LTSS PE Feedback Log

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1	Please email any additions or changes you would like to add to HCPF_LTSSPE@state.co.us
2	Platform	Date submitted	Stakeholder name	Stakeholder group/agency name	Feedback	Status	Rationale/Notes

3	Stakeholder Feedback form	08/08/2024	Kelly May	"Other stakeholder group"	I encourage HCPF to consider including assisted living (alternative care facility) and DD residential services (host home, PCA, etc.) as a part of the services available under presumptive eligibility for members in crisis. When I worked in crisis management there were a number of situations from community stakeholders, police, hospitals, and adult protection regarding people with disabilities who needed access to 24/7 care and who would not be able to live independently with HCBS. For the IDD population we could leverage State SLS as a stop-gap while waiting for LTC Medicaid and HCBS eligibility to process; however there are not very many State SLS respite providers who are also DD residential providers which created issues finding providers. For the non-IDD population, they often remain in the hospital waiting for HCBS to transition to assisted living and I saw a trend of skilled nursing facility (SNF) placements as that route tended to be faster (I presume because SNFs were more willing to wait for LTC to process and back-bill compared to HCBS providers). Feedback on eligibility: Individuals who required access to 24/7 who are homeless, stuck in a hospital, or stuck in another inappropriate setting (i.e. acute mental health facility) who are waiting for LTC Medicaid and/or HCBS in order to transition to a 24/7 care service setting Feedback on services: Alternative care facility (assisted living) and DD waiver residential services should also be considered. There are a number of members who need 24/7 care in a supportive service setting who are homeless or stuck in a hospital waiting for LTC and HCBS. I am not sure on the availability of respite in alternative care facilities and that may bridge the gap for the non-IDD disability population. For the IDD population, there is less availability for per day respite unless the provider is approved for both respite and DD waiver residential services.	Under Review	Thank you for this feedback. We recognize the importance of housing and value your thoughts as we consider the resources available to serve our LTSS populations.
4	Stakeholder Feedback form	08/10/2024	Julie Reiskin	Colorado Cross Disability Coalition	Feedback on eligibility: Should we also consider people who are currently homeless since they have a hard time following up without stability and often need the supports to gain the stability? Feedback on services: Home modification, access to equipment (which is not LTSS but coordination with regular Medicaid is needed) , non medical transportation	Under Review	Thank you for this feedback. We're currently weighing various options for which populations and services to consider, and appreciate your input.
5	LTSS PE email inbox	08/12/2024	Yesenia Torres	El Paso Adult & Family Services DHS	1. Who is going to process LTSS PE if not the county? 2. This will likely send clients an incorrect message that they qualify when they may not, or that because they got LTSS PE, no need to follow-though with the application, because they may think they qualified already when they have not. 3. What happens when a client does not follow through with the application process and they are active LTSS PE? 4. What happens when a client is not eligible, and they have been on LTSS PE? Will those approved for LTSS PE be subject to recovery/claims for services used under LTSS PE? If no recovery, who is paying for LTSS PE (services) used if the client is not eligible? 5. If it is an RTE type situation, will counties even see the application? And if not, how will counties know that LTC is being requested? 6. Would counties be expected to house these cases in an intake or on-going mode due to the presumed approval?	Under Review	Thank you - these are great questions 1. At this stage we’re examining a few different options for this, but haven’t landed on one yet. 2. We also see the value in ensuring the completion of the LTC Medicaid application, and will work to incorporate that step/expectation into the LTSS PE process and communication. 3. I think the answer to #2 addresses this? Also, as we currently understand allowances, we're not able to adjust current LTC Medicaid timelines for those on LTSS PE and are continuing to look into this. 4. There will not be any recoupment of funds for services rendered during the PE period for those found ineligible. This contingency is built into our 1115 waiver application budget request. 5. Thanks for offering this scenario. We’re working through different process flow scenarios and I’ll bring this question to the conversations. 6. Once an individual’s LTC Medicaid eligibility is established, their case will be transferred to their appropriate county for eligibility tracking.
6	Stakeholder Feedback form	08/19/2024	Declined to have name listed		Feedback on services: Including LTHH in LTSS PE will be very beneficial to our members and providers as there can be a delay in recognition of the need to authorize LTHH services, resulting in breaks in care for members and reimbursement issues for providers. Feedback on eligibility: Being at risk for loss of housing	Under Review	Thank you for completing the form! We're looking at service options, and also see the value in LTHH for members in vulnerable situations. We also agree that supporting individuals with housing needs is important.
7	Stakeholder Feedback form	08/22/2024	Declined to have name listed		Feedback on services: PE should include Skilled Nursing Facility placement as well as should include coverage for Physical, Occupational and Speech Therapy after an acute health episode. The limited availability of these services for Medicaid patients often precludes positive outcomes	Under Review	Thanks for this feedback. We're still in the process of determining the implications and feasibility of including various services and supports with LTSS PE, and I appreciate your thoughts on this.
8	Stakeholder Feedback form	08/26/2024	Declined to have name listed		Question: Would this only be for adults or is there a child/family aspect as well? Feedback on eligibility: Losing services if eligibility takes over 90 days. Feedback on services: Mental health assistance	Under Review	We're looking to support eligible adults with this program. Thanks for this feedback. We also identify mental health support as an important priority across many populations.
9	Stakeholder Feedback form	08/29/2024	Jennifer Martinez	InnovAge	On behalf of InnovAge below are our questions. 1. Is the PACE program included in the LTSS PE design? If not, please consider. 2. If so, are full PACE services available with a full monthly capitation paid to the provider? The presentation appeared to identify limited scope services would be available. 3. Would the classification of “senior” or those at risk of entering a nursing home be a crisis/in need be a category for PE consideration? 4. Who determines if an individual meets the crisis definition? These can be subjective, may be an issue of consistency. Feedback on eligibility: Risk of entering an institution without services Feedback on services: PACE Services	Under Review	Thank you for these questions! After talking with stakeholders about the logistics surrounding offering PACE as an LTSS PE service, at this stage we're looking at services outside of the PACE realm. Thanks for your other feedback regarding eligibility. We are looking at how to best capture the at-risk of NF admission population through some additional criteria. Also, we agree on the challenges that self-declaration can pose, and we're working through different options to help ensure accurate and appropriate program referrals.
10	LTSS PE email inbox	10/17/2024	Robin Yasui, MD	Head of Geriatrics, Denver Health	1. I am very interested in how this (program) will roll out 2. "I think it will be incredibly invaluable to so many of our Denver Health older patients who often fall through the cracks as they transition through life as patients/elders needing care giving services. I always advocate for our seniors at Denver Health; our population is unique in many ways. Our patients are incredibly diverse in culture, language, socioeconomics, and cognition and struggle against the odds to get the supports and care they need. If there is any way in which I can be of help as you look at this very special microcosm of elders in the metro area, please do not hesitate to reach out."	Under Review
11	LTSS PE email inbox	10/25/2024	Martha Johnson, LCSW	Director, La Plata County Department of Human Services	Suggested that applicants be required to complete LTC Medicaid application (or at least partially complete it) before LTSS PE enrollment	Under Review
12	LTSS PE email inbox	10/27/2024	not stated	not stated	"Do you also do Presumptive Eligibility for skilled nursing homes and if so, can you direct me to any documentation or process?"		Emailed response: "Thank you for reaching out. For Presumptive Eligibility for Long-Term Services and Supports (LTSS PE), we're anticipating an implementation date of January 1, 2026. At this time we plan to include services such as personal care, respite, home-delivered meals, and personal emergency response system in the LTSS PE service package. We may consider including nursing facility admission in subsequent program phases, but this is will be under consideration in the future, and not for January 1, 2026. Please let me know if you have any additional questions."
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