providing 24-hour care for a child or children and certified by either a County Department of Social/Human Services or a child placement agency. A Foster Care Home, for the purposes of this waiver, shall not include a family member as defined in Section 25.10-202 (16)(a)(I)-(IV)(b), C.R.S.Y. Guardian: An individual at least twenty-one years of age, resident or non-resident, who has qualified as a guardian of a minor or incapacitated person pursuant to appointment by a court. Guardianship may include a limited, emergency, and temporary substitute court appointed guardian but not guardian ad litem.Z.. Guardian ad litem or GAL: A person appointed by a court to act in the best interests of a child involved in a proceeding under Title 19, C.R.S., or the "School Attendance Law of 1963", set forth in Article 33 of Title 22, C.R.S.AA. Harmful Act: as defined at Section 25.5-10-202 (18.5) and 26.3.1-101 C.R.S.BB. Home and Community-based Services (HCBS) Waivers: Services and supports authorized through a 1915 (c) waiver of the Social Security Act and provided in community settings to a Client who requires a level of institutional care that would otherwise be provided in a hospital, nursing facility or intermediate care facility for individuals with intellectual disabilities (ICF-IID).CC. Increased Risk Factors: Situations or events that when occur at a certain frequency or pattern historically have led to Crisis.DD. Informed Consent: An assent that is expressed in writing, freely given, and preceded by the following: 1. A fair explanation of the procedures to be followed, including an identification of those which are experimental;2. A description of the attendant discomforts and risks;3. A description of the expected benefits;4. A disclosure of appropriate alternative procedures together with an explanation of the respective benefits, discomforts and risks;5. An offer to answer any inquiries regarding the procedure(s);6. An instruction that the person giving consent is free to withdraw such consent and discontinue participation in the project or activity at any time; and,7. A statement that withholding or withdrawal of consent shall not prejudice future availability of services and supports.EE. Injury/Illness to Client: An injury or illness that requires treatment beyond first aid which includes lacerations requiring stitches or staples, fractures, dislocations, loss of limb, serious burns, and skin wounds; an injury or illness requiring immediate emergency medical treatment to preserve life or limb; an emergency medical treatment that results in admission to the hospital; and a psychiatric crisis resulting in unplanned hospitalization.FF. Institution: A hospital, nursing facility, or ICF-IID for which the Department makes Medicaid payments under the State Plan.GG. Intellectual and Developmental Disability: A disability that manifests before the person reaches twenty-two (22) years of age, that constitutes a substantial disability to the affected person, and that is attributable to an intellectual and developmental disability or related conditions, including Prader-Willi syndrome, cerebral palsy, epilepsy, autism, or other neurological conditions when the condition or conditions result in impairment of general intellectual functioning or adaptive behavior similar to that of a person with an intellectual and developmental disability. Unless otherwise specifically stated, the federal definition of "developmental disability" found in 42 U.S.C. sec. 15001 et seq., does not apply. "Impairment of general intellectual functioning" The person has been determined to have an intellectual quotient equivalent which is two or more standard deviations below the mean (70 or less assuming a scale with a mean of 100 and a standard deviation of 15), as measured by an instrument which is standardized, appropriate to the nature of the person's disability, and administered by a qualified professional. the standard error of measurement of the instrument should be considered when determining the intellectual quotient equivalent. when an individual's general intellectual functioning cannot be measured by a standardized instrument, then the assessment of a qualified professional shall be used.
"Adaptive behavior similar to that of a person with intellectual and developmental disabilities" The person has overall adaptive behavior which is two or more standard deviations below the mean in two or more skill areas (communication, self-care, home living, social skills, community use, self-direction, health and safety, functional academics, leisure, and work), as measured by an instrument which is standardized, appropriate to the person's living environment, and administered and clinically determined by a qualified professional. These adaptive behavior limitations are a direct result of, or are significantly influenced by, the person's substantial intellectual deficits and may not be attributable to only a physical or sensory impairment or mental illness.
"Substantial intellectual deficits" An intellectual quotient that is between 71 and 75 assuming a scale with a mean of 100 and a standard deviation of 15, as measured by an instrument which is standardized, appropriate to the nature of the person's disability, and administered by a qualified professional. the standard error of measurement of the instrument should be considered when determining the intellectual quotient equivalent.
HH. Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF-IID): A publicly or privately-operated facility that provides health and habilitation services to a Client with intellectual or developmental disabilities or related conditions.II. Kin: As defined in 12 CCR 2509-1, Section 7.000.2.A.JJ. Kinship Foster Care Home: As defined in 12 CCR 2509-1, Section 7.000.2.A.KK. Level of Care (LOC): The specified minimum amount of assistance a Client must require in order to receive services in an institutional setting under the Medicaid State Plan.LL. Level of Care Eligibility Determination: As defined in Section 8.390.1.MM. Level of Care Eligibility Determination Screen: As defined in Section 8.390.1.NN. Licensed Child Care Center (less than 24 hours): As defined in Section 26-6-102(5), C.R.S. and as described in 12 CCR 2509-8; Section 7.701.OO. Licensed Medical Professional: A physician, physician assistant, registered nurse, and advanced practice nurse. Long-Term Services and Supports (LTSS): The services and supports used by Clients of all ages with functional limitations and chronic illnesses who need assistance to perform routine daily activities such as bathing, dressing, preparing meals, and administering medications.PP. Medicaid Eligible: The Applicant or Client meets the criteria for Medicaid benefits based on the financial determination and disability determination.QQ. Medicaid State Plan: The federally approved document that specifies the eligibility groups that a state serves through its Medicaid program, the benefits that the state covers, and how the state addresses additional federal Medicaid statutory requirements concerning the operation of its Medicaid program.RR. Medication Mis-Management: Issues with medication dosage, scheduling, timing, set-up, compliance and administration or monitoring which results in harm or an adverse effect which necessitates medical care.SS. Missing Person: A waiver participant is not immediately found, their safety is at serious risk, or there is a risk to public safety.TT. "Mistreated" or "Mistreatment": As defined at Section 25.5-10-202 (29.5)(a)-(d) and 26.3.1-101.UU. Natural Supports: Unpaid informal relationships that provide assistance and occur in the Client's everyday life such as, but not limited to, community supports and relationships with family members, friends, co-workers, neighbors and acquaintances.VV. Other Serious Issues: Incidents that do not fall into one of the Critical Incident categories.WW. Predictive Risk Factors: Known situations, events, and characteristics that indicate a greater or lesser likelihood of success of Crisis interventions.XX. Prior Authorization: Approval for an item or service that is obtained in advance either from the Department, a state fiscal agent or the CMA.YY. Professional: Any person, not including family, performing an occupation that is regulated by the State of Colorado and requires state licensure and/or certification.ZZ. Professional Medical Information Page (PMIP): as defined in Section 8.390.1 DEFINITIONS.AAA. Relative: A person related to the Client by blood, marriage, adoption or common law marriage.BBB. Residential Child Care Facility: As defined in 12 CCR 2509-8, Section 7.705.1.CCC. Retrospective Review: The Department's review after services and supports are provided to ensure the Client received services according to the PCSP and standards of economy, efficiency and quality of service.DDD. Separation: The restriction of a Client for a period of time to a designated area from which the is not physically prevented from leaving, for the purpose of providing the Client an opportunity to regain self-control.EEE. Service Provider: A Specialized Group Facility, Residential Child Care Facility, Foster Care Home, Kinship Foster Care Home, Child Placement Agency, Licensed Child Care Facility (non-24 hours), and/or Medicaid enrolled provider.FFF. Person-Centered Support Plan (PCSP): Defined in Section 8.390.1 DEFINITIONS.GGG. Person-Centered Support Planning (PCSP): Defined in Section 8.390.1 DEFINITIONS.HHH. Specialized Group Facility: As defined in 12 CCR 2509-8; Section 7.701.2(B).III. Support: Any task performed for the Client where learning is secondary or incidental to the task itself or an adaptation is provided.JJJ. Support Level: A numeric value determined by the Support Need Level Assessment that places Clients into groups with other Clients who have similar overall support needs.KKK. Support Need Level Assessment: The standardized assessment tool used to identify and measure the support requirements for HCBS-CHRP waiver participants.LLL. Targeted Case Management (TCM): Has the same meaning as in Section 8.761.MMM. Third Party Resources: Services and supports that a Client may receive from a variety of programs and funding sources beyond Natural Supports or Medicaid. This may include, but is not limited to community resources, services provided through private insurance, non-profit services and other government programs.NNN. Unsafe Housing/Displacement: An individual residing in an unsafe living condition due to a natural event (such as fire or flood) or environmental hazard (such as infestation) and is at risk of eviction or homelessness.OOO. Waiver Service: Optional services defined in the current federally approved waivers and do not include Medicaid State Plan benefits.PPP. Wraparound Facilitator: A person who has a bachelor's degree in a human behavioral science or related field of study and is certified in a wraparound training program. Experience working with LTSS populations in a private or public social services agency may substitute for the bachelor's degree on a year for year basis. When using a combination of experience and education to qualify, the education must have a strong emphasis in a human behavioral science field. The wraparound certification must include training in the following: Trauma informed care.
Youth mental health first aid.
Crisis supports and planning.
Positive Behavior Supports, behavior intervention, and de-escalation techniques.
Cultural and linguistic competency.
Family and youth serving systems.
Family engagement.
Child and adolescent development.
Accessing community resources and services.
Conflict resolution.
Intellectual and developmental disabilities.
Mental health topics and services.
Substance abuse topics and services.
Psychotropic medications.
Motivational interviewing.
Prevention, detection, and reporting of Mistreatment, Abuse, Neglect, and Exploitation.
QQQ. Wraparound Transition Plan: A single plan that incorporates all relevant supports, services, strategies, and goals from other service/treatment plans in place and supports a Client and his or her family, including a transition to the family home after out of home placement.RRR. Wraparound Plan: A single plan that incorporates all relevant supports, services, strategies, and goals from other service/treatment plans in place and supports a Client and his or her family, including a plan to maintain stabilization, prevent Crisis, and/or for de-escalation of Crisis situations.SSS. Wraparound Support Team: Case managers, Licensed Medical Professionals, behavioral health professionals, therapeutic support professionals, representatives from education, and other relevant people involved in the support/treating the Client and his or her family.TTT. Wraparound Transition Team: Case managers, Licensed Medical Professionals, behavioral health professionals, therapeutic support professionals, representatives from education, and other relevant people involved in the support/treating the Client and his or her family.