10 Colo. Code Regs. § 2505-10-8.7560

Current through Register Vol. 47, No. 24, December 25, 2024
Section 10 CCR 2505-10-8.7560 - State Funded Supported Living Services (State-SLS) Program
1. The State Funded Supported Living Services (State-SLS) program is funded through an allocation from the Colorado General Assembly. The State-SLS program is designed to provide services to individuals with an intellectual or Developmental Disability to remain in their community. The State-SLS program shall not supplant Home and Community-Based Services for those who are currently eligible.
8.7560.AState-SLS Definitions
1. Corrective Action Plan means a written plan, which includes the detailed description of actions to be taken to correct non-compliance with State-SLS requirements, regulations, and direction from the Department, and includes the date by which each action shall be completed and the individuals responsible for implementing the action.
2. Community Resource means services and supports that a Member may receive from a variety of programs and funding sources beyond Natural Supports or Medicaid. This may include, but is not limited to, services provided through private insurance, non-profit services and other government programs.
3. Natural Supports means an informal relationship that provides assistance and occurs in the Member's everyday life including, but not limited to, community supports and relationships with Family Members, friends, co-workers, neighbors and acquaintances
4. Performance and Quality Review means a review conducted by the Department or its Contractor at any time to include a review of required Case Management services performed by the Case Management Agency to ensure quality and compliance with all statutory and regulatory requirements
5. State Fiscal Year means a 12-month period beginning on July 1 of each year and ending June 30 of the following calendar year.
8.7560.BState-SLS Administration
1. The Case Management Agency (CMA) shall administer the State Supported Living Services (State-SLS) program according to all applicable statutory, regulatory and contractual requirements, and Department policies and guidelines.
a. The Case Management Agency is responsible for providing Case Management to all individuals enrolled in the State-SLS program.
b. The Case Management Agency shall have written procedures related to the administration, Case Management, service provision, and waiting list for the State-SLS program.
c. All records must be maintained in accordance with Section 8.7405.
d. The Case Management Agency shall maintain a waiting list of eligible individuals for whom Department funding is unavailable in accordance with Section 8.7560.G.
e. The Case Management Agency shall develop procedures for determining how and which individuals on the waiting list will be enrolled into the State-SLS program that comply with all applicable statutory, regulatory and contractual requirements including Section 8.7560.G.
f. Any decision to modify, reduce or deny services or supports set forth in the State-SLS program, without the Individual's or Legally Authorized Representative's agreement, are subject to the requirements in Section 8.7202.S.
2. Member Eligibility
a. General Eligibility requirements
i. Individuals must be a resident of Colorado;
ii. Be eighteen (18) years of age or older; and
iii. Be determined to have an intellectual or Developmental Disability pursuant to the procedures set forth in Section 8.7202.D.
b. Eligibility for the State-SLS program does not guarantee the availability of services under this program.
3. General Provisions
a. The availability of services offered through the State-SLS program may not be consistent throughout the State of Colorado or between Case Management Agencies.
b. An individual enrolled in the State-SLS program shall access all benefits available under the Medicaid State Plan, HCBS Waiver or EPSDT, if available, prior to accessing services under the State-SLS program. Services through the State-SLS program may not duplicate services provided through the State Plan when available to the Member.
c. Evidence of attempts to utilize all other public benefits and available and accessible community resources must be documented in the State-SLS individualized Support Plan by the Case Manager, prior to accessing State-SLS services or funds.
d. The State-SLS program shall be subject to annual appropriations by the Colorado General Assembly.
e. These regulations shall not be construed to prohibit or limit services and supports available to persons with Intellectual and Developmental Disabilities that are authorized by other state or federal laws.
f. When an individual is enrolled only in the State-SLS program the Case Manager shall authorize a Provider Agency to deliver the services, when available.
g. The Case Manager may authorize services from multiple State-SLS service categories at once, unless otherwise stated.
h. Unless otherwise specified, State-SLS services may be utilized in combination with other community resources and/or Medicaid services. State-SLS services shall not be duplicative of other resources or HCBS services, and all other available and accessible resources shall be utilized before State-SLS services.
4. Performance and Quality Review
a. The Department shall conduct a Performance and Quality Review of the State-SLS program to ensure that the Case Management Agency is in compliance with all statutory and regulatory requirements.
b. A Case Management Agency found to be out of compliance shall be required to develop a Corrective Action Plan, upon written notification from the Department. A Corrective Action Plan must be submitted to the Department within 10 business days of the date of the written request from the Department. A Corrective Action Plan shall include, but is not limited to:
i. A detailed description of the actions to be taken to remedy the deficiencies noted on the Performance and Quality Review, including any supporting documentation;
ii. A detailed timeframe for completing the actions to be taken;
iii. The employee(s) responsible for implementing the actions; and
iv. The estimated date of completion.
c. The Case Management Agency shall notify the Department in writing, within 3 business days if it will not be able to present the Corrective Action Plan by the due date. The Case Management Agency shall explain the reason for the delay and the Department may grant an extension, in writing, of the deadline for the submission of the Corrective Action Plan.
i. Upon receipt of the proposed Corrective Action Plan, the Department will notify the Case Management Agency in writing whether the Corrective Action Plan has been accepted, modified, or rejected.
ii. In the event that the Corrective Action Plan is rejected, the Case Management Agency shall re-write the Corrective Action Plan and resubmit along with the requested documentation to the Department for review within five (5) business days.
iii. The Case Management Agency shall begin implementing the Corrective Action Plan upon acceptance by the Department.
iv. If the Corrective Action Plan is not implemented within the timeframe specified therein, funds may be withheld or suspended.
8.7560.CState-SLS Inclusions and Covered Services
1. Services for individuals waiting for HCBS waiver enrollment.
a. Eligible Members may receive the following services:
i. All HCBS Waiver Services identified as available to Members enrolled in the SLS waiver as identified throughout section 8.7500 et seq.
ii. Service limitations in the HCBS SLS waiver and set forth in section 8.7500 et seq. apply to the State-SLS program.
iii. When a Provider Agency is not available to provide services, the Case Management Agency may authorize the services identified in the State-SLS Individual Support Plan.
2. Services for Individuals Experiencing Emergency Situations or Temporary Hardships
a. State-SLS may be utilized to provide the following emergency or temporary services to individuals who have been determined to meet the criteria for an Intellectual / Developmental Disability as specified in Section 8.7202.D, in situations where temporary assistance can alleviate the need for a higher Level of Care. These services cannot be duplicative and shall not be accessed if available through other sources. In order to access State-SLS, an Individual Support Plan must be completed.
i. Payment of utilities:
1) Paying gas/electric bills and/or water/sewer bills:
a) Documentation must be maintained by the Case Management Agency that all alternative programs, community support, and natural supports were utilized before any State-SLS funds were authorized.
ii. Services with acquiring emergency food, at a retail grocery store when there are no other community resources available
1) Documentation must be maintained by the Case Management Agency demonstrating the reason why State-SLS funds were utilized over other sources of emergency food. This may include but is not limited to:
a) Other emergency food programs are not available.
b) Home delivered meals have unexpectedly stopped.
iii. Pest infestation abatement:
1) Documentation must be maintained by the Case Manager showing that infestation abatement is not covered under the Member's residential agreement or lease.
2) Documentation that the pest abatement professional is licensed in the state of Colorado, must be maintained by the Case Management Agency and provided to the Department upon request.
3) Pest infestation abatement shall not be authorized if the Member resides in a provider owned and/or controlled property.
4) Documentation showing proof of payment must be maintained by the Case Management Agency administering the State-SLS program.
b. Service Limitations
i. Support for utilities shall not exceed $1,000.00 in a State Fiscal Year.
ii. Support for pest infestation abatement shall not exceed $2,000.00 in a State Fiscal Year.
1) Supports for pest infestation abatement shall not cover more than one infestation event in a State Fiscal Year; and
2) Multiple treatments per event may be authorized, if determined necessary by a licensed pest abatement professional.
iii. Emergency food support shall not exceed $400.00 in a State Fiscal Year.
3. Services to Support Independence in the Community.
a. State-SLS may be utilized to provide an individual found eligible for or enrolled in an HCBS Medicaid waiver, with a one-time payment or acquisition of needed household items, in the event the Member is moving into a residence as defined in Section 8.7101.I.2.e.
i. State-SLS funds may be utilized for payment or acquisition of:
1) Initial housing costs including but not limited to a one-time initial set up for pantry items and/or kitchen supplies and/or furniture purchase.
ii. Individuals enrolled in the HCBS-DD waiver residing in a Group Residential Services and Supports (GRSS) or Individual Residential Services and Supports - Host Home (IRSS-HH) setting are not eligible for this Support.
b. State-SLS funds may support someone to have greater independence when they are moving into their own home, by paying for housing application fees.
c. The Case Management Agency shall maintain receipts or paid invoices for purchases authorized in this section. Receipts or paid invoices must contain at a minimum, the following information: business name, item(s) purchased, item(s) cost, date paid, and description of items purchased. Documentation must be made available to the Department upon request. All items must be purchased from an established retailer that has a valid business license.
d. Service limitations
i. The one-time furniture purchase shall not exceed $300.00.
ii. The one-time initial pantry set up shall not exceed $100.00.
iii. The one-time purchase of kitchen supplies shall not exceed $200.00.
iv. The payment of housing application fees are limited to five (5) in a State Fiscal Year.
4. On-going State-SLS Support.
a. State-SLS funds may be authorized by the Case Management Agency for individuals who have been determined to meet the DD Determination requirements, but do not meet the requirements to be enrolled in HCBS-SLS Waiver Section 8.7101.I.
i. All HCBS Waiver Services identified as available to Members enrolled in the SLS waiver as identified throughout Section 8.7500, et seq.
ii. Service limitations and service rules found in the HCBS-SLS eligible Waiver Services in Section 8.7500, et seq. apply to the State-SLS program.
iii. A Provider Agency is authorized to provide State-SLS services; and
b. When an individual is enrolled in an HCBS waiver, State-SLS services may be utilized in combination with other community resources and/or Medicaid services. State-SLS services shall not be duplicative of other resources or HCBS services, and all other available and accessible resources shall be utilized before State-SLS services.
i. Individuals enrolled in HCBS SLS and HCBS DD shall not use State SLS for ongoing services but may use State SLS for emergency services or temporary hardships only.
ii. Only a Provider Agency can provide these services.
c. Service Limitation
i. Total authorization limit for the plan year shall be determined by the Department and be communicated annually on the State-SLS Program rate schedule.
8.7560.D State-SLS Individual Support Plan
1. State-SLS Members are required to have a State SLS Individual Support Plan that is signed and authorized by the CMA Case Manager and the Member, or their Legally Authorized Representative.
2. The State-SLS Individual Support Plan shall be developed through an in-person face to face meeting that includes at least, the individual seeking services and the Case Manager. 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 Member (e.g. natural disaster, pandemic, etc.
3. If a Member seeks additional services or identifies a change in need, the State-SLS Individual Support Plan shall be reviewed and updated by the Case Manager prior to any change in authorized services.
4. The State-SLS Individual Support Plan shall be effective for no more than one year and reviewed at least every 6 months, in a face-to-face meeting with the Member or on a more frequent basis if a change in need occurs. 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 Member (e.g. natural disaster, pandemic, etc.)
a. Any changes to the provision of the services identified in the State-SLS Individual Support Plan are subject to available funds within the defined service area.
b. Any decision to modify, reduce or deny services set forth in the State-SLS Individual Support Plan, without the Member's consent is subject to the Dispute Resolution Process found in Section 8.7202.S.
5. The State-SLS Individual Support Plan and all supporting documentation will be maintained by the Case Manager and will be made available to the Department upon request.
6. The State-SLS Individual Support Plan shall include the following:
a. The services authorized, the Member's identified needs and how the services will address the needs.
b. The scope, frequency, duration, and cost of each service.
c. Other community resources being utilized.
d. Documentation demonstrating why the individual enrolled in State-SLS is not eligible or enrolled in a HCBS Medicaid waiver or documentation showing which HCBS waiver the individual is enrolled in;
e. Documentation demonstrating if other public or community resources have been utilized and why State-SLS funds are being utilized instead of or in combination with other resources.
f. Total cost of the services being authorized.
g. Information to support authorization of services for Individuals Experiencing Temporary Hardships, including:
i. A description of the hardship.
ii. The reason for the hardship.
iii. The length of time the support will be authorized, including the date of the onset of the hardship and the date it is expected to end.
iv. Total amount needed to support the individual and what other community resources are contributing.
v. A plan to reasonably ensure the hardship is temporary.
vi. A plan to reasonably ensure that dependence on State-SLS funds will be temporary.
vii. The dates of when the long-term solution will be in place and when the temporary hardship is expected to end.
viii. Documentation demonstrating how utilizing State-SLS funds will lead to the Member gaining more independence in the community or maintaining their independence in the community
8.7560.EState-SLS Case Management Services
1. Administration
a. The Case Management Agency shall comply with all requirements set forth in Section 8.7200, et seq.
2. Case Management Duties:
a. The Case Manager shall coordinate, authorize, and monitor services based on the approved State-SLS Individual Support Plan.
i. The Case Manager shall have, based on the Member's preference, a face to face or telephone contact once per quarter with the Member.
b. The Case Manager shall assist Members to gain access to other resources for which they are eligible and to ensure Members secure long-term support as efficiently as possible.
c. The Case Manager shall provide all State-SLS documentation upon the request from the Department.
d. Referrals to the State-SLS program shall be made through the Case Management Agency in the geographic defined service area the Member or Applicant resides in.
8.7560.FState-SLS Transferring Services Between Case Management Agencies
1. When an individual enrolled in, or on the waiting list for, the State-SLS program moves to another Case Management Agency's defined service area, and wishes to transfer their State-SLS, the following procedure shall be followed:
a. The originating Case Management Agency will contact the receiving Case Management Agency to inform them of the individual's desire to transfer.
b. The originating Case Management Agency will send the State-SLS Individual Support Plan to the receiving Case Management Agency, where the receiving Case Management Agency will determine if appropriate State-SLS funding is available or if the individual will need to be placed on a waiting list. The receiving Case Management Agency's decision of service availability will be communicated in the following way:
i. The receiving Case Management Agency will notify the individual seeking transfer of its decision by the individual's preferred method, no later than 10 business days from the date of the request; and
ii. The receiving Case Management Agency will notify the originating Case Management Agency of its decision by U.S. Mail, phone call or email of its decision no later than 10 business days from the date of the request.
c. The decision shall clearly state the outcome of the decision including:
i. The basis of the decision; and
ii. The contact information of the assigned Case Manager or waiting list manager.
d. The originating Case Management Agency shall contact the individual requesting the transfer no more than five days from the date the decision was received to:
i. Ensure the individual understands the decision; and
ii. Support the individual in making a final decision about the transfer.
e. If the transfer is approved, there shall be a transfer meeting in-person when possible, or by phone if geographic location or time does not permit, within 15 business days of when the notification of service determination is sent out by the receiving Case Management Agency. The transfer meeting must include but is not limited to the transferring individual and the receiving Case Manager. Any additional attendees must be approved by the transferring individual.
f. The receiving Case Management Agency must ensure that:
i. the transferring individual meets their primary contact of the receiving Case Management Agency.
ii. The individual is informed of the date when services will be transferred, when services will be available, and the length of time the services will be available.
g. The receiving Case Manager shall have an in-person face to face meeting with the Member to review and update the State-SLS Individual Support Plan, prior to the services being authorized. 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 Member (e.g. natural disaster, pandemic, etc.).
8.7560.GState-SLS Waiting List Protocol
1. Persons determined eligible to receive services under the State SLS program, shall be eligible for placement on a waiting list for services when state funding is unavailable.
2. Waiting lists for persons eligible for the State SLS program shall be administered by the Case Management Agency, uniformly administered throughout the State and in accordance with these rules and the Department's procedures.
3. Persons determined eligible shall be placed on the waiting list for services in the Case Management Agency service area of residency.
a. The date used to establish a person's placement on a waiting list shall be:
i. The date on which an individual is determined eligible for the State-SLS program through the DD Determination and the identification of need.
4. As funding becomes available in the State SLS program in a defined service area, persons shall be considered for services in order of placement on the local Case Management Agency's waiting list.
5. Individuals with no other State or Medicaid funded services or supports will be given priority for enrollment including individuals who lose Medicaid eligibility and lose Medicaid Waiver Services.
6. Exceptions to these requirements shall be limited to:
a. Emergency situations or temporary hardships where the health, safety, and welfare of the person or others is greatly endangered, and the emergency cannot be resolved in another way. Emergencies are defined as follows:
i. Homeless: the person will imminently lose their housing as evidenced by an eviction notice; whose primary residence during the night is a public or private facility that provides temporary living accommodations; any other unstable or non-permanent situation; is discharging from prison or jail; or is in the hospital and does not have a stable housing situation to go upon discharge.
ii. Abusive or Neglectful Situation: the person is experiencing ongoing physical, sexual, or emotional abuse or neglect in their present living situation and his/her health, safety or well-being are in serious jeopardy.
iii. Danger to Others: the person's behavior or psychiatric condition is such that others in the home are at risk of being hurt by them. Sufficient supervision cannot be provided by the current caretaker to ensure the safety of persons in the community.
iv. Danger to Self: a person's medical, psychiatric, or behavioral challenges are such that they are seriously injuring/harming themself or is an imminent danger of doing so.
v. Loss or Incapacitation of Primary Caregiver: a person's primary caregiver is no longer in the person's primary residence to provide care; the primary caregiver is experiencing a chronic, long-term, or life-threatening physical or psychiatric condition that significantly limits the ability to provide care; the primary caregiver is age 65 years or older and continuing to provide care poses an imminent risk to the health and welfare of the person or primary caregiver; or, regardless of age and based on the recommendation of a professional, the primary caregiver cannot provide sufficient supervision to ensure the person's health and welfare.
7. Documentation demonstrating how the individual meets the emergency criteria shall be kept on file at the Case Management Agency and made available to the Department upon request.
8.7560.HState-SLS Case Management Agency and Provider Agency Reimbursement
1. A Provider Agency must submit all claims, payment requests, and/or invoices to the Case Management Agency for payment within thirty (30) days of the date of service, except for Services and Supports rendered in June, the last month of the State Fiscal Year. All claims, payment requests, and/or invoices for services rendered in June must be submitted by the date specified by the Case Management Agency to ensure payment.
2. Case Management Agency must submit all claims, payment requests, and/or invoices in the format and timeframe established by the Department.
3. Case Management Agency and Provider Agency claims, payment requests, or invoices for reimbursement shall be made only when the following conditions are met:
a. Services are provided by a qualified Provider Agency.
b. Services are authorized and delivered in accordance with the frequency, amount, scope and duration of the service as identified in the Member's State-SLS Individual Support Plan;
c. Required documentation of the specific service is maintained and sufficient to support that the service is delivered as identified in the State-SLS Individual Support Plan and in accordance with the service definition;
d. All Case Management Activities must be documented and maintained by the Case Management Agency.
4. Case Management Agency and Provider Agencies shall maintain records in accordance with Sections 8.130.2 and 8.7405.
5. Case Management Agency and Provider Agency reimbursement shall be subject to review by the Department and may be completed after the payment has been made to the Case Management Agency and Provider Agency.
6. Case Management Agencies and Provider Agencies are subject to all program integrity requirements in accordance with Section 8.076.
7. The reimbursement for this service shall be established in the Department's published fee schedule.
8. Except where otherwise noted, Provider Agency reimbursement shall be based on a statewide fee schedule. State developed fee schedule rates are the same for both public and private provider agencies and the fee schedule and any annual/periodic adjustments to the fee schedule are published in the provider bulletin and can be accessed through the Department's fiscal agent's website.
a. State-SLS rates shall be set and published in the provider bulletin annually each State Fiscal Year.

10 CCR 2505-10-8.7560

47 CR 21, November 10, 2024, effective 11/30/2024