10 Colo. Code Regs. § 2505-10-8.555

Current through Register Vol. 47, No. 24, December 25, 2024

Section 10 CCR 2505-10-8.555 - Money Follows the Person (MFP) Demonstration

8.555.1Program Overview

8.555.1.AProgram Definition, Authority, and Scope

1. Program Definition

a. Money Follows the Person is a federal grant that supports state strategies to rebalance their long-term services and supports (LTSS) systems from institutional to community-based care. MFP plays a key role in LTSS rebalancing efforts under the Medicaid program. The program provides flexible funding opportunities to help states develop and test the necessary processes, tools, and infrastructure to advance LTSS system reform and to support successful transitions from institutional to community-based settings for individuals eligible for Medicaid LTSS. The model demonstrates the likely impact of new methods of service delivery, coverage of new types of service, and new payment approaches to promote the objective of the Medicaid program.

2. Legal Authority

a. The federal authority for the MFP demonstration is section 6071 of the Deficit Reduction Act of 2005 (DRA). Section 6071 of the DRA has been amended by: section 2403 of Patient Protection and Affordable Care Act; section 2 of the Medicaid Extenders Act of 2019; section 5 of the Medicaid Services Investment and Accountability Act of 2019; section 4 of the Sustaining Excellence in Medicaid Act of 2019; section 205 of the Further Consolidated Appropriations Act, 2020 (CAA); section 3811 of the Coronavirus Aid, Relief, and Economic Security Act, 2020; section 2301 of the Continuing Appropriations Act, 2021 and Other Extensions Act; section 1107 of the Further Continuing Appropriations Act, 2021, and Other Extensions Act; and section 204 of the Consolidated Appropriations Act, 2021 (CAA).

b. MFP is designed to complement the services offered through the Home and Community-Based Services (HCBS) waivers authorized through Section 1915(c) of the Social Security Act (42 U.S.C. § 1396n).

c. The State Authority for the Rule is in C.R.S. § 25.5-6-1501(6).

3. Scope and Purpose

a. The MFP program assists members residing in qualified institutions with exploring their community-based options for long term supports and services; facilitates the transition of members to a community setting so long as the right services and supports can be arranged in the community to ensure the health, welfare, and safety of the member; and provides enhanced services and supports through willing and qualified providers.

b. The MFP program strengthens the transition process for members of qualified institutions and provides additional support and services for a successful transition. These additional supports and services fall into the categories of demonstration services or supplemental services.

c. Demonstration Assurances:

i. Services will be made available throughout the entirety of the demonstration and last for 365 calendar days, 366 days during a leap year if applicable, following discharge to a qualified residence.

ii. Services offered under the demonstration will not duplicate any existing benefits, and adequate services definitions will create role clarity for those involved in the processes.

iii. Outreach and training will be provided to build awareness of the services offered under the demonstration to include program goals, documentation, and quality oversight.

iv. Successful completion of the demonstration will include authorization of HCBS services needed for continuity of care following the demonstration period.

8.555.1.BDefinitions

1. Case Management means the Assessment of an individual seeking or receiving Long-Term Services and Supports' needs, the development and implementation of a Person-Centered Support Plan for such individual, Referral and related activities, the coordination and monitoring of long-term service delivery, the evaluation of service effectiveness, and the periodic Reassessment of such individual's needs and collaboration with other entities impacting the Members' HCBS, health and welfare.

2. Demonstration Services for the purposes of the MFP demonstration means Targeted Case Management - Transition Coordination (TCM-TC) where support will be available to members upon confirmation of member eligibility and for 365 calendar days following discharge from the qualified institution. Need for demonstration services will be identified by the TCM-TC Community Needs and Preference Assessment and Risk Mitigation Plan.

3. Division of Housing (DOH) is the State entity within the Department of Local Affairs (DOLA) that represents the housing authority for MFP programs through an Interagency Agreement (IA) with the Department of Health Care Policy and Financing (HCPF)

4. Qualified institution means a nursing facility; intermediate care facilities for individuals with intellectual disabilities (ICF-IID); Regional Center (RC) or institutions for mental diseases (IMD), which include Psychiatric Hospitals only to the extent medical assistance is available under the State Medicaid plan for services provided by such institutions.

5. Qualified residence means a home owned or leased by the member or the member's family member; a residence, in a community-based residential setting, in which no more than 4 unrelated individuals reside; or an apartment with an individual lease, eating, sleeping, cooking, and bathing areas, lockable access and egress, and not associated with the provision or delivery of services.

6. Qualified services mean services that are provided through an existing HCBS waiver and may continue if needed by the member and if the member continues to meet eligibility for HCBS at the end of his or her enrollment in MFP.

7. MFP Supplemental Services mean services not otherwise available under Medicaid but that directly support a member through one-time or short-term expenses. Supplemental Services are reimbursable for up to six months while the member resides in a qualified institution and for a period of up to six months following discharge to a qualified residence. Need for Supplemental Services will be identified by the TCM-TC Community Needs and Preference Assessment and Risk Mitigation Plan.

8. Targeted Case Management - Transition Coordination (TCM-TC) services means transition coordination assistance provided to a member who is transitioning from a skilled nursing facility, extended SNF LOC hospital stay, intermediate care facility for individuals with intellectual disabilities, or regional center and includes the following activities: comprehensive assessment for transition, community risk assessment, development of a transition plan, referral and related activities, and monitoring and follow up activities as they relate to the transition

9. Transition Assessment/Plan means an assessment of member needs completed by a transition coordinator prior to a transition and the corresponding plan developed by the coordinator to meet the needs of the member in a community-setting post-transition.

10. Transition Coordinator (TC) means a person who provides Transition Coordination Services and meets all regulatory requirements for a TC at Section 8.519.27.

11. Transition Coordination Agency (TCA) means a public or private not-for-profit or for-profit agency that meets state and federal requirements at Section 8.519.27 and 8.763 and is certified by the Department to provide Targeted Case Management - Transition Coordination (TCM-TC) services pursuant to a provider participation agreement with the Department.

12. Transition Options Team (TOT) means a group of individuals who have a personal or professional relationship with the member who is exploring their options for community living. This group is responsible wholly or in part for the transition assessment, transition plan, determining whether the transition is recommended, completing the service plan, and brokering services.

8.555.2Eligibility

8.555.2.A.Eligible Persons

1. MFP services shall be offered only to persons who meet all of the following eligibility requirements:

a. Members shall be aged 18 years or older.

b. Members shall have resided in a qualified institution for a period of 60 days or more. Days in a nursing facility for a rehabilitation stay will count towards the 60 days.

2. Members shall be Medicaid eligible

3. Members shall reside in a qualified residence post-transition.

4. MFP members admitted to a nursing facility or hospital for 30 consecutive days or longer, post-transition, shall be discontinued from the MFP program but may have the option to re-enroll once they meet all eligibility requirements. The Department has the right to exempt the 30-day exclusion on a case-by-case basis where failure to do so would result in health and safety concerns, loss of housing, loss of caregivers, or loss of benefits.

a. MFP members entering a nursing facility for Respite Care as a qualified HCBS waiver service shall not be discontinued from the MFP program.

5. Members who reside in a residence that is not a Qualified Residence as defined in Section 8.555.1 are not eligible for MFP services.

8.555.2.BFinancial Eligibility

1. Members shall meet the eligibility criteria as specified in the Income Maintenance Staff Manual of the Colorado Department of Health Care Policy and Financing regulations at Section 8.100, Medical Assistance Eligibility.

8.555.2.CLevel of Care Criteria

1. Members shall require long-term support services at a level comparable to services typically provided in a hospital, nursing facility, or ICF-IID in accordance with the waiver to which they will enroll upon transition.

8.555.2.D.Need for MFP Services

1. Members will be eligible for the MFP program when all eligibility criteria listed in Section 8.555.2. have been met.

a. The desire or need for any Medicaid services other than MFP demonstration services, as listed at Section 8.555.1, or qualified services offered through one of the waiver programs listed in Section 8.555.2 shall not satisfy this eligibility requirement.

2. Eligible services include but are not limited to Transition Coordination, Peer Mentorship, Pre-tenancy Support, and Environmental Adaptations.

3. Once enrolled, members who have not received demonstration or qualified services for a period greater than 30 consecutive days shall be discontinued from the program.

4. MFP members will be eligible to receive all MFP Supplemental Services identified as a need during MFP enrollment

8.555.3MFP Demonstration Program

8.555.3.AProgram Duration

1. MFP members may be enrolled in the demonstration and receiving TCM-TC Services for a period of 365 days, 366 days during a leap year if applicable, following discharge from a qualified institution. After discharge the member may be enrolled in the appropriate long-term care program.

2. Following discharge from a qualified institution, MFP members will be concurrently enrolled in the MFP program and one of the following waivers:

a. Home and Community Based Services for the Elderly, Blind and Disabled (HCBS-EBD) (Section 8.7101.);

b. Home and Community Based Services Complementary and Integrative Health (HCBS-CIH) (Section 8.7101.)

c. Home and Community Based Services for People with Brain Injury (HCBS-BI) (Section 8.7101.);

d. Home and Community Based Services for Community Mental Health Supports (HCBS-CMHS) (Section 8.7101.);

e. Home and Community Based Services for the Developmentally Disabled (HCBS-DD) (Section 8.7101.; or

f. Home and Community Based Services for Supported Living Services (HCBS-SLS) (Section 8.7101.).

3. At the end of the 365-day enrollment period for the MFP program, HCBS case managers will disenroll members from the program.

a. TCM-TC Demonstration services will terminate at the end of the 365 days of MFP enrollment period.

b. Supplemental services will end 6 months after discharge.

c. After MFP concludes, if members continue to meet eligibility requirements at the time of the Continued Stay Review (CSR) for one of the waivers listed in Section, 8.555.3, case managers will arrange for the continuation of qualified HCBS services through the appropriate waiver. For members that do not meet eligibility requirements for one of the waivers listed in Section 8.555.4, case managers will provide referrals to alternate resources that may include Medicaid state plan benefits.

8.555.3.BMFP Demonstration Service

1. Targeted Case Management - Transition Coordination (TCM-TC)

a. Transition Coordination will be provided in accordance with requirements defined in Transition Coordination Services Section 8.519.27.

b. Eligibility

i. Members will be eligible for MFP Transition Coordination services when all eligibility criteria described in Targeted Case Management - Transition Coordination (TCM-TC) Section 8.519.27, 8.763 and 8.555.2 are met.

c. Inclusions

i. Transition Coordination will ensure that members meet all eligibility requirements identified in Section 8.555.2 prior to enrollment.

ii. Transition Coordination shall facilitate the completion of the Department approved Transition Assessment/Plan for each member with the support of the Transitions Options Team members. The need for MFP supplemental services will be determined through this assessment process.

d. Exclusions

i. Reimbursement for mileage, travel, or transportation

e. Provider Requirements

i. Transition Coordination Agencies will follow all policies and procedures defined in Section 8.519.27 and made available through training and other guidance.

f. Provider Reimbursement

i. TCM-TC services will be reimbursed according to requirements outlined in Section 8763 and the Targeted Case Management - Transition Coordination (TCM-TC) Billing Manual.

ii. Reimbursement shall be claimed only by a qualified provider who delivers services in accordance with the service definition and policy guidance established by the Department.

2. MFP Housing Assistance

a. MFP Supplemental service that provides funding for MFP members while long-term solutions are established. Colorado administers State-funded housing resources that provide members with housing vouchers. MFP Housing Assistance supports members in urgent situations while long-term State-funded options are pending or unavailable.

b. Eligibility

i. Members who have identified housing payments as a need during MFP enrollment will be eligible for six months of total rental payments through MFP Housing Assistance. MFP Housing Assistance recognizes rental arrears and monthly rental payments as eligible expenses where the combination of the two types of payments cannot exceed six months of total MFP Housing Assistance payments.

ii. Will be documented by the TCA and reported to the Division of Housing (DOH) who will be responsible for authorizing the start date and amount of monthly MFP Housing Assistance payments and subsequent State-funded housing assistance.

c. Inclusions

i. Activities reimbursable as short-term rental assistance

1) Monthly rental payments:

2) Will be calculated based on State-funded housing standards

3) Will be administered and tracked by the DOH who will be responsible for implementing State-funded housing assistance for members to avoid any interruption of payment following the member's eligibility period for MFP Housing Assistance.

ii. Rental arrears:

1) Rental arrears payments are eligible expenses under MFP Housing Assistance and will offset funding available for rental assistance following transition.

2) Rental arrears payments will not exceed six months of calculated MFP Housing Assistance.

iii. Activities reimbursable for payment prior to transitioning

1. Security Deposit

2.

d. Exclusions

i. Any MFP Housing Assistance to exceed a combination of six months of rental payments

ii. Expenses for home furnishings or grocery items

iii. Payment for modifications or accessibility adaptations to the home associated rental and utility fees identified during transition planning

e. Provider Requirements

i. MFP Housing Assistance will be administered by the Division of Housing (DOH) as a State entity within the Department of Local Affairs (DOLA) through an Interagency Agreement (IA) with the Department of Health Care Policy and Financing (HCPF) and/or HCPF Department staff or contracts.

f. Provider Reimbursement

i. MFP Housing Assistance payments will be made by the State's designated entity to landlords and/or property management groups.

ii. Reimbursement shall be claimed only by a qualified provider who delivers services in accordance with the service definition and policy guidance established by the Department.

3. MFP Food Assistance

a. MFP Supplemental Service that provides short-term funding for food pantry items, community meal programs, and food boxes. This service will ensure that a member has access to food while adjusting to community-living. Funding will be available for MFP Food Assistance for 30 days following transition to the community

b. Eligibility

i. Members who have identified food as a need during MFP enrollment will be eligible for MFP Food Assistance for a period of 30 days following transition to the community

c. Inclusions:

i. Food pantry stocking items may include:

1) Perishable food items

2) Non-perishable food items

3) Nutritional vitamins and other meal supplements

4) Nutritional items associated with dietary restrictions

5) Food preparation items

ii. Community meal delivery fees for non-Medicaid resources prior to authorization of HCBS Home Delivered Meals (HDM) or other long-term alternatives. Membership fees for community programs such as Meals on Wheels or food boxes would be an example of appropriate costs under this category

d. Exclusions

i. The combination of costs associated with Short-term Food Assistance will not exceed $500 per member for the 30-day period.

ii. HCBS Home Delivered Meals

iii. Any costs that exceeds the member's MFP Food Assistance eligibility period

e. Provider Requirements

i. MFP Food Assistance providers will be subject to the standards outlined in Section 8.7549.

f. Provider Reimbursement

i. MFP Food Assistance must not exceed $500 per eligible member for a period of 30 days following discharge from a qualified institution

ii. Funding provided will not duplicate any other food expenses covered by Medicaid

iii. The total amount will be prior authorized in the State's MMIS system and will be reimbursable upon delivery of service

iv. Reimbursement for MFP services shall reflect the lower of billed charges or the maximum rate of reimbursement set by the Department.

1) The statewide fee schedule for these services is reviewed annually and published in the provider billing manual.

2) Reimbursement for MFP services is also conditional upon:

a) The member's eligibility for MFP services;

b) The provider's certification status; and

c) The submission of claims in accordance with proper billing procedures.

v. Payments will be made by agencies designated by contract with the State to provide this service

vi. Reimbursement shall be claimed only by a qualified provider who delivers services in accordance with the service definition and policy guidance established by the Department

4. MFP Pre-Tenancy Support

a. MFP Supplemental Service that teaches members how to satisfy the requirements of community-based tenancy through education and direct support. The service teaches members how to successfully secure and maintain community housing and avoid unnecessary returns to higher levels of care.

b. Eligibility:

i. Members who have identified housing as a need during MFP enrollment will be eligible for MFP Pre-Tenancy Support for a period up to six months prior to transitioning

c. Inclusions

i. Teaching members how to satisfy the requirements of tenancy

ii. Teaching members their rights as tenants

iii. Teaching members compliance requirements for lease agreements

iv. Teaching members about tenancy sustaining practices

v. Completing lease applications and requesting rental accommodations

vi. Coordinating required documentation

vii. Teaching members how to make payments to landlords

viii. Teaching members how to schedule tours for prospective units

ix. Accessing other resources related to Pre-tenancy Support and household management

d. Exclusions

i. Pre-tenancy Support shall not be available to members following transition to the community

ii. Pre-Tenancy Support services will be limited to 52 units where 1 unit equals 15 minutes

1) Reimbursement for mileage, travel, or transportation

iii. Provider Requirements

1) Providers of MFP services must:

a) Abide by all the terms of their provider agreement with the Department; and

b) Not discontinue or refuse services to a member unless documented efforts have been made to resolve the situation that triggers such discontinuation or refusal to provide services

c) Comply with all applicable federal and state statutes, regulations, and guidance

e. Provider Reimbursement

i. Pre-Tenancy Support will be reimbursed up to 52 units where 1 unit equals 15 minutes

ii. The total amount will be prior authorized in the State's MMIS system and will be reimbursable upon delivery of service

iii. Requests for units above the authorized amount will be reviewed by designated State staff

iv. Reimbursement for MFP services shall reflect the lower of billed charges or the maximum rate of reimbursement set by the Department.

1) The statewide fee schedule for these services is reviewed annually and published in the provider billing manual.

2) Reimbursement for MFP services is also conditional upon:

a) The member's eligibility for MFP services;

b) The provider's certification status; and

c) The submission of claims in accordance with proper billing procedures.

3) Payments will be made by agencies designated by contract with the State to provide this service

4) Reimbursement shall be claimed only by a qualified provider who delivers services in accordance with the service definition and policy guidance established by the Department.

5. MFP Peer Mentorship

a. MFP Supplemental Service that offers support from providers with lived experience to better understand the transition process, how to navigate Colorado's Medicaid System and other community resources prior to transition. The goal of MFP Peer Mentorship is to connect members with other people who have transitioned to the community to build independence and reduce impacts of social isolation after leaving a long-term care facility.

b. Eligibility

i. MFP Peer Mentorship will be available to members for a period up to six months prior to transitioning who meet the following eligibility criteria:

c. Inclusions

i. MFP Peer Mentorship means support provided by peers of the member on matters of community living and may include:

1) Problem-solving issues drawing from shared experience

2) Goal setting, self-advocacy, community acclimation and techniques

3) Assisting with interviewing potential providers, understanding complicated health and safety issues, and participating on private and public boards, advisory groups, and commissions

4) Activities that promote interaction with friends and companions of choice

5) Teaching and modeling of social skills, communication, group interaction, collaboration

6) Developing community relationships with the intent of building social capital that results in the expansion of opportunities to explore personal interests

7) Assisting the person in acquiring, retaining, and improving self-help, socialization, self-advocacy, and adaptive skills necessary for community living.

8) Support for integrated and meaningful engagement and awareness of opportunities for community involvement including volunteering, self- advocacy, education options, and other opportunities identified by the individual

9) Assisting members to be aware of and engage in community resources.

ii. Exclusions

1) MFP Peer Mentorship will not be available to members following transition to the community

2) Reimbursement for mileage, travel, or transportation

iii. Provider Requirements

1) MFP Peer Mentorship providers must meet requirements at Section 8.7535

2) Providers of MFP services must:

a) Conform to all state established standards for the specific services they provide under this program b) Not discontinue or refuse services to a member unless documented efforts have been made to resolve the situation that triggers such discontinuation or refusal to provide services c) Abide by all the terms of their provider agreement with the Department; and

3) Comply with all applicable federal and state statutes, regulations, and guidance

iv. Provider Reimbursement

1) MFP Peer Mentorship will be reimbursed up to 26 units where 1 unit equals 15 minutes

2) Requests for units above the authorized amount will be reviewed by designated State staff

3) The total amount will be prior authorized in the Department's MMIS system and will be reimbursable upon delivery of service

4) Reimbursement for MFP services shall reflect the lower of billed charges or the maximum rate of reimbursement set by the Department.

5) The statewide fee schedule for these services is reviewed annually and published in the provider billing manual.

6) Reimbursement for MFP services is also conditional upon:

a) The member's eligibility for MFP services

b) The provider's certification status

c) The submission of claims in accordance with proper billing procedures

7) Payments will be made by agencies designated by contract with the State to provide this service

8) Reimbursement shall be claimed only by a qualified provider who delivers services in accordance with the service definition and policy guidance established by the Department.

6. Environmental Adaptations

a. MFP Supplemental Service that allows for modifications to a member's residence to be completed prior to transitioning where the modification represents a barrier that would otherwise prevent a member from discharging safely to the community. This support is differentiated from the existing home modification waiver benefit through the ability to initiate modifications to a member's home while they reside in a skilled setting. The TCA will work directly with the member to make referrals to Environmental Adaptation providers while the member resides in the facility planning for transition. The TCA will communicate with the HCBS case manager to ensure continuity with further home modifications under the HCBS Waiver following transition as warranted.

b. Eligibility

i. Members who have identified home accessibility as a need during MFP enrollment will be eligible for MFP Environmental Adaptations for a period up to six months prior to transitioning

c. Inclusions

i. Inclusions for Environmental Adaptations are outlined in Section 8.7524.

d. Exclusions

i. Exclusions for Environmental Adaptations are outlined in Section 8.7524.

e. Environmental Adaptations Oversight Responsibilities

i. The Environmental Adaptation (EA) Contractor shall consider alternative funding sources to complete the Environmental Adaptation These alternatives and the reason they are not available shall be documented in the case record.

1) The EA Contractor must confirm that the member is unable to receive the proposed adaptations, improvements, or modifications as a reasonable accommodation through federally funded assisted housing as required by the Fair Housing Act.

ii. The EA Contractor may approve Environmental Adaptation projects estimated at less than $2,500 without Department approval, contingent on member authorization and confirmation of Environmental Adaptation fund availability.

iii. The EA Contractor shall obtain prior approval by submitting an Environmental Adaptation (EA) Request to the Department for Environmental Adaptation projects estimated at between $2,500 and $14,000.

1) The EA Contractor must submit the request and all supporting documentation according to Department prescribed processes and procedures. EA Requests submitted with improper documentation cannot be authorized.

2) The EA Contractor is responsible for retaining and tracking all documentation related to a member's Environmental Adaptation benefit and communicating that information to the member and EA Providers. The EA Contractor may request confirmation of a member's Environmental Adaptation history from the Department, its fiscal agent, or DOH.

iv. Environmental Adaptations estimated to cost $2,500 or more shall be evaluated according to the following procedures:

1) An occupational or physical therapist (OT/PT) shall assess the member's needs and the therapeutic value of the requested Environmental Adaptation. When an OT/PT with experience in Environmental Adaptation is not available, a Department-approved qualified individual may be substituted. An evaluation specifying how the Environmental Adaptation would contribute to a member's ability to remain in or return to their home, and how the Environmental Adaptation would increase the individual's independence and decrease the need for other services, shall be completed before bids are solicited. This evaluation shall be submitted with the EA Request.

2) The evaluation services may be provided by a home health agency or other qualified and approved OT/PT through Medicaid Home Health consistent with Home Health rules set forth in Section 8.520, including physician orders and plans of care.

a) The Transition Coordinator (TC) may initiate the OT/PT evaluation process before the member has been approved for waiver services, as long as the member is Medicaid eligible.

b) A TC may initiate the OT/PT evaluation process before the member physically resides in the home to be modified, as long as the current property owner agrees to the evaluation.

3) The EA Contractor and the OT/PT shall consider less expensive alternative methods of addressing the member's needs.

4) The EA Contractor shall solicit bids according to the following procedures:

a) The EA Contractor shall solicit bids from at least two Environmental Adaptation Providers.

i) The EA Contractor must verify that the provider is an enrolled Environmental Adaptation Provider.

ii) The bids must be submitted according to Department prescribed processes and procedures

b) The bids shall include a breakdown of the costs of the project including:

i) Description of the work to be completed.

ii) Description and estimate of the materials and labor needed to complete the project. Material costs should include price per square foot for materials purchased by the square foot. Labor costs should include price per hour.

iii) Estimate for building permits, if needed.

iv) Estimated timeline for completing the project.

v) Name, address and telephone number of the Environmental Adaptation Provider.

vi) Signature, including option for digital signature, of the Environmental Adaptation Provider.

vii) Signature, including option for digital signature, of the member or guardian or other indication of approval.

viii) Signature, including option for digital signature, of the homeowner or property manager if applicable.

c) Environmental Adaptation Providers have a maximum of ten (10) business days to submit a bid for the Environmental Adaptation project after the EA Contractor has solicited the bid.

i) If the EA Contractor has made three attempts to obtain a written bid from an Environmental Adaptation Provider and the Environmental Adaptation Provider has not responded within ten (10) business days, the EA Contractor may request approval of one bid. Documentation of the attempts shall be maintained by the EA Contractor.

d) The EA Contractor shall submit copies of the bid(s) and the OT/PT evaluation with the EA Request to the Department or its agent. The Department or its agent shall authorize the lowest bid that complies with the requirements of {Section 8.7524} and the recommendations of the OT/PT evaluation.

i) If a member or homeowner requests a bid that is not the lowest of the submitted bids, the EA Contractor shall request approval by submitting a written explanation with the EA Request.

e) A revised bid and Change Order request shall be submitted according to the procedures outlined in this section for any changes from the original EA Request according to Department prescribed processes and procedures.

v. If the member does not own a property to be modified, the EA Contractor shall obtain signatures from the homeowner or property manager on the submitted bids authorizing the specific modifications described therein. Signatures may be completed using a digital signature based on preference of the individual signing the form.

1) Written consent of the homeowner or property manager, as evidenced by the above-mentioned signatures, is required for all projects that involve permanent installation within the member's residence or installation or modification of any equipment in a common or exterior area.

2) If the member vacates the property, these signatures can be used as evidence that the homeowner or property manager agrees to allow the member to leave the modification in place or remove the modification as the member chooses. If the member chooses to remove the modification, the property must be left equivalent or better to its pre-modified condition. The homeowner or property manager may not hold any party responsible for removing all or part of an Environmental Adaptation project.

vi. If the EA Contractor does not comply with the process described above resulting in increased cost for an Environmental Adaptation, the Department may hold the EA Contractor financially liable for the increased cost.

vii. The Department or its agent may conduct on-site visits, or any other investigations deemed necessary prior to approving or denying the EA Request.

f. Environmental Adaptations Provider Requirements

i. An Environmental Adaptations Agency means a provider agency that has met all the standards for Home Modification and is an enrolled Medicaid provider.

ii. Provider Requirements for Environmental Adaptations are outlined in Section 8.7524.

iii. Providers of MFP services must

1) Conform to all state established standards for the specific services they provide under this program

2) Not discontinue or refuse services to a member unless documented efforts have been made to resolve the situation that triggers such discontinuation or refusal to provide services

3) Abide by all the terms of their provider agreement with the Department; and

4) Comply with all applicable federal and state statutes, regulations, and guidance

iv. Provider Reimbursement

1) Environmental Adaptations will be reimbursable up to a maximum cost of $14,000

2) Payment for Environmental Adaptations is outlined in Section 8.7524.

3) The total reimbursement will not exceed the total amount identified in the bid

4) Reimbursement for MFP services shall reflect the lower of billed charges or the maximum rate of reimbursement set by the Department.

a) The statewide fee schedule for these services is reviewed annually and published in the provider billing manual.

b) Reimbursement for MFP services is also conditional upon:

i) The member's eligibility for MFP services;

ii) The provider's certification status; and

iii) The submission of invoices in accordance with proper billing procedures.

v. Payments will be made by agencies designated by contract with the State to provide this service

1) Payment for Environmental Adaptations does not offset the funding available to members under HCBS Home Modification benefits

vi. Reimbursement shall be claimed only by a qualified provider who delivers services in accordance with the service definition and policy guidance established by the Department

8.555.4.MFP Case Management Functions

8.555.4.ACase Management Responsibilities

1. The case manager shall provide support in accordance with the functions outlined in Section 8.7206

8.555.4.B.Case Management Responsibilities - MFP Disenrollment

1. The case manager shall begin preparing members for dis-enrollment from the MFP program 90 days prior to the end of the member's MFP enrollment period and arrange for the continuation of HCBS services if the member continues to meet the eligibility requirements for a waiver listed at Section 8.7100

8.555.4.C.MFP Service Plan

1. The MFP Service Plan will be developed with input from the transition coordinator, staff from the discharging facility, the resident wanting to transition and others at the invitation of the member or guardian.

2. The transition assessment/plan, the member's level of functioning, service needs, available resources and potential funding resources will inform the development of the service plan.

3. The MFP Service Plan shall document that the member has been offered a choice:

a. Between community-based services or institutional care;

b. Between the MFP Program or a traditional HCBS Waiver;

c. Among qualified and demonstration services; and

d. Among qualified providers.

4. A new MFP Service Plan will be developed each time a member is reinstitutionalized and plans to return to a community setting. The MFP Service Plan shall address the reasons for the member's reinstitutionalization.

8.555.5MFP SERVICE AUTHORIZATION

1. Determination for MFP services shall occur when all requirements defined in 8.555.2 have been met. Members will be identified in the State's prescribed case management system during the MFP referral screening. Once identified in the system, all services prior authorized for the member's care will be mapped to MFP funds in the State's MMIS system.

2. Transition Coordination services may be offered prior to the member's transition in preparation of the transition to a community setting.

10 CCR 2505-10-8.555

47 CR 17, September 10, 2024, effective 9/30/2024