Hot Documents
Information from the legislature - February 2007:
Last year additional 90 "resources" (formerly "slots") were approved for Comprehensive Services in addition to a Cost of Living increase for Comprehensive Services. Due to the CMS and HCPF demand for immediate changes in the waiver services beginning in December 2005, the resources were changed to be fully funded with General Fund dollars (resulting in half as many resources) while the State rewrote the waiver application requesting a new cap on numbers served. The Cost of Living Funds were not distributed for the first six months but used for such things as the Division for DD decided to reimburse to certain providers under a "Hold Harmless" provision. It is great news that CMS has approved the Comprehensive waiver for the increased number to be served and the rate increase. The Joint Budget Committee has approved the full number of resources as authorized last year with accompanying Medicaid match.
The movement to the new system under Medicaid requirements resulted in the State funding the full cost of services this year where local dollars were used to supplement in prior years. There was some question as to what would happen with those dollars since it required a $7 million increase in General Funds from the State of Colorado. The Joint Budget Committee agreed in late January of 2007 to include those funds in their supplemental appropriation for this year. They should then continue to flow in subsequent years. (However, the funding for this year is a one year temporary system and it is unknown what changes will be made starting July 1, 2007.
Letter from the Executive Director - Significant Medicaid Changes Coming
Information below is "old" now but addresses the things that have been happening the past year.
Federal CMS and the state Health Care Policy and Finance raised serious questions with the State of Colorado's application of Federal rules, relating back to a review in 2004. Documents below relate to questions that arose from January to August, 2006 and information that might clarify some issues.. A letter was released jointly by HCPF and DDD on May 31, 2006 clarifying some of the issues, and providing a link to an FAQ (Frequently Asked Questions) page at DDD which attempts to answer many questions that have been raised. The link does not work in that document but is provided here. As stated, the changes are not expected to address SLS and CES until later. At this time they were only to apply to Comprehensive Services (Residential). However, that turned out to not be correct and you will find some of the FAQ's from the HCPF CMS Committee respond to some of those changes in SLS.
One of the big changes is the method of determination of funding levels for each individual in Comprehensive Services (Residential Programs). CMS requires that reimbursement levels be the same for anyone served by different agencies. They have agreed that there can be a number of rates depending on the need level of the individual and geographic differences can exist if there are demonstrated cost differences. CMS and HCPF have determined that the rates should be "tiered" based on need. Since the changes came so fast, in order to comply with federal requirements and maintain federal funding, it was decided by HCPF that rates would be determined by a survey of last year's rates and set at a similar level in 06-07. However, in July, 2007, rates must be based on needs assessments of every individual. A tool had to be determined to make that assessment and HCPF and DDD agreed, after much discussion and a HSRI Rate Review Study (PDF), on the Support Intensity Scale. Everyone in Comprehensive Services must be evaluated utilizing that tool before June 30, 2007.
For anyone wanting to really understand the development of the DD program in Colorado and the iterations it has gone through, see the HSRI Evaluation of the Systems Change Project in Colorado. This report goes into a lot of detail about how the system developed, how Systems Change was developed and an evaluation of what has been accomplished with it. Particularly, near the bottom of page 16, it indicates the approval by the Federal Government of bundling rates. Earlier in the report it details the designation of CCBs as Managed Service Organizations and Organized Health Care Delivery Systems (OHCDS). These are the issues which the federal government said violated the regulations in December 2005, thereby creating the reorganization of the system undertaken in 2006. Since that time they have backed away from a ban on use of OHCDS but the funding and billing mechanisms have to be changed fundamentally.
Joint Budget Committee DD Staff Briefing for 2007-2008 budget year (PDF)
HCPF Website CMS Committee FAQs and Minutes
DDD/HCPF Comp Services Letter 5/31/06 (PDF)
Joint Budget Committee Hearing 3/22/06 (PDF)
DHS/DDD Response to JBC Questions 3/22/06 (PDF)
Joint Budget Committee Hearing 4/19/06 (PDF)
Joint Budget Committee Figure Setting 2/23/06
Joint Budget Commitee Calendar of meetings - updated regularly (PDF)
Joint Budget Commitee DD Budget Hearing 1/4/06 9AM (PDF)
Latest regarding the budget emergency in the state!
Look at the rate increases given CCB's vs salary increases given!
Issue Paper generated by DDS March 2003 to come up with a Colorado DD Strategic Plan (PDF)
Statement of Privacy Practices - HIPAA (PDF)
Waiting List Lawsuit Decision in Pennsylvania (PDF)
Draft of the HSRI report (PDF) on results of study of Systems Change Project, recommended Performance Measures, and pros, cons and cost of an Ombudsman to deal with concerns of stakeholders.
