10 Colo. Code Regs. § 2505-10-8.7201

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

Section 10 CCR 2505-10-8.7201 - Case Management Agency Overall Requirements

8.7201.A Administration of a Case Management Agency

1. The Case Management Agency shall be required in their mission statement, by-laws, articles of incorporation, and contracts, to comply with all regulations which govern the Case Management Agency, and to comply with the following standards:

a. The Case Management Agency shall serve individuals in need of Long-Term Services and Supports as defined in Section 8.7100.A.48

b. The Case Management Agency shall have the capacity to accept funding from multiple sources;

c. The Case Management Agency may subcontract with individuals, for-profit entities and not-for-profit entities to provide Case Management Agency Targeted Case Management and administrative Case Management Activities up to the limitations established in the Case Management Agency contract. Subcontractors must abide by the terms of the Case Management Agency contract with the Department and are obligated to follow all applicable federal and state statutes and regulations. The Case Management Agency is responsible for subcontractor performance.

d. The Case Management Agency may receive funds from public or private foundations and corporations; and

e. The Case Management Agency shall be required to publicly disclose all sources and amounts of revenue as described in Section 25.5-6-1708 CRS.

2. The Case Management Agency shall fulfill all functions of a Case Management Agency and Case Manager as described in these rules.

3. The Case Management Agency shall:

a. Not provide guardianship services for any individual applying for Long-Term Services and Supports or Member enrolled in a Long-Term Services and Supports program.

b. Maintain, or have access to, information about public and private state and local services, supports and resources and shall make such information available to the individual, Member and/or persons inquiring upon their behalf.

c. Be separate from the delivery of direct services and supports paid for by any payer for the same individual they provide Case Management, unless otherwise approved by the Department through a Conflict Free Case Management Waiver and except pursuant to Section 8.7202.W when the Case Management Agency is acting as the Organized Health Care Delivery System, or approved by the Department through a Conflict Free Case Management Waiver and in accordance with Section 25.5-6-1703(6) C.R.S.

d. Establish and maintain working relationships through Memorandum of Understanding processes and procedures with community-based resources, supports, and organizations, hospitals, service providers, and other organizations that assist in meeting the individuals' and Members' needs including but not limited to local Regional Accountable Entities, Behavioral Health Administration, Aging and Disability Resource Centers, counties, schools, and Medical Assistance sites as necessary for individual and Member support.

e. Maintain a website that at a minimum contains contact information for the Case Management Agency, the ability for electronic communication, hours of operation, available resources, program options, services provided, and the transparency documentation required in Section 25.5-6-1708 C.R.S.

f. Provide Case Management services without Discrimination on the basis of race, religion, political affiliation, gender, national origin, age, sexual orientation, gender expression or disability.

4. The Department may grant a Case Management Agency a Conflict Free Case Management waiver (CFCMW) to provide direct services and Case Management in the event that no other willing and qualified providers are available for the capacity of Member services necessary.

a. Applications for this waiver shall be received and evaluated in the manner in which has been communicated by the Department.

b. The Department may grant a Case Management Agency a Conflict-Free Case Management Waiver (formerly known as a rural exception) to provide specific direct services within their Defined Service Area to ensure access to these services in rural and frontier areas across Colorado.

c. The Case Management Agency shall:

i. Submit a formal application (found on the Department website) for a Conflict-Free Case Management Waiver.

ii. The Department shall provide formal notification to the Case Management Agency within 10 business days of the receipt of the application. The Department shall notify Applicants of their approval or denial within 90 days of receipt of the application.

iii. If the Applicant submits a response to the Case Management Agency Request for Proposal (RFP), the Department shall notify the Agency of approval or denial prior to the delivery of intent to award letters to RFP Respondents or within 90 day of receipt of the application whichever occurs first.

iv. If the Conflict-Free Case Management Waiver application is denied, the Department will coordinate with the Case Management Agency for a transition period, if necessary.

v. If a Case Management Agency requires a waiver between Case Management Agency contract cycles, the Case Management Agency must submit the application for the Conflict Free Case Management Waiver and maintain the documentation for the next RFP submission.

1) If the Conflict-Free Case Management Waiver application is approved, the Department will coordinate with the Case Management Agency for next steps in implementation and execution, if necessary.

2) If the Conflict-Free Case Management Waiver application is denied, the Department will coordinate with the Case Management Agency for a transition period within their contract period, if necessary.

vi. A Case Management Agency that is granted a Conflict-Free Case Management Waiver shall provide an annual report to the Department subject to Department approval that includes but will not be limited to:

1) a summary of individuals participating in direct services and Case Management;

2) how the Case Management Agency has ensured informed consent and/or choice, if other providers exist in the Defined Service Area; and

3) how the Case Management Agency continues to support the recruitment of willing and qualified providers in their Defined Service Area.

4) how the direct service provider functions and Case Management Agency functions are administratively separated (including staff) with safeguards in place to ensure a distinction between direct services and Case Management exists as a protection against conflict of interest.

vii. If a new service provider(s) becomes available in the area, the Case Management Agency may continue to provide direct services until the Department has determined that the alternate provider(s) is capable of meeting all needs in that service area.

viii. If other service providers are available in the area, the Case Manager must document the offering of choice of provider and/or that no provider had capacity to serve new Members in the Information Management System.

ix. To ensure conflict of interest is being mitigated by the Case Management Agency, the Department will conduct annual quality reviews that will include but not be limited to, reviews of documentation of Members' choice of provider and informed consent for services.

8.7201.BCase Management Agency Governing Body

1. Each Case Management Agency shall assemble a governing body or board of directors that complies with requirements in Section 25.5-6-1708 C.R.S.

a. The Case Management Agency shall maintain all meeting agendas, minutes, and documents that are required to be posted on the Case Management Agency's website for at least three months after posting.

b. The Case Management Agency shall maintain all contracts, financial statements, and 990s that are required to be posted on the Case Management Agency's website on its website for at least three calendar years after posting.

c. The Case Management Agency shall not screen or divert any email that is sent to a member of the board of directors or governing body of a Case Management Agency. The Case Management Agency shall ensure that all emails addressed to a member of the board of directors or governing body are delivered to that member.

i. In the event a member of the board of directors or governing body is unable to access a computer or needs assistance with email, the Case Management Agency shall provide appropriate assistance, including providing emails in alternative formats upon request or mailing correspondence through the U.S. postal service.

d. The Department shall maintain a website form for community members to make anonymous Complaints regarding the Case Management Agency compliance with the transparency requirements in C.R.S. 25.5-6-1708. The Case Management Agency and its governing body shall comply with the Department's direction for responding to all Complaints.

2. The Case Management Agency governing body function shall include but not be limited to:

a. Financial oversight and solvency

b. Ensuring accountability and the provision of high quality Case Management

c. Ensuring a working Community Advisory Committee convenes at least quarterly

d. Resolving disputes between individuals, Members and Case Management Agency that are elevated to the governing body and

e. Developing and presenting the Long-Range Plan annually to the Department

f. Ensuring adherence to all state and federal regulations and contractual obligations and requirements.

8.7201.CCommunity Advisory Committee

1. The Case Management Agency shall establish and maintain a community advisory committee for the purpose of providing public input for Case Management Agency operations.

2. The Community Advisory Committee Responsibilities shall include:

a. Monthly review of Case Management Agency Complaint log

b. Receiving Complaints from the community regarding the Case Management Agency via open forum at their meetings

c. Supporting Case Management Agency in resolving Complaints with Members, including Referral to the Department's escalation process

d. Making recommendations to the Case Management Agency about policies and procedures, and

e. Providing public input and guidance to the Case Management Agency in the review of service delivery policies and procedures, marketing strategies, resource development, overall Case Management Agency operations, service quality, individual Member satisfaction, resolution of Complaints at the local level and other related professional problems or issues.

3. Community Advisory Committee Membership

a. The Case Management Agency shall demonstrate efforts to recruit and support members of the Community Advisory Committee who represent the characteristics of the community as it relates to diversity of race, color, ethnic or national origin, ancestry, age, sex, gender, sexual orientation, gender identity and expression, religion, creed, abilities, and disabilities, and socio-economic status.

b. The membership of the Community Advisory Committee shall include regional representation from, but not be limited to, at least one of each of the following:

i. The Defined Service Area's county commissioners, area agencies on aging, medical professionals, physical and/or intellectual disability professionals, ombudsmen, human service agencies, county government officials, mental/behavioral health professionals, and

ii. Regional representation from one or more Long-Term Services and Supports Members or Family Members of individuals receiving Long-Term Services and Supports including Members with I/DD and/or Members with disabilities.

1) Members shall be given priority of selection over Family Members.

iii. The Case Management Agency shall make every effort to recruit and maintain a majority of members or people with lived experience on the Community Advisory Committee over professionals as outlined in 8.7201.C.3.b.i-ii. If the Case Management Agency is unable to maintain this majority, the Case Management Agency shall submit the attempts at recruitment with their annual report to the Department.

c. The Community Advisory Committee shall have a membership count and quorum based on the number of people served. The quorum must include a majority of Members or people with lived experience.

i. Case Management Agencies serving 400-2000 people will have a committee membership count of 5 minimum with a quorum of 3.

ii. Case Management Agencies serving 2001-7000 people will have a committee membership of 7 minimum with a quorum of 4.

iii. Case Management Agencies serving 7001 or more people will have a committee membership of 9 with a quorum of 5.

d. In the event a Community Advisory Committee is comprised of greater than the minimum number of committee members, the quorum shall be a simple majority.

i. If the quorum is not reached, the meeting may continue but the committee must abstain from final recommendation votes until the quorum is met.

4. The Community Advisory Committee shall function only as an advisory body providing recommendations to the Case Management Agency and Case Management Agency governing body and shall have no decision-making power.

5. The Case Management Agency shall train the Community Advisory Committee members in confidentiality, mandatory reporting and disability cultural competency.

6. The Community Advisory Committee shall maintain public notices in accordance with confidentiality requirements of the following: meetings, meeting minutes, and documentation of actions taken in response to recommendations and Complaints. Public notices of meetings shall be made available online and by request for increased equitable access.

7. The Community Advisory Committee shall provide options for equitable access to meetings including live, online audiovisual access to meetings.

8. The Community Advisory Committee shall report to the Case Management Agency governing body quarterly on all Case Management complaints trends and documentation of actions taken in response to recommendations and complaints. These reports shall be made public.

9. The Community Advisory Committee shall provide reports to the Department and its committees upon request. These reports shall be made public.

10. The Community Advisory Committee may be combined in purpose or name with other Case Management Agency committees in the Case Management Agency Defined Service Area so long as it meets the above purpose, criteria and reporting requirements.

11. The Case Management Agency must provide an annual summary of the Community Advisory Committee's activities over the prior year in its Long Range Plan and presentation to the Department

8.7201.DCase Management Agency Complaint Process for Individuals and Members

1. Every Case Management Agency shall use the Department prescribed Case Management Agency Complaint log and have procedures setting forth a process for the timely resolution of Complaints received from a Member, Parent(s) of a minor, Guardian and/or other Legally Authorized Representative, as appropriate. The Case Management Agency shall not take any action that affects the future provision of appropriate services or supports based on the receipt of a Complaint from a Member or their Parent, Guardian or representative.

2. The procedure shall be provided, orally and in writing and in the communication method of the member's or guardian's choosing, to all Members, the Parents of a minor, Guardian and/or other Legally Authorized Representative, as appropriate, at the time of admission, at any time changes to the procedure occur and as part of the annual service planning process.

3. The Case Management Agency shall make all Complaint procedures available on their public facing website.

4. The Complaint procedure shall include, at a minimum, the following:

a. Contact information for a person within the Case Management Agency who will receive Complaints.

b. Identification of support person(s) who can assist the individual or Member in submitting a Complaint.

c. An opportunity to find a mutually acceptable solution. This could include the use of mediation if both parties voluntarily agree.

d. Timelines for resolving the Complaint.

e. Escalation of the Complaint to the Agency director or designee for consideration if the Complaint cannot be resolved at a lower level. This may include the Department escalation process, if necessary.

f. Assurances that no Member shall be coerced, intimidated, threatened, or retaliated against because the Member has exercised his or her right to file a Complaint or has participated in the Complaint process.

g. Review of redacted Complaint log and resolutions with the Community Advisory Committee.

5. The Department shall review the Complaint procedure and logs annually to ensure appropriate resolution of Complaints and provide feedback and follow up to Case Management Agency as necessary.

6. If an Agency goes without Complaints for more than two years, the Department shall require the Case Management Agency to complete a statistically valid customer satisfaction survey each year for each of the following two years.

7. The Department shall maintain a website form for community Members to make anonymous Complaints regarding the Case Management Agency.

8.7201.EPersonnel System

1. The Case Management Agency shall have a system that complies with all rules, regulations, and Department communications for recruiting, retaining, hiring, evaluating, and terminating Case Management Agency employees including but not limited to

a. Colorado Bureau of Investigations criminal history background check

b. Colorado Adult Protective Services data system checks, and

c. Verification of compliance with applicable state regulations.

2. Case Management Agency employment policies and practices shall comply with all federal and state affirmative action and civil rights requirements.

3. The Case Management Agency shall maintain a current job description for each employment position.

8.7201.FStaffing Patterns

1. Each Case Management Agency shall assure adequate staffing levels and infrastructure, including maintaining caseload sizes or ratios as set forth in contract, to effectively manage the Case Management Agencies' s caseload to ensure timely delivery of high-quality services. This includes at least one full-time Case Manager to provide Case Management functions and administrative support, and, as needed, additional Case Managers, case aids, supervisors, and other staff.

2. Within their staffing patterns, Case Management Agencies shall publicly post its policies and procedures and provide choice of Case Manager to Members served in their Defined Service Area and shall clearly communicate to each individual and Member the steps for requesting a new Case Manager.

3. Case Management Agencies shall maintain staffing patterns in accordance with Department prescribed best practices for Long-Term Services and Supports Case Manager-level caseloads for all Targeted Case Management Activities and shall comply with all contractual requirements.

a. Case Management Agency shall not exceed the best practice standards for HCBS waiver caseload sizes without written approval from the Department.

4. Case Management Agencies shall ensure staff have access to statutes and regulations relevant to the provision of authorized services.

5. For each individual Members, Case Management Agencies shall assign one (1) primary Case Manager or point of contact who ensures Case Management services are provided on behalf of the Member or individual across all programs. Case Management Agencies must maintain a best practice standard in their policies and procedures for notification of a Member when a new Case Manager is assigned to a Member.

6. Case Management Agencies shall ensure persons who are employed by the Agency meet the requirements of these regulations.

7. Case Management Agencies shall verify and document that Case Managers who are employed meet minimum requirements and qualifications.

8. Case Management Agencies and their staff shall avoid situations that create the potential for a real or perceived conflict of interest. If a situation that may involve potential conflict of interest cannot be avoided, staff shall notify affected parties of possible the conflict of interest and policies and procedures in place to ensure protection of the Member or individual's rights.

8.7201.GCase Management Agency Communication and Documentation

1. The Case Management Agency shall:

a. Comply with all reporting and billing policies and procedures established by the Department, document individual and Member records within the Department's prescribed systems and adhere to the system requirements provided by the Department for these systems.

b. Have access to Member eligibility, Prior Authorization Request (PAR), and claims data reporting provided through a data query application, program eligibility determination, Financial Eligibility determination, Person-Centered Support Planning, service authorization, Critical Incident reporting and follow-up, monitoring of health and welfare, monitoring of services, information and Referral services provided by the Agency, Complaint trends and resolutions, resource development and fiscal accountability.

c. Maintain individual and Member records within the Department's prescribed systems for the purposes of individual and Member information management.

d. Maintain accurate and detailed documentation of all Case Management and State General Fund Program activities required by the Case Management Agency Contract and these rules.

e. Maintain accurate and detailed supporting documentation in the Department's prescribed system within ten (10) business days of all activities as required through the Case Management Agency Contract and these rules to substantiate claims for reimbursement.

f. Provide supporting documentation not already residing within the Department's prescribed systems to the Department upon request

g. Correct one hundred percent (100%) of data errors, discovered by the Department, and confirm the accuracy of the data it enters into the Department prescribed system within ten (10) Business Days of notification from the Department of an error.

h. Provide information and reports as required by the Department including, but not limited to, data and records necessary for the Department to conduct operations.

2. The Case Management Agency shall have adequate phone and computer hardware and software for communication with Members, individuals, employees and stakeholders, compatible with the Information Management System with such capacity and capabilities as prescribed by the Department to manage the administrative requirements necessary to fulfill the Case Management Agency responsibilities.

3. The Case Management Agency shall have adequate staff support to maintain a computerized information system in accordance with the Department's requirements.

8.7201.HCase Management Agency Individual and Member Recordkeeping

1. The Case Management Agency shall complete and maintain all required records in the Information Management System in accordance with program requirements and Department training or communication and shall maintain individual records at the Agency level for any additional documents associated with the individual seeking or enrolled in a Long-Term Services and Supports program or service.

2. The Case Manager shall use the Information Management System for purposes of documentation of all case activities, monitoring of service delivery, and service effectiveness. If applicable, the individual's Legally Authorized Representative shall be identified in the record, with a copy of appropriate documentation.

3. The Case Management Agency may accept physical or digital signatures on Department forms. If the individual is unable to sign a form requiring his/her signature because of a medical condition, any mark the individual is capable of making shall be accepted in lieu of a signature. If the individual is not capable of making a mark or performing a digital signature, the physical or digital signature of a Guardian or other Legally Authorized Representative shall be accepted.

4. The case records shall include:

a. Information identifying the individual, including the individual's state Medicaid identification number, date of birth (DOB), social security number (SSN) if applicable, address and phone number;

b. Forms required by the Department for the specific program in which the individual is enrolled; and

c. Documentation of all Case Management activity;

d. Any communication accommodations necessary for the Member or Guardian.

5. The Department shall examine the Case Management Agency's documentation practices when monitoring the Case Management Agency's performance.

6. Records pertaining to persons seeking or receiving services shall be maintained in accordance with these rules and other applicable federal and state regulations and accreditation standards. Where no superseding regulation or policy applies, records may be purged and destroyed per Agency policy.

7. A Case Management Agency shall designate an employee who shall be responsible for the record at all times during the examination of the record by entities other than employees of that Agency.

8. Records shall be made available for review at the Agency to authorized persons within a reasonable period of time as negotiated by the Agency and the party seeking access.

9. At no time may a person examining a record remove anything from it or otherwise make changes in it, except as delineated below:

a. If the person seeking or receiving services, Parent of a minor, Guardian or other Legally Authorized Representative, if within the scope of his/her authority, objects to any information contained in the record, he/she may submit a request for changes, corrections, deletions, or other modifications.

b. The person seeking or receiving services, Parent of a minor, Guardian or other Legally Authorized Representative shall sign and date the request.

c. The Agency administrator shall make the final determination regarding the request and shall notify the requesting party of the decision.

d. If the Agency administrator denies the request, then the requestor has the right to have a statement regarding their request entered into the record.

10. Records or portions of records may be photocopied or otherwise duplicated only in accordance with written Agency procedures, and any fee for duplication shall be reasonable pursuant to section 24-72-205, C.R.S.

11. The Case Management Agency shall provide a Member one free copy of any information contained in their record upon request.

12. The Case Management Agency shall maintain records for seven (7) years after the date a Member discharges from a waiver program, including all documents, records, communications, notes and other materials related to services provided and work performed.

8.7201.IConfidentiality of Information

1. The Case Management Agency shall protect the confidentiality of all records of individuals seeking and receiving services required by Section 26-1-114(3)(a)(I), C.R.S. and 45 C.F.R., Parts 160 and 165, Subparts A and C (HIPAA). Release of information forms obtained from the individual must be signed, dated, and kept in the Member's record. Release of information forms shall be renewed at least annually, or with the new Provider Agency whenever there is a change of provider. Fiscal data, budgets, financial statements and reports which do not identify individuals by name or Medicaid ID number, and which do not otherwise include Protected Health Information, are subject to disclosure pursuant to the Colorado Open Records Act, Title 24, Article 72, Part 2, C.R.S.

2. Identifying information regulated by this rule is any information which could reasonably be expected to identify the individual seeking or receiving services or their Family or contact persons, including, but not limited to, name, Social Security number, Medicaid Member identification number, household number or any other identifying number or code, street address, and telephone number, photograph or digital image, or any distinguishing mark. Identifying numbers assigned and used internally within a single Agency shall be excluded from this regulation.

3. At the time of eligibility determination and enrollment, the individual, parent of a minor, Guardian and/or other person acting as an advisor to the person shall be advised of the type of information collected and maintained by the Agency, and to whom and when it is routinely disclosed.

4. This rule applies to confidential information in any format including, but not limited to, individual records, correspondence or other written materials, verbal communication, photographs, and electronically stored data.

5. The records and all other documentation or correspondence concerning individuals seeking or receiving services are the property of the Agency which is responsible for maintaining and safeguarding their contents.

6. All written authorizations referenced within this chapter must be:

a. Signed and dated;

b. For a specified time period;

c. Specific as to the information or photograph or digital image to be disclosed and the intended use of such information or photograph; and,

d. Specific as to whom it will be disclosed.

7. Authorizations may be revoked in writing or verbally at any time by the person who provided the authorization.

8. Disclosure of confidential information shall be limited to:

a. The individual seeking or receiving services, Parent of a minor, or Guardian.

b. Persons or entities presenting written authorization signed by the person seeking or receiving services, Parent of a minor, or Guardian.

c. The Legally Authorized Representative of the person seeking or receiving services as defined in Section 8.7001.A.7, if access to confidential information is within the scope of their authority.

d. Qualified professional personnel of community centered boards, regional centers and other service agencies including boards of directors and Human Rights Committee Members to the extent necessary for the acquisition, provision, oversight, or Referral of services and supports.

e. The Department or its designees as deemed necessary by the Executive Director to fulfill the duties prescribed by Title 25.5, Article 10 of Colorado Revised Statutes.

f. To the extent necessary, qualified professional personnel of authorized external agencies whose responsibility it is to license, to accredit, to monitor, to approve or to conduct other functions as designated by the Executive Director of the Department.

g. Physicians, psychologists, and other professionals providing services or supports to a person in an emergency situation which precludes obtaining consent in such an instance:

i. Documentation of this access shall be entered into the person's record.

ii. This documentation shall contain the date and time of the disclosure, the information disclosed, the names of the persons by whom and to whom the information was disclosed, and the nature of the emergency.

h. The court or persons authorized by an order of the court, issued after a hearing, notice of which was given to the person, Parents of a minor or legal Guardian, where appropriate, and the custodian of the information.

i. Other persons or entities authorized by law; and,

j. The entity designated as the protection and advocacy system for Colorado pursuant to 42 U.S.C. § 604 when:

i. A Complaint has been received by the protection and advocacy system from or on behalf of a person with a Developmental Disability; and,

ii. Such person does not have a legal Guardian or the state or the designee of the state is the legal Guardian of such person.

9. Nothing in this regulation should be taken to mean that a person or entity who is authorized to access confidential information regarding an individual per Section 8.606.2.A is authorized to access any and all confidential information available regarding that individual. Disclosure of confidential information must be limited to the information which is necessary to perform the duties of that person or entity requiring access. The individual seeking or receiving services, Parent of a minor, or Guardian may access any and all aspects of that person's record. The Legally Authorized Representative of an individual may access those aspects of a person's record that are within the scope of their authority.

8.7201.JPreservation of Member Rights

1. Case Management Agencies shall have policies and procedures that assure the preservation of Member rights contained in Sections 25.5-10-216 through 240, C.R.S. and 8.7001.

a. The Case Management Agency shall assure the protection of the rights of Members as defined by the Department under applicable programs, including but not limited to Section 8.7001.

b. The Case Management Agency shall assure that the following rights are preserved for all individuals served by the Case Management Agency, whether the individual is a recipient of a state-administered program or a private pay individual:

i. The individual and/or the individual's Legally Authorized Representative, as necessary, is fully informed of the individual's rights and responsibilities;

ii. The individual and/or the individual's Legally Authorized Representative participates in the development and approval of, and is provided a copy of, the individual's Person-Centered Support Plan;

iii. The individual and/or the individual's Legally Authorized Representative selects service providers from among available qualified and willing providers;

iv. The individual and/or the individual's Legally Authorized Representative has access to a uniform Complaint system provided for all individuals served by the Case Management Agency; and

v. The individual who applies for or receives publicly funded benefits and/or the individual's Legally Authorized Representative has access to a uniform appeal process, which meets the requirements of Section 8.057, when benefits or services are denied or reduced and the issue is appealable.

2. Members shall have the right to read or have Case Management Agency explain any rules or regulations adopted by the Department and policies and procedures of the Case Management Agency pertaining to such persons' activities, services and supports, or to obtain copies of Title 25.5 Article 10, C.R.S., rules, policies or procedures at no cost or at a reasonable cost in accordance with Section 24-72-205, C.R.S..

3. Case Management Agencies shall inform Members, Parents of minors, Guardians and other Legally Authorized Representatives of the rights provided in Title 25.5, C.R.S., and:

a. Case Management Agencies shall provide a written and verbal summary of rights and a description of how to exercise them, at the time of eligibility determination, at the time of enrollment, and when substantive changes to services and supports are considered through the Individualized Planning process.

b. The information shall be provided in a manner that is easily understood, verbally and in writing, in the native language of the individual, or through other modes of communication as may be necessary to enhance understanding for the Member.

c. Case Management Agencies shall provide assistance and ongoing instruction to Members in exercising their rights.

4. Case Management Agencies shall ensure that no individual, Member, their Family Members, Guardian or other Legally Authorized Representatives, are retaliated against in their receipt of Case Management services, direct services or supports or otherwise as a result of attempts to advocate on their own behalf.

5. Case Management Agency employees and Contractors must be made aware of the rights of Members and procedures for safeguarding these rights.

8.7201.KMember Access to Case Management Agency

1. Case Management Agencies shall have policies and procedures that assures compliance with all federally mandated requirements for access to services.

a. In accordance with the Americans with Disabilities Act (ADA), 42 U.S.C. 12101 et seq. there shall be no physical or programmatic barriers which prohibit individual participation,

b. The Case Management Agency shall not require Members to come to the Agency's office in order to receive Case Management Agency services.

c. The Case Management Agency shall comply with nondiscrimination requirements, as defined by federal and Department rules and outlined in contract.

d. Case Management Agency functions shall be provided in a person-centered model of Case Management service delivery.

e. Case Management Agencies shall complete a Level of Care Screen when it is requested by the Member or individual in accordance with Member rights, even if the Case Management Agency staff does not believe the individual will be deemed eligible.

f. The Case Management Agency shall have office location(s) and building office hours in accordance with written requirements in Case Management Agency contract and in accordance with Americans with Disabilities Act (ADA), 42 U.S.C. 12101 et seq.

8.7201.L.Incident Reporting

1. Case Management Agencies shall have a written policy and procedure for the timely reporting, recording and reviewing of Incidents occurring on the Case Management Agency property or care which shall include, but not be limited to:

a. Allegations of abuse, mistreatment, neglect, or exploitation;

b. Serious Illnesses and injuries to a person receiving services that require intervention that is above and beyond basic first aid;

c. Lost or missing persons receiving services;

d. Medical emergencies involving Members that require intervention that is above and beyond basic first aid or that are not screened out by medical professionals;

e. Hospitalization of Members;

f. Death of Members;

g. Errors in medication administration; and,

h. Stolen personal property belonging to a Member.

2. Reports of Incidents shall include, but not be limited to:

a. Name of the person reporting;

b. Name of the Member who was involved in the Incident;

c. Name of persons involved or witnessing the Incident;

d. Type of Incident;

e. Description of the Incident;

f. Date and place of occurrence;

g. Duration of the Incident;

h. Description of the action taken in response to the incident;

i. Whether the Incident was observed directly or reported to the Case Management Agency;

j. Names of persons notified;

k. Follow-up action taken or where to find documentation of further follow-up; and,

l. Name of the person responsible for follow-up.

3. Case Management Agencies shall ensure all staff are trained to identify Critical Incident Reporting criteria according to the Agency's written policy and procedure and Department requirements.

4. Case Management Agencies shall ensure staff are trained to identify Incidents that are required to be reported to Colorado Department of Public Health and Environment (CDPHE).

5. Incidents meeting Critical Incident Reporting criteria, including but not limited to, Allegations of mistreatment, abuse, neglect and exploitation, and injuries which require emergency medical treatment or result in hospitalization or death shall be reported by the Case Management Agency in the Department's prescribed system within 24 hours or 1 business day of being reported.

6. The Case Management Agency shall place in the Member's record reports of Incidents not meeting Critical Incident Reporting criteria.

7. The Case Management Agency shall provide records of Incidents not meeting Critical Incident Reporting criteria to the Department upon request.

8. Case Management Agencies shall review and analyze information from Incident reports to identify trends and problematic practices which may be occurring in specific services and shall take appropriate action to report Complaints as necessary.

8.7201.MMistreatment, Abuse, Neglect, and Exploitation

1. Pursuant to Section 25.5-10-221, C.R.S., all Case Management Agencies shall prohibit mistreatment, abuse, neglect, or exploitation of any individual and or Member.

2. Case Management Agencies shall have written policies and procedures for handling cases of alleged or suspected mistreatment, abuse, neglect, or exploitation of any individual and or Member. These policies and procedures must be consistent with state law and:

a. Definitions of mistreatment, abuse, neglect, or exploitation must be consistent with state law and these rules;

b. Provide a mechanism for monitoring to detect instances of mistreatment, abuse, neglect, or exploitation. Monitoring is to include, at a minimum, the review of:

i. Incident reports;

ii. Verbal and written reports of unusual or dramatic changes in behavior(s) of Members; and,

iii. Verbal and written reports from Members, advocates, families, Guardians, and friends of Members.

c. Provide procedures for reporting, reviewing, and collaborating with Adult/Child Protection Services, and law enforcement entities/representatives for investigating all allegations of mistreatment, abuse, neglect, or exploitation;

d. Ensure that appropriate disciplinary actions up to and including termination, and appropriate legal recourse are taken against employees and Contractors who have engaged in mistreatment, abuse, neglect, or exploitation;

e. Shall procure a memorandum of understanding (MOU) with local Adult/Child Protection Services, and Law Enforcement, and Provider Agencies outlining roles and responsibilities as well as outline standard practices for reporting and mitigating risk for Members.

f. Ensure that employees and Members receiving services and Contractors are made aware of applicable state law and Agency policies and procedures related to mistreatment, abuse, neglect or exploitation;

g. Require immediate reporting by employees and Contractors according to Agency policy and procedures and to the Agency administrator or his/her designee;

h. Require reporting of allegations within 24 hours of learning of the Incident to appropriate authorities, recording in Information Management System, reporting to the Parent of a minor, Guardian, or other Legally Authorized Representative, and Case Management Agency;

i. Require timely reporting of Critical Incident Report follow-up and reporting of actions taken by caregivers, Provider Agencies, DHS, and Law Enforcement to protect the Member receiving services. Case Management Agencies shall ensure prompt action to protect the safety, as well as, mental and physical health of the Member. Such action may include any action that would protect the Member(s) receiving services if determined necessary and appropriate by the Provider Agency or Case Management Agency pending the outcome of the investigation. Actions may include, but are not limited to, removing the Member from his/her residential and/or day services setting and removing or replacing staff;

j. Require advocating for Referral to victim support and protective orders for Members as applicable to the mistreatment, abuse, neglect, or exploitation. Provide necessary victim supports;

k. Require prompt reporting of the allegation to appropriate authorities in accordance with statutory requirements and pursuant to Section 8.7201.M.3;

l. Ensure Human Rights Committee review of all allegations; and,

m. Ensure that no individual is coerced, intimidated, threatened or retaliated against because the individual, in good faith, makes a report of suspected mistreatment, abuse, neglect or exploitation or assists or participates in any manner in an investigation of such allegations in accordance with Section 8.7201.M.3.

3. Case Management Agencies shall develop relationships with local authorities required to investigate mistreatment, abuse, neglect, and exploitation. All alleged Incidents of abuse, mistreatment, neglect, or exploitation shall be thoroughly investigated in a timely manner using the specified investigation procedures. However, such procedures must not be used in lieu of investigations required by law or which may result from action initiated pursuant to Section B, above.

a. Within 24 hours of becoming aware of the Incident, a Critical Incident report shall be made available to the Agency administrator or designee and the Case Management Agency.

b. The Agency shall maintain a written administrative record of all such investigations including:

i. The Incident report and preliminary results of the investigation;

ii. A summary of the investigative procedures utilized;

iii. The full investigative finding(s);

iv. The actions taken; and,

v. The Human Rights Committee review of the investigative report and the action taken on recommendations made by the committee.

c. The Agency shall ensure that appropriate actions are taken when an allegation against an employee or Contractor is substantiated, and that the results of the investigation are recorded, with the employee's or Contractor's knowledge, in the employee's personnel or Contractor's file.

10 CCR 2505-10-8.7201

47 CR 03, February 10, 2024, effective 3/16/2024

47 CR 23, December 10, 2024, effective 12/30/2024