10 Colo. Code Regs. § 2505-10-8.607

Current through Register Vol. 47, No. 16, August 25, 2024

Section 10 CCR 2505-10-8.607 - [Repealed effective 9/14/2024] CASE MANAGEMENT SERVICES

Case management service for Individuals with Intellectual and Developmental Disabilities HCBS waivers shall be provided pursuant to Section 8.519.1 through 8.519.23.

8.607.1ADMINISTRATION

A. Community Centered Boards and regional centers shall be responsible to maintain sufficient documentation of case management activities performed and to support billings.

B. Community Centered Boards shall be responsible to maintain or have access to information about public and private, state and local services, supports and resources which may be available for persons with developmental disabilities, and shall make such information available to persons eligible for services and supports and authorized persons inquiring upon their behalf.

C. Each Community Centered Board and regional center, as appropriate, shall establish agency procedures sufficient to execute case management services according to the provisions of these rules and regulations.

D. Case management services shall be a direct responsibility of the executive level of the Community Centered Board or regional center organization and are separate from the delivery of services and supports unless otherwise approved by the Department.

E. The Community Centered Board or regional center shall assign one (1) primary person who ensures case management services are provided on behalf of the person receiving services across all program, professional and agency lines. Reasonable efforts shall be made by the Community Centered Board or regional center to include the preferences of the eligible person in this assignment.

8.607.2DETERMINATION OF DEVELOPMENTAL DISABILITY

A. Any person, his/her legal guardian, parent(s) of a minor or such person(s) authorized by law may submit a written request for a determination of whether the applicant has a developmental disability.

B. A determination of developmental disability does not constitute a determination of eligibility for services or supports. The Community Centered Boards shall determine whether a person has a developmental disability and therefore may be eligible to receive services and supports pursuant to Sections 25.5-10-202(2) and 211, C.R.S., in accordance with criteria as specified by the Department.

Eligibility for Medicaid funded programs specific to persons with developmental disabilities shall be determined pursuant to the Colorado Department of Health Care Policy and Financing's Medical Assistance rules (10 C.C.R. 2505-10).

C. The developmental disability determination shall be made according to Department procedures, which shall identify the qualifications of person(s) making such a determination.

D. A request for determination of developmental disability shall be submitted to the Community Centered Board in the designated service area where the person resides, including temporary residence such as incarceration or hospitalization.

E. At the time of request, the Community Centered Board shall:

1. Provide the applicant any required forms and a list of the minimum required documents and information necessary for the determination of developmental disability; and,

2. Provide the applicant with information on where to obtain testing for the level of intellectual functioning and adaptive behavior, if requested. The responsibility for obtaining such assessments shall be with the applicant and/or legal guardian.

F. The applicant and/or legal guardian shall provide all documentation and information necessary for the determination of developmental disability within ninety (90) calendar days of the request.

1. The Community Centered Board may request additional documentation and/or information, as needed, to complete the determination of developmental disability.

2. The applicant and/or legal guardian may have additional assessments completed and submitted to the Community Centered Board for consideration.

G. If the applicant and/or legal guardian has not provided the documentation and information necessary for the determination within ninety (90) calendar days of the request, the Community Centered Board shall:

1. Close the request and notify the applicant in writing according to the procedures established at Section 8.607.2.L.4; or,

2. The Community Centered Board may, at the request of the applicant and/or legal guardian, extend the deadline for providing the necessary documentation and information by up to an additional ninety (90) calendar days.

a. In no case shall the deadline for providing the necessary documentation and information exceed one hundred eighty (180) calendar days.

b. The Community Centered Board shall provide a written update to the applicant no less than every ninety (90) calendar days until a determination of developmental disability is completed or the request is closed.

c. If the extended deadline for providing the necessary documentation and information has expired and there is still insufficient information to make a determination of developmental disability, the Community Centered Board shall close the request and notify the applicant and/or legal guardian in writing according to the procedures established at Section 8.607.2.L.4.

H. For all applicants, the Community Centered Board shall enter into the Department's designated data system and shall permanently maintain a written and/or electronic record of the developmental disability determination on a Department prescribed form. The record, at a minimum, shall include:

1. The name of the applicant;

2. The applicant's date of birth;

3. The date of the determination of developmental disability;

4. A description of the rationale for the developmental disability determination including, at minimum, assessment scores and diagnoses;

5. The name(s) and title(s) of the person(s) involved in making the determination.

I. All information and assessments used to determine a developmental disability shall be current so as to accurately represent the applicant's abilities at the time of determination.

1. Assessments of adaptive behavior shall have been completed within three (3) years of the request.

2. Assessments of intellectual functioning shall have been completed as follows:

a. If an individual is between five (5) and eighteen (18) years of age, at least one intellectual assessment shall have been completed to determine the individual's impairment of general intellectual functioning; or,

b. If an individual is eighteen (18) years of age or older and there is only one intellectual assessment available to determine the individual's impairment of general intellectual functioning, the assessment shall have been completed when the individual was at least eighteen (18) years of age and shall have been completed within ten (10) years of the request; or,

c. If there is historical pattern of consistent scores, based on two (2) or more intellectual assessments, that demonstrates an impairment of general intellectual functioning, the assessments may be used regardless of the individual's age at the time of determination.

3. An established neurological condition shall be documented as follows:

a. A diagnosed neurological condition shall be determined by a licensed medical professional practicing within the scope of his/her license; or,

b. If a specific diagnosis is not possible, a written statement from a licensed medical professional, practicing within the scope of his/her license, or a licensed psychologist may be used as long as there is a documented effort to determine a diagnosis and the available assessment information reasonably supports a conclusion that a neurological impairment is present.

4. The effects of mental illness or physical or sensory impairment must be considered to determine the extent to which such impairments are the sole contributing factor to the impairment of general intellectual functioning or limitations to adaptive behavior.

J. Prior to July 1, 2015, the Community Centered Board shall make the determination of developmental disability within ninety (90) calendar days of the receipt of all necessary information. On or after July 1, 2015, the Community Centered Board shall make the determination of developmental disability within thirty (30) calendar days of the receipt of all necessary information.

K. The date of the developmental disability determination shall be the date that the Department prescribed form and all documentation and information necessary for the determination of developmental disability was received by the Community Centered Board.

If a delay to the determination of developmental disability is due to the actions or inactions of the Community Centered Board, the original date of request shall be used.

L. The Community Centered Board making the developmental disability determination shall, in writing, notify the applicant or legal guardian, and the authorized person requesting the determination, if other than the applicant or legal guardian, and other such persons as designated by the applicant, of the decision. Such notification shall:

1. Be mailed to the person within seven (7) calendar days of the date of determination;

2. Be provided in such alternative means of communication as to reasonably ensure that the information has been communicated in an understandable form; and,

3. For persons determined to have a developmental disability, contain an explanation of the process that will occur and notice that, at a minimum, an Individualized Plan shall be developed upon enrollment into a developmental disability service;

4. For persons determined not to have a developmental disability or persons whose request is closed without the determination of a developmental disability, state the reasons for the determination or closure, and provide a written For persons determined not to have a developmental disability or persons whose request is closed without the determination of a developmental disability, state the reasons for the determination or closure, and provide a written Long-Term Care Notice of Action form in accordance with the provisions of Section 8.057 regarding the applicant's right to appeal the decision to the Office of Administrative Courts.

M. Applicants determined not to have a developmental disability may request a new determination of developmental disability at any time upon receipt of new or missing required information, and a new request date shall be established.

N. A determination of developmental disability shall be accepted by other Community Centered Boards, service agencies and regional centers.

O. A determination of developmental disability shall be permanent and shall not require renewal or review unless:

1. The interdisciplinary team determines that developmental disability services are no longer needed due to improvement in a person's condition and recommends a redetermination; or,

2. Information from a new evaluation becomes available which demonstrates sufficient improvement in a person's condition such that the determination should be reviewed.

8.607.3SERVICE AND SUPPORT COORDINATION

A. Service and support coordination shall be the responsibility of the community centered boards and regional centers. Service and support coordination shall be provided in partnership with the person receiving services, the parents of a minor, legal guardian and public and private agencies to the extent such partnership is requested by these individuals. Persons receiving services who are their own guardians may also request their family or others to participate in this partnership.

B. Service and support coordination shall assist the eligible person to ensure:

1. An Individualized Plan is developed, utilizing necessary information for the preparation of the Individualized Plan and using the Interdisciplinary Team process;

2. Facilitating access to and provision of services and supports identified in the Individualized Plan;

3. The coordination of services and supports identified in the Individualized Plan for continuity of service provision; and,

4. The Individualized Plan is reviewed periodically, as needed, to determine the results achieved, if the needs of the person receiving services are accurately reflected in the Individualized Plan, whether the services and supports identified in the Individualized Plan are appropriate to meet the person's needs and what actions are necessary for the plan to be achieved.

8.607.4INDIVIDUALIZED PLAN (IP)

A. Under the coordination and direction of the community centered board or regional center, the Interdisciplinary Team (IDT) shall develop the Individualized Plan (IP).

B. There shall be at least ten (10) days written notice from the timestamped date given to all Interdisciplinary Team members prior to an Individualized Plan meeting unless waived by the person receiving services or guardian as necessary and desirable.

Every effort shall be made to convene the meeting at a time and place convenient to the person receiving services, their legal guardian, authorized representative and parent(s) of a minor. Upon Department approval, contact may be completed by the case manager at an alternate location, via the telephone or using virtual technology methods. Such approval may be granted for situations in which face-to-face meetings would pose a documented safety risk to the case manager or client (e.g. natural disaster, pandemic, etc.).

C. The community centered board, and service agency or regional center as applicable, shall make available to the interdisciplinary team for each person receiving services such information as is necessary to develop the Individualized Plan.

D. The Individualized Plan shall:

1. Identify the unique strengths, abilities, preferences, desires, and needs of the person receiving services and their family, as appropriate;

2. Identify the specific services and supports appropriate to meet the needs of the eligible person, and family, as appropriate;

3. Document decisions made through the interdisciplinary team planning process including, but not limited to, rights suspension, the existence of appropriate services and supports, the actions necessary for the plan to be achieved, including which services and supports will be addressed through the development of an Individual Service and Support Plan (ISSP). The services and supports funded by the Department to be provided shall be described in sufficient detail as to provide for a clear understanding by the service agency(ies) of expected responsibilities and performance;

4. Describe the results to be obtained from the provision of services and supports identified in the Individualized Plan;

5. Document the authorized services and supports funded by the Department and the projected date of initiation;

6. Identify a contingency plan for how necessary care for medical purposes will be provided in the event that the person's family or caregiver is unavailable due to an emergency situation or to unforeseen circumstances. "Medical purposes" refers to a medical condition that places the individual at risk of not surviving, and that requires the support of persons qualified to address the specific medical needs of the person receiving services. Such medical conditions include, but are not limited to:

a. Dependency on technology, such as respirators, tracheotomy tubes, or ventilators;

b. Monitoring of medical equipment, such as a heart monitor; or,

c. Uncontrolled seizures for which a response while receiving services is likely.

A contingency plan is not needed for non-medical purposes or if the person receiving services does not have specific medical needs that would place him/her at risk because of the unavailability of the family or service provider. The development of a contingency plan in and of itself does not create an entitlement for services, for which none existed before.

7. Have a listing of the Interdisciplinary Team participants and their relationship to the person receiving services; and,

8. Contain a statement of agreement with the plan signed by the person receiving services or other such person legally authorized to sign on behalf of the person and a representative of the community centered board or regional center. The case manager may accept digital signatures on the agreement.

E. Copies of the Individualized Plan shall be disseminated to all persons involved in implementing the Individualized Plan including the person receiving services, their legal guardian, authorized representative and parent(s) of a minor, and the Department or others, as necessary and appropriate. If requested, copies shall be made available prior to the provision of services or supports; or within a reasonable period of time not to exceed thirty (30) days from the development of the Individualized Plan and in accordance with these rules.

F. The Individualized Plan shall remain in effect for a period not to exceed one year without review, and shall be reviewed and amended more frequently by the Interdisciplinary Team, as determined necessary and appropriate by Interdisciplinary Team members in order that the Individualized Plan accurately reflects the eligible person's current needs and circumstances. The community centered board or regional center shall coordinate the scheduling of such reviews.

8.607.5OBTAINING SERVICES AND SUPPORTS

A. Each community centered board shall establish and maintain a system to disseminate a Request for Provider (RFP) for clients who are seeking a Program Approved Provider Agency and to refer the client to approved providers who respond to the RFP.

B. Each community centered board shall establish one (1) waiting list for services and supports for eligible persons for whom funding from the Department is unavailable. This waiting list shall be maintained in an up-to-date, consolidated written form as specified by the Department and managed pursuant to the rules of the Colorado Department of Health Care Policy and Financing's Medical Assistance Staff Manual (10 C.C.R. 2505-10), and the guidelines of the Department regarding waiting lists for Developmental Disabilities Services.

8.607.6MONITORING

Regional centers shall be responsible to monitor the overall provision of services and supports authorized by the Department.

A. The frequency and level of monitoring shall meet the guidelines of the program in which the person is enrolled. At a minimum, monitoring shall include the following for each person:

1. The delivery and quality of services and supports identified in the Individualized Plan;

2. The health, safety and welfare of individuals;

3. The satisfaction with services and choice in providers; and,

4. That the regional center's and service agency's practices promote a person's ability to engage in self-determination, self-representation and self-advocacy.

B. A review of overall services and supports provided on an agency and system level shall be conducted to determine:

1. The general satisfaction of persons in regard to services and supports received;

2. The general practices of service agencies regarding health, safety and welfare of persons receiving services;

3. Fiscal compliance related to the implementation of Individualized Plans; and,

4. The nature and frequency of complaints regarding a service agency.

8.607.8MEDICAID PROGRAMS FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES

A. Regional Center Referral Process

1 A Client may be referred to a regional center for emergency short-term placement not to exceed ninety (90) days. Such referral shall be made as specified by the Colorado Department of Human Services (CDHS) and, at minimum, shall ensure that the CMA has exhausted all reasonable alternatives in an effort to procure or provide emergency services and supports in the Client's local community.

2. Clients may be referred to a regional center for long-term placement as specified by the CDHS. Such procedures shall include, but are not limited to:

A. The CMA responsible for case management services has notified the appropriate regional center and has involved the regional center in the evaluation process;

B. The CMA, Client, and the service planning team have reviewed and recommended placement;

C. All reasonable alternatives have been exhausted by the CMAto procure services and supports in the Client's local community and such efforts have been documented; and,

D. The Client or legal guardian is a resident of Colorado.

B. Nursing Facilities

For persons referred for a Preadmission Screening and Annual Resident Review (PASARR), the completion of the PASARR in accordance with the Department's guidelines, shall be the responsibility of the Community Centered Board in the area in which the person is physically residing, unless otherwise agreed upon by the Community Centered Boards affected.

10 CCR 2505-10-8.607

47 CR 16, August 25, 2024, effective 9/14/2024