10 Colo. Code Regs. § 2505-10-8.615

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

Section 10 CCR 2505-10-8.615 - [Repealed effective 9/14/2024] TELEHEALTH DELIVERY OF HOME AND COMMUNITY-BASED SERVICES

8.615.1DEFINITIONS

A. Assessment shall be as defined at Section 8.390.1.DEFINITIONS.

B. Case Management means as defined in Section 8.390.1 DEFINITIONS.

C. Case Management Agency (CMA) means a public or private not-for-profit or 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 Section 25.5-10-209.5, C.R.S. and pursuant to a provider participation agreement with the state department.

D. Community Centered Board (CCB) means a private corporation, for profit or not for profit, which when designated pursuant to Section 25.5-10-209, C.R.S., provides case management services to Members with developmental disabilities, is authorized to determine eligibility of such Members within a specified geographical area, serves as the single point of entry for Members to receive services and supports under Section 25.5-10-201, C.R.S. et seq, and provides authorized services and supports to such Members either directly or by purchasing such services and supports from service agencies.

E. Department means the Department of Health Care Policy and Financing.

F. Home and Community-Based Services (HCBS) means services and supports authorized through a 1915(c) waiver of the Social Security Act and provided in community settings to a Member who requires a level of institutional care that would otherwise be provided in an institutional setting.

G. Home and Community-Based Services Telehealth (HCBS Telehealth) is a method of service delivery of those HCBS services listed at Section 8.615.2.

H. Medicaid State Plan means 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.

I. Member means as defined in Section 8.390.1.

J. Prior Authorization Request (PAR) means the Department prescribed form to authorize the reimbursement for services.

K. Person-Centered Support Plan means as defined in Section 8.390.1 DEFINITIONS.

L. Person-Centered Support Planning means as defined in Section 8.390.1 DEFINITIONS.

M. Telehealth means the broad use of technologies to provide services and supports through HCBS waivers, when the Member is in a different location from the provider.

N. Waiver Service means optional services defined in the current federally approved waiver documents and do not include Medicaid State Plan benefits.

8.615.2INCLUSIONS

A. HCBS Telehealth may be used to deliver support through the following authorized HCBS waiver services:

1. Adult Day Services - Basic, Tier 1; defined at Section 8.491.1;

2. Adult Day Services - Brain Injury, Tier 1; defined at Sections 8.515.3 and 8.515.70;

3. Behavioral Management and Education; defined at Section 8.516.40;

4. Behavioral Services - Behavioral Consultation; defined in Sections 8.500.5.B.1. and, 8.500.94.B.2,;

5. Behavioral Services - Behavioral Counseling, Group, defined in Sections 8.500.5.B.1, and 8.500.94.B.2,;

6. Behavioral Services - Behavioral Counseling, Individual, defined in Sections 8.500.5.B.1, and 8.500.94.B.2,;

7. Behavioral Services - Behavioral Plan Assessment; defined in Sections 8.500.5.B.1 and, 8.500.94.B.2,;

8. Benefits Planning; defined in Sections 8.500.5.B.2 and 8.500.94.B.3

9. Bereavement Counseling; defined at Section 8.504.1;

10. Community Connector; defined at Section 8.503.40.A.3;

11. Day Habilitation; defined at Section 8.500.5.B.2;

12. Expressive Therapy - Art and Play Therapy, Group; defined at Sections 8.504.1 and 8.504.2.D;

13. Expressive Therapy - Art and Play Therapy, Individual; defined at Sections 8.504.1 and 8.504.2.D;

14. Expressive Therapy - Music Therapy, Group; defined at Sections 8.504.1 and 8.504.2.D;

15. Expressive Therapy - Music Therapy, Individual; defined at Sections 8.504.1 and 8.504.2.D;

16. Independent Living Skills Training; defined at Section 8.516.10;

17. Mental Health Counseling, Family; defined at Section 8.516.50;

18. Mental Health Counseling, Group; defined at Section 8.516.50;

19. Mental Health Counseling, Individual; defined at Section 8.516.50;

20. Mentorship; defined at Section 8.500.94B.10;

21. Movement Therapy; defined in Sections 8.500.94B.15 and 8.503.40.A.8;

22. Palliative Supportive Care - Care Coordination; defined at Section 8.504.1;

23. Substance Abuse Counseling, Family; defined at Section 8.516.60;

24. Substance Abuse Counseling, Individual; defined at Section 8.516.60;

25. Supported Employment - Job Coaching, Individual, defined in Sections 8.500.5.B.9 and 8.500.98.C;

26. Supported Employment - Job Development, Levels 1-6, Individual, defined in Sections 8.500.5.B.9 and 8.500.98.C;

27. Transition Services - Life Skills Training; defined at Section 8.553.1;

28. Transition Services - Peer Mentorship; defined at Section 8.553.1;

29. Therapeutic Life Limiting Illness Support, Family; defined at Sections 8.504.1 and 8.504.2.B;

30. Therapeutic Life Limiting Illness Support, Group; defined at Sections 8.504.1 and 8.504.2.B;

31. Therapeutic Life Limiting Illness Support, Individual; defined at Sections 8.504.1 and 8.504.2.B;

32. Wrap Around Service - Intensive Support; defined at Section 8.508.100.H; and,

33. Wrap Around Service - Transition Support; defined at Section 8.508.100.M;

B. HCBS Telehealth may only be used to deliver consultation for the following services:

1. Adaptive Therapeutic Recreational Fees and Equipment, defined at Section 8.503.40.A.1;

2. Assistive Technology; defined in Sections 8.500.94.B.1 and, 8.503.40.A.2;

3. Home Modification and Adaptation; defined in Sections 8.493.1, 8.500.94.B.6, and 8.503.40.A.5; and

4. Vehicle Modifications, defined in Sections 8.500.94.B.20 and 8.503.40.A.12.

5. Providers shall follow all billing policies and procedures as outlined in the Department's current waiver billing manuals and rates/fees schedules and may not bill separately for consultation.

8.615.3LIMITATIONS

A. HCBS Telehealth is subject to the limitations of the respective service it supports as referenced in this rule at Section 8.615.2.

B. HCBS Telehealth is not a duplication of Health First Colorado Telehealth or Telemedicine services.

C. HCBS Telehealth is not permitted to be used for any service not listed in this rule at Section 8.615.2.

8.615.4PROVIDER REQUIREMENTS

A. HCBS waiver providers that choose to use HCBS Telehealth shall develop and make available a written HCBS Telehealth Policy which at a minimum shall include the following:

1. The Member may refuse telehealth delivery at any time without affecting the Member's right to any future services and without risking the loss or withdrawal of any service to which the Member would otherwise be entitled;

2. All required and applicable confidentiality protections that apply to the services;

3. The Member shall have access to all collected information resulting from the services utilized as required by state law;

4. How utilization of HCBS Telehealth will be made available to those Members who require assistance with accessibility, translation, or have limited visual and/or auditory capabilities;

5. A contingency plan for service delivery if technology options fail; and,

6. HCBS waiver providers shall maintain a copy of the HCBS Telehealth Policy signed by the Member in their records.

B. HCBS waiver providers shall ensure the use of HCBS Telehealth is the choice of the Member. The HCBS waiver provider shall maintain a consent form for the use of HCBS Telehealth in the Member's record.

C. The HCBS waiver provider shall complete a provider developed evaluation of the Member and caregiver prior to using HCBS telehealth services that identifies a Member's ability to participate and outlines any accommodations needed while utilizing HCBS Telehealth.

D. HCBS waiver providers must comply with all HIPAA and confidentiality procedures. HCBS waiver providers must be able to use a technology solution that allows real-time interaction with the Member which may include audio, visual and/or tactile technologies.

E. HCBS waiver providers shall not use HCBS Telehealth to address a Member's emergency needs.

F. HCBS waiver providers shall use a HIPAA compliant technology solution meeting all privacy requirements.

8.615.5CASE MANAGEMENT REQUIREMENTS

A. Members eligible to use HCBS Telehealth are those enrolled in the waivers and services as defined in this rule at Section 8.615.2.

B. The CMA shall ensure the use of HCBS Telehealth is the choice of the Member through the Support Planning process by indicating the Member's choice to receive HCBS Telehealth in the Department prescribed IT system.

C. Through the Support Planning process, the CMA shall identify and address the benefits and possible detriments to Members choosing to use HCBS Telehealth for service delivery.

D. HCBS Telehealth delivery must be prior authorized and documented in the Member's Support Plan.

E. Telehealth as a service delivery method for authorized HCBS waiver services, shall not interfere with any client rights or be used as any part of a Rights Modification or Suspension plan.

8.615.6REIMBURSEMENT

A. HCBS Telehealth does not include reimbursement for the purchase or installation of telehealth equipment or technologies.

B. HCBS waiver service providers utilizing Telehealth shall follow all billing policies and procedures as outlined in the Department's current waiver billing manuals and rates/fees schedules. This includes the prohibition on collecting copayments or charging Members for missing set times for services.

10 CCR 2505-10-8.615

44 CR 14, July 25, 2021, effective 8/14/2021

46 CR 11, June 10, 2023, effective 6/30/2023

46 CR 13, July 10, 2023, effective 7/30/2023

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