1

Case Management Agency Quarterly Meeting

September 2024

HCPF, CMA

Welcome

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CMQP Leadership Team

Amanda Lofgren - Case Management and Quality Performance Division Director

Michelle Topkoff - Case Management Section Manager

Rhyann Lubitz - Quality and Training Section Manager

Kidron Backes - Section Manager

Lori Thompson - CCM System Improvement Unit Supervisor

Brent Salner - Continuous Quality Improvement Unit Supervisor

Karli Altman - Training Unit Supervisor

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CMA Introductions

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CMA Introductions

Each Agency will have 5 minutes

1. Name of your agency
2. Who you are and your role
3. 3 things that you want to share about your agency, including a top win from CMRD

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Northeastern Colorado Association of Local Governments (NECALG) DSA 1

Sarah Christensen CMA Supervisor

Lori Araujo CMA Supervisor

• All but one person transferred over with the transition.
• We've created a collaborative work environment that emphasizes the need to work together and share information to achieve success.
• We’re determined to make this transition successful within our agency and with the members we serve.

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Prowers County Public Health DSA 2

Delaine Dunning CMA Supervisor

Sarah Settles

Case Managers: Zujey, Janet, Amy, Brandie, Nichole, Sarah, and Delaine

Administrative Assistant: Morgan

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We were in the first wave for the Redesign, so many changes as we went along and so far, we have survived.

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Otero County DSA 3

Anne Russell- CMA Supervisor

David Cobb - Team Lead

• We have great case managers who care about their members
• We have a good rapport with the agencies we work with
• We have continued retention

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Las Animas County DSA 4

Laura Ringo - Social Services Manager II

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Serves Las Animas County and Huerfano County

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Developmental Pathways DSA 5

Alyssa Pae, Director of Case Management

Amy Grogan, Vice President of Case Management

• Our teams have shared that getting to know and connect with new �members/families has been energizing and helps to ground us in our �shared why – in August we hosted another member/family full-day �open house where individuals could connect with various team �members to get their needs met.
• We hosted a case manager in office workday/engagement event for �DP teams, we had various supports available and walked through �demos of workarounds along with how to complete various tasks in �CCM. We also provided in-person training for how to use our recently rolled �out Caseload App (tool for case managers and supervisors to manage caseloads / core work outcomes).
• The picture we’ve included is from this connection space with our teams.
• Lastly, DP celebrated our 60th anniversary – we honored this milestone in varied ways, including a wonderful event for our teams and community partners.

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Rocky Mountain Human Services (RMHS) DSA 6

Kris Kogan, Deputy Operations Officer

Melisa Emery, Director of Case Management

• RMHS has many programs outside of our CMA programs: Homes for All Veterans, Momentum and Community Transitions, START (mental health crisis supports for children and adults w/IDD who live in Denver), and Mission Supports (support for adults w/IDD experiencing homelessness in Denver) to name a few.
• RMHS started in 1992 as Denver Options.
• Top win from CMRD: Strengthening partnerships with our fellow CMAs during each phase of the transition.

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Jefferson County DSA 7

Tim Young: Division Director

Jessica Thayer: Program Manager Non-IDD

• We hired 37 former employees from DDRC �including 7 supervisors and 1 manager.
• We are very proud of the collaboration �between our previous SEP team and those �moving over from the CCB’s to create �something new that takes the best aspects �of both of those agencies.
• Biggest win for CMRD is the financial eligibility (Long-Term Care) is right down the hall from our CMA to problem solve.

The picture is July 1 with our new staff and previous SEP staff together for the first time.

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A&I Avenues DSA 8

Jenna Corder, Director of Programs and Services

Jennie Giurgila, Assistant Director of Case Management

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• We serve Boulder, Broomfield and Gilpin Counties.
• We are also the Local Early Intervention Program for Boulder and Broomfield.
• We have a robust crisis management program to support individuals in our region.

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Weld County DSA 9

Kelly Morrison, Home and Community Supports Director/CMA Director

Angela Korthaus, CMA Manager

• The biggest achievement is the successful transition, as shown by numerous community partners and members reaching out to praise the transition efforts.
• Merging the IDD and Non-IDD intake processes into a single, unified intake unit.
• Establishing a comprehensive training program within the first months of becoming a CMA.

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Region 10 CMA and CCB(Larimer County)

Marla Maxey

Case Management Director

• Intake
• HCBS-DD
• Non-I/DD Waivers

Three wins:

1. Fully staffed, minimal turnover and good integration of new staff into FGI culture.
2. Scheduled two-day, person-centered training for all new staff.
3. FGI has hosted several provider outreach fairs which have been great at developing relationships among providers, case managers and people looking for service providers.

Pat Carney

Case Management Director

• FSSP
• Early Intervention
• Children’s Waivers
• Supported Living Services

The Resource Exchange (TRE) DSA 11, 12

Brandi Griffiths - Service Coordination Manager

Heather Meizis - Manager of Quality and Nursing Facilities

• TRE is celebrating its 60th anniversary this month
• TRE serves El Paso, Park, Teller, and Pueblo County (DSA 11 and DSA 12)
• CMRD has streamlined access to services in our catchment area for members.

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Rocky Mountain Health Plans (RMHP) DSA 13, 14, 16, 17, 18

Denise Rooks, Bonnie Kuhn, Jennifer Price, Jackie Stephens, Heather Murphy, Laura Russell, Erica Anderson, Heather Rose, Meg Taylor

• 5 DSAs, 19 counties, all but one county are rural/frontier
• Participated in all 3 CMA transition phases
• Retaining staff/talent/expertise from CCBs/SEPs that transitioned to RMHP and internal collaboration for members

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Garfield County DSA 15

Linda Byers, Program Manager, Adult Programs; �Wendy Steckler, CMA Supervisor

• Garfield County Department of Human Services CMA serves Garfield, Eagle, Pitkin, and Summit Counties. We previously served 9 Northwest Colorado Counties as Northwest Colorado Options for Long-Term Care.
• Top Win: Garfield County CMA received coaching and guidance through multiple grant opportunities to support us with Case Management Redesign.
• Top Win: Garfield County Department of Human Services CMA hired 100% of the case management team from Mountain Valley Developmental Services for the July 1, 2024 transition.

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Montrose County DSA 19

Julie Miller – CMA Program Manager & Kendra Sitton – Program Supervisor

Montrose County CMA continues to serve the same region as we did previously as the Single Entry Point, covering Montrose, Ouray, and San Miguel counties. We have been able to maintain seamless accessibility to our community, both inside and outside our DSA.

Since the transition, we have received several calls from community members �expressing confusion or dissatisfaction with the previous case management �system. After navigating and now truly understanding the community benefits �of CMRD, it is very rewarding to guide people through the current case �management system.

It is exciting to have a website for people to obtain information regarding all �LTSS services, supports, and programs and to be able to discuss ways for �individuals to get involved/contribute to shaping the future of case management�in our community and in Colorado.

I recently received a call from a mother in Gunnison. Her 6-year-old child has �multiple physical disabilities, which she initially believed were "developmental �disabilities" because he is still “developing”. I was able to explain how invaluable �it is to receive the kind of feedback she had provided.

We talked about how complicated and confusing the LTSS system used to be, and how exciting the future of case management is in Colorado. By the end of our conversation, she was eager to connect with the CMA in her DSA, RMHP, to share her experiences and desire to participate on the Community Advisor Committee (CAC). These are the moments that truly make this work enjoyable!

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Montrose County DSA 19

It's been incredibly exciting and rewarding to see doors open up for our EBD and CMHS members, allowing them to access programs like FSSP, DD determination and delay testing, and the DD �waitlist! This success is a result of team integration and comprehensive �training, which has helped everyone gain a much more robust understanding �of all LTSS waivers and programs available to our members. As a result of the �high volume of internal referrals for DD determinations and programs like �FSSP, we've created a new Internal Referral form and process to efficiently �assign and track these referrals. “It’s a huge win to open up full access to all �members without unnecessary obstacles”- Kendra Sitton.

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The biggest "win" for our CMA was being able to hire most of the case managers�from the transitioning CCB agency. We were incredibly fortunate to bring on �staff with years of experience working with the IDD community! Our IDD �Program Supervisor, who has extensive experience with DD determinations and �is a SIS assessor, has played a significant role in ensuring a smooth transition and early success. However, the real "win" goes beyond that. I've always believed that cohesion and integration are crucial aspects of building a successful team, and by extension, a successful agency. Like any transition, there was some apprehension about merging two teams into one united CMA team. Looking back now, it's amazing to think there were ever those concerns — I can't imagine this team without our IDD team/case managers! We are ONE fun-loving, supportive and integrated team that cares deeply for one another and the members we serve. 😊

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Community Connections Inc. (CCI) DSA 20

Elizabeth Fabrey, Vice President of Case Management

• Our top win from case management redesign is the ability to have one agency for our community to turn to for support. This has enabled us to work on implementing best practices and a streamlined approach to accessing long-term services and supports.
• We created an intake case manager position who provides information and guides individuals and families through the intake process. This has meaningfully increased the quality of our case management and customer service.
• Through all of the changes and obstacles, we have been able to minimize the impact to members and become a more cohesive and supportive internal team.

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CMA Fall CCM Survey

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Survey Summary

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Survey Summary

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Survey Summary

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Survey Summary

Currently Pending ARPA

• Auto generate a task to confirm that the LOC Cert information has sent successfully to CBMS
• Easier view of log note details without having to click on everyone, one by one.
• Create a search function across log notes
• Make it possible to see the log note and the name of the person who wrote the log note at the same time.
• Allow CMs to review multiple/all log notes from a single screen instead of clicking in and out of individual notes.
• There seems to be a discrepancy between what happens in CBMS and how it is interpreted by CCM and the difference in terms used.
• Remove the care plan section all together and return the goal to the service plan where we enter just the goal in one simple box.
• ADT data would be great.

Current Pending LTSS Stabilization

• The Health Coverage information may not match what is in CBMS and/or PEAKPro.
• More flexibility in the specific order in which things are completed.
• When a field is required for making a workflow trigger, please make that field actually required so that the user can’t save the screen unless that field is filled out. Limit the selections a user can make if only certain selections are appropriate at certain points in the evolution of the program card (i.e. when it is created).
• Pull over information from the 100.2 to the program card when a CM associates the program card with the 100.2.
• Remove the ability for the user to enter a CIR and select the security risk toggle.

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Survey Results-

Review for Possible Defect

• The risk scores do not consistently update if the SIS changes.
• CM name not always showing on banner despite being correct everywhere else
• County of Service is almost never right, or says Multiple. As some people have it different. Others it says n/a, even though the address has the county listed.
• Do not automatically creates another entry on the CM’s caseload list every time a CM edits a program card.
• The 40/40 progress tracker for service plans cannot be attained, despite following procedures correctly.
• CIRs entry and CIR follow up entry saves inconsistently and has resulted in multiple re-entries of data.

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Survey Results

Training & Information Needed

• PEAKPro is very hard to understand and not clear - it would be helpful to have more clear information in PEAKPro.
• Can we add descriptions of what the notes we are seeing in PEAKPro mean and also a guide of terminology added to the current Streamline Eligibility job aids?
• Utilization needs to be cleaned up and provide additional guidance on how to use it. When I look at what is there, I don't understand what it is supposed to be telling me.
• Can a section for the contingency plan be added into the 100.2 or the service plan?
• Create a way to sort and filter tasks
• LTC notices of action should automatically be saved in some way to the member’s record within the CCM

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Under Consideration

• Create a mechanism so CMAs cannot move someone to another CMA without their approval
• Diagnosis section is duplicative of the PMIP.
• Either remove the need to upload the PMIP or take the medical section out of the 100.2 assessment.

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Survey Results-

You will be prioritizing the remaining items.

• Review and discuss the comments with your table mates.
• Write the corresponding # on a sticky note
• Place the sticky notes according to their priority.

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Survey Summary

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Reports Open Issues

• Total Reports-38. 25 need to be optimized. we have optimized 18
• Open Issues on 13 reports
• Awaiting 3 New CRs

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Reports Open Issues

• CR 122-Awaiting modification to the CR

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Reports Open Issues

• Future Release

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CCM System Training

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CMA Training Updates: Live Trainings

• Monthly New Case Manager training sessions
• New Hire Curriculum - located on the Google Drive
• Once they have completed the prerequisites, they can email Sara Hood at shood@assurecare.com for registration.
• 70 Case Managers have attended a session since we implemented these training sessions on June 5, 2024

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CMA Training Updates: Live Trainings

• Monthly focused topics training series for all Case Management Agencies
• Please encourage your case managers to attend these sessions and reach out if they need the Webex registration. They must register to be able to attend.

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CMA Training Updates: Meetings

• SuperUser Call twice monthly
• Topics include:
• Reviewing Training Trends:
• System Automation when completing the Service Plan Assessment.
• For a CSRs, discussed the importance of keeping the current Program Card open when opening a new Program Card for a CSR and using the Program Sequence field.
• For CSR, discussed what happens when a user does not wait overnight for Streamline Eligibility to happen before switching the Program card Status from “Pending Financial Eligibility” to “Pending Assessments.

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CMA Training Updates: Meetings

• Other Trends
• The current way task are handled and assigned in the CCM are a burden and users are assigned task for member’s that are not even in their caseload. CCM users have told us they are not using task.
• New Job Aid Previews
• Training Topic Reminders
• Responses to SuperUser Questions
• Develop plan for individualized Case Management Agency trainings that is a data driven approach
• Continued planning and development of Phase 3 training.
• Continued planning and development of ARPA training.

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CMA Training Updates: Documentation

• We have created 13 User Friendly release note documents, 26 updates to existing job aids, and 9 brand new job aids, since our last quarterly meeting in April including:
• Health Coverage
• Troubleshooting and Workarounds
• Several Program Checklist
• We have added Table of Contents to 3 larger Job Aids and are in the processes of breaking out larger job aids into more manageable documents starting with the Service Plan, Care Plan, and Bridge Interface Job Aid. Also added Table of Contents as needed as new job aids have been created.
• Updated and published 10 microlearning videos that are accessible in the Google Drive.
• We appreciate your Job Aids feedback! Job Aid Feedback Form.

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Lunch

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Policy & Announcements

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Looking Ahead

Quick Updates:

• Upcoming Contract Amendment in January 1st
• CHRP Expansion January 1, 2025
• * No longer limited to children with Intellectual and Developmental Disabilities
• * Serious Emotional Disturbance is added to the Targeting Criteria as an additional way to qualify
• New Reserved Capacity Enrollment Request form
• Community of Practice
• Community First Choice

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Community First Choice (CFC) Overview

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What is Community First Choice?

Community First Choice (CFC), also known as 1915(k), is an optional Medicaid program that allows states to offer select home and community-based attendant services and supports to eligible members on the State Plan, expanding these long-term care services to more Health First Colorado (Colorado's Medicaid Program) members. 

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1915(c) Waiver versus 1915(k) CFC Authorities

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Community First Choice

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Goal of CFC: Making HCBS accessible for more Medicaid members with expanded options and availability for self-directed care

Future CFC Services: 

• Homemaker 
• Personal Care 
• Health Maintenance Activities 
• Acquisition, Maintenance, and Enhancement of Skills (new federally required service)
• Remote Supports 
• Remote Supports Technology 
• Home Delivered Meals 
• Transition Setup
• Electronic Monitoring 
• Personal Emergency Response System 
• Medication Reminders  

Selected waiver services

CFC

Community First Choice

• Goal is to implement Community First Choice by July 1, 2025
• CFC expands access to home and community-based services across the state, including more opportunities for members to self-direct their care
• Received legislative approval in 2023 to implement CFC through Senate Bill 23-289
• HCPF receives an enhanced 56% federal match, for CFC Services, which will help save the state money

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CFC Communications

• How to submit questions, feedback, or comments:

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• CFC Email:   hcpf_cfc@state.co.us 

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• Phone: 303-866-2354

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Upcoming CFC Council Meeting

• Next Meeting: Wednesday, October 2, 2024�10:00 to 11:30 a.m. 
• CFC Stakeholder Website

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CFC Resources

CMS Technical Guide for CFC

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CFC Final Regulation

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HCPF CFC Resources webpage

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Final Statewide Transition Plan

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Updates on CFC and Related Initiatives

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LTSS System Stability

• Community First Choice implementation coincides with a lot of other important work
• HCPF and our partners continue to work to stabilize the Long-Term Services and Supports system
• Recent system launches have provided valuable insight into the challenges of large programmatic and system changes
• Honor feedback received from stakeholders, our commitments to the legislature, and our dedication to evolve our system to be more person-centered
• We continue to seek feedback from stakeholders as we move LTSS stabilization and CFC work forward

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CFC Implementation Update 

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Given our current challenges with LTSS stabilization, to launch CFC by July 1, 2025, HCPF proposes the following changes:

• Continue use of the ULTC 100.2 as the eligibility assessment and current Service Plan process for CFC and HCBS waivers and delay the use of the Colorado Single Assessment (CSA) for all populations except adult IDD waivers
• Modify Task Worksheets to be used for all CFC Personal Care and Homemaker Services, including CDASS, IHSS, and Agency-based service delivery options, including adults and children.
• Delay the Person-Centered Budget Algorithm (PCBA) until after CFC launches and the CSA has been fully implemented for all waiver programs and sufficient data has been gathered to develop and evaluate the PCBA within the confines of CFC.

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Intersecting Initiatives

The following are HCPF initiatives that are independent of CFC, but support the successful launch of CFC.

• Decommission the Support Intensity Scale (SIS)
• Implement an interim support level strategy for members who are newly enrolling in the Developmental Disabilities and Supported Living Services waivers
• Discontinue use of Service Plan Authorization Limits (SPAL). Utilize the same process for SLS as used for non-IDD waiver participants to enroll in CFC/HCBS services.
• Maintain existing unit limitations on HCBS waiver services, for non-CFC services remaining in waivers​

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Intersecting Initiatives, continued

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The following are HCPF initiatives that are independent of CFC, but support the successful launch of CFC.

• Pediatric Long-Term Home Health PARs: Continue to move forward with current efforts to reinstate Pediatric Long-Term Home Health Prior Authorization Requests (PARs) to ensure that authorized skilled services are medically necessary and that members receive services that are most aligned with their needs
• Skilled Nurse Assessor: Utilize the planned Skilled Nurse Assessor to complete a skilled care acuity assessment prior to the authorization of Long-Term Home Health (LTHH), Private Duty Nursing (PDN), and Health Maintenance Activities (HMA)

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What is the Skilled Care Nurse Assessor?

• A process to streamline the way members are assessed and receive authorization for skilled care services
• HCPF will assess members, using a 3rd party skilled nurse assessor, for the appropriate level of skilled care services across the service modalities
• Reduces duplicative service authorizations
• Potential conflicts of interest with providers reduced
• The skilled nurse assessor will also provide the member with education on all service delivery options, including self direction

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The legislature approved funding for this initiative during the 23-24 session as R-10 Third Party Nursing Assessments for Nursing Services

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Skilled Nurse Assessor Updates

• R-10 was approved through long bill HB 24-1430
• Work started on this initiative Summer 2024
• HCPF anticipates posting a request for proposal (RFP) to solicit vendor interest in conducting this work on behalf of HCPF
• RFP to be posted Fall 2024
• Limited stakeholder engagement can occur during the RFP process
• HCPF anticipates phasing in the skilled nurse assessor with the launch of LTHH PAR requirements

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What Do We Need to be Aware of?

• The RFP document will be posted publicly
• The RFP is based on the nurse assessor process outlined in R-10
• What else, based on your experiences, does HCPF need to be aware of as we consider the finer details of this process design?

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Engagement Opportunities

CFC Council

• Meets monthly - next meeting Wednesday, October 2, 2024

Task Worksheet workgroup

• Beginning Fall 2024, see OCL Engagement Calendar for info soon!

Skilled Nurse Assessor, additional feedback

• Contact us: homehealth@state.co.us

Pediatric LTHH PAR Restart

• Workgroup info
• Contact us: homehealth@state.co.us

Webinar: Update on Office of Community Living (OCL) Priority Projects

• Thursday, October 10, 2024, 11:00 to 11:45 a.m. Register to attend

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Questions/Feedback

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Rapid Reintegration and�At-Risk

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Background

In 2024, HCPF requested funding through BA-08 to implement programs that:

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1. Provide Information to Prevent Unnecessary Institutionalization
2. Provide Effective Transition Services
3. Expand Access to Colorado’s Community-Based Service System
4. Increase Access to Integrated Community-Based Housing Opportunities

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Purpose

The programs HCPF is implementing to support the previously stated goals are:

• At-Risk and Rapid Reintegration provided by CMAs
• Group and Individual In-Reach provided by Local Contact Agencies (LCAs),
• Housing support increased through MFP and partnerships with DOLA

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At-Risk/Diversion

• Opportunity to provide additional community support and resources to members in the community before institutionalization is required.
• HCPF will share a list of members that fall into the “At-Risk” population and possibly other members defined as at-risk by community partners.
• Additional process/questions will be documented in the CCM at the time of member quarterly monitoring.

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At-Risk/Diversion Process

1. HCPF will identify members in the community that are most “at-risk” for institutionalization
2. The list will be uploaded to the CCM quarterly
3. CMs will be required to outreach each member on the list on two timelines
1. If it is the members initial time on the list the CM will reach out within 10 days
2. If the members is ongoing they should reach out within the quarter at the members quarterly contact
4. CM will ask the member questions in the CCM and provide additional resources like housing Navigation/vouchers and transition coordination provided under TCM-TC (Targeted Case Management Transition Coordination)

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At-Risk/Diversion Continued

• CMAs will be paid for initial outreach provided (10 days outreach requirement)
• Conducted by Case Management Agencies and Regional Accountable Entities (RAEs)
• Conducted through the CCM
• To be implemented Jan/Feb 2025
• Training Winter 2024 (Nov/Dec)

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At-Risk/Diversion Continued

• Estimated 1,000 individuals on the initial list
• Majority already assigned to a CMA

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Rapid Reintegration

• Purpose: To provide the opportunity for members to make an informed choice about transitioning to the community sooner than the current transition process.
• Creation/tracking of member plan to transition into community setting from the skilled nursing facility (SNF).

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Rapid Reintegration continued

• Any member receiving an level of care (LOC) for Nursing facility admission will be asked a series of questions to determine their desire to live in the community.
• If the member states they are interested in living in the community they will have the opportunity to receive a Rapid Reintegration

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Rapid Reintegration Process

• Member Receives LOC, asked about desire to live in the community
• If member is interested they will receive either a Rapid Reintegration barrier assessment, will determine if member should have a Rapid Reintegration plan or a Rapid Referral
• either completed at the time of the LOC/100.2
• If/When member transitions CM will provide a follow-up survey about experience

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Rapid Reintegration Plan

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Who: Medicaid HCBS member going into a NF with little to no barriers as defined by the barrier assessment

What: Create a plan to support a transition back into the community

When: During the LOC/100.2

Rapid Referral

Who: Medicaid Members who require NF stay for over 30 days or need/want additional support to re-establish themselves in the community

What: Referral to the transition services coordinator

When: within 2 days of LOC

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Rapid Reintegration Plan Versus Rapid Referral

Rapid Reintegration Continued

• Conducted by Case Management Agencies
• Conducted through the CCM during LOC for any individual transitioning to a SNF
• Will be triggered when a case manager asks member if they are interested in learning more about community living options.
• Payments will be implemented for this process in the contract. One for each step completed (Barrier Questions, Rapid Reintegration Plan and Post Rapid Reintegration questions)
• Training Winter 2025 (Jan/Feb)
• Implementation March 2025

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Questions?

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• What impact do you see this having for your agency?

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• What support from HCPF would be helpful during the implementation of these new processes/programs?

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• In what ways do you see Colorado already meeting these initiatives

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Contact Info

Jill Schnathorst

In-Reach Unit Supervisor

jill.schnathorst@state.co.us

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Chanelle Pugh

In-Reach Unit Supervisor

Chanelle.Pugh@state.co.us

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hcpf.colorado.gov/transition-services

hcpf.colorado.gov/community-living-updates

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Equity, Diversity, Inclusion, �and Accessibility

(EDIA)

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CMA Ideas to Move

EDIA & CAC Requirements Forward Together

September 2024

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Learning Team

HCPF Sponsorship

• Tasia Sinn (she/her/hers), HCPF, OCL

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Civic Consulting Collaborative

• Roshan Bliss (he/him/his)
• Amy Engelman (she/her/hers)
• Jack Becker (he/him/his)

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Background & Purpose

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ARPA 3.01 Equity Study

(Winter/Spring 2023)

To understand disparities within Home and Community-Based Services (HCBS) enrollment and identify solutions to reduce barriers for more equitable awareness, enrollment, and use in underrepresented communities

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Find reports and project information at: �ARPA HCBS Initiative 3.01 - Equity Study

Uncovering Community Driven Strategies Network Partners’ Perceptions

Disability Prevalence in Colorado

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Acronyms: AIAN = American Indian and Alaska Native, NHOPI=Native Hawaiian and Other Pacific Islander Source: Census, Colorado, 2020

American Indian, Black, and Hispanic/Latino Children with Disabilities are Underrepresented in HCBS

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Source: Medicaid MMIS claims data, April 2021 through March 2022

American Indian and Hispanic/Latino Adults with Disabilities are Underrepresented in HCBS

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Source: Medicaid MMIS claims data, April 2021 through March 2022

Learning Goals with CMAs

To understand:

• Strengths and challenges with representation and root causes for any disparities in membership
• Long range EDIA plan goals and strategies
• EDIA policies and procedures
• Community Advisory Committee (CAC) development to support EDIA
• What meaningful EDIA support from HCPF looks like

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Learning Process

• Spoke with all CMAs July 15 - Sept 15
• 45-75 minute zoom conversations
• Between 1-5 staff per agency participated, including executive directors, case managers, human resources, program managers, supervisors, vice presidents, and chiefs of operations
• Case managers and supervisors were most common

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Moving

EDIA & CAC Requirements Forward Together

Did We Hear You Correctly?

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Regular Learning & Co-Creation Sessions

• Build positive working relationships and collaboration among peers
• Share what’s working and workshop what is challenging.

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Consider partnering with known organizations, such as CO Cross Disability Coalition, CO Statewide Independent Living Centers, and Alliance CO, to:

• Lead EDIA learning sessions and/or
• Provide direct technical assistance/coaching

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Topics for EDIA Learning & Co-Creation

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Clarity on the Why, What, & When �of EDIA

Why: The purpose and end goal of the new EDIA requirements contribute to CMAs continuous improvement efforts.

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What: Equity, diversity, inclusion, and access contribute uniquely to the end goal.

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When: Some of the new requirements need to be fulfilled now (e.g., expanding on non-discrimination policies to more than the absence of explicit exclusion), and others (e.g., effective engagement of new and existing social networks to support members) will be achieved slowly over time so should be articulated through CMAs long range plans.

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Language Access Resources

Translation:

• Required forms available in all languages spoken in CO
• Most effective website translation tools

Interpretation:

• Highly qualified, medical interpretation services, including less common languages
• Interpretation providers and training institutions to learn CMA-specific terminology
• Interpretation to be a Medicaid billable service

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Resources for EDIA Long Range Planning & Implementation

Region-Specific Demographic & EDIA Data

• Relevant access and utilization disparities in CMA service areas to compare to Census or other county level demographic data
• Technical support and training for access and interpretation of data

High-Quality EDIA Education Resources

• Trainings, tools, and coaches to support all levels of EDIA commitment, through the lens of disability and age to respect and build on the EDIA work CMAs already do

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The Purpose of CAC and Guidance Available

• The main function of the CAC is to ensure accountability in complaint resolution processes and to include community in the process for transparency.
• The Colorado Case Management Agency Community Advisory Council Application Guide and Workbook is useful and underutilized.

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Support CAC Community Members with Lived Experience

• Trainings and guidance for community members on:
• Complaint policies and procedures
• Patient privacy, particularly in rural communities
• Partnerships with local disability advocates & professional organizations for recruitment
• Stipends for CAC members, without an organizational affiliation

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Long Term Consideration for Future Contract Cycles

Outcome-based contracting or payment models for CMAs in order to:

• Enhance CMA autonomy, buy-in, and efficiency,
• Catalyze new partnerships and practices, and
• Enable the emergence of innovative, context-specific solutions to challenges and disparities.

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CMA Feedback

Note Catcher

• Any feedback on the topics we identified?
• What topics are missing?
• Which topics feel most pressing for your CMA or the CMA system collectively? (place a * next to them)

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Ideas to Move EDIA Forward

Regular EDIA Learning & Co-Creation Sessions

• Clarity on the Why, What, & When of EDIA
• Language Access Resources
• Resources for EDIA Long Range Planning & Implementation
• Regional Census and Disparity Data
• EDIA Education Resources
• The Purpose of CAC and Guidance Available
• Support CAC Members with Lived Experience

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Next Steps

• We will incorporate your feedback into our final report, which will include more detail on where the strengths and opportunities lie.
• HCPF will share the report with all CMAs.
• HCPF will continue to work with CMAs on EDIA efforts.

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Stay tuned!

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EDIA Training Resources

Learn about yourself: Implicit Bias Module Series

Learn about others: Cultural and Interpersonal Competency (Web-Based Training for CMAs)

Build foundational knowledge about health equity and disparities: Health Equity Modules (no cost to set up an account)

Learn how to create accessible materials: Web Accessibility Fundamentals

Find more equity-related training resources and materials: HCPF Health Equity Training and Resource Guide

If your CMA is looking for specific trainings not included here, you can reach out to �Aaron Green, HCPF Health Disparities and Equity, Diversity & Inclusion Officer

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New Resources

New HCPF “Learn about LTSS” webpage with educational materials in English and Spanish:

hcpf.colorado.gov/learn-about-ltss

�Translating member-facing forms and documents (most translated versions will be added here):

hcpf.colorado.gov/long-term-services-and-supports-case-management-tools

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BREAK

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Engagement Activity

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Otowi Group

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Closing Remarks

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Next Meeting

November 7, 2024

hcpf.colorado.gov/case-management-agency-resources

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hcpf.colorado.gov/long-term-services-and-supports-programs

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Thank you!

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