Listening Log Home and Community Based Services (HCBS ... · Listening Log – HCBS Waiver Renewals Page 6 of 33 Published April 5, 2019 . Comment Number Date Received Time Received

Page 1 of 33 Listening Log – HCBS Waiver Renewals Published April 5, 2019

Listening Log Home and Community Based Services (HCBS) Waiver Amendments

CES, CHRP, DD, SLS - February 7 – March 9, 2019 Feedback Received at: [email protected]

Comment

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Waiver Comment Synopsis Department Response

1 08/23/2018 12:17 PM Sara Taylor DD Is there any possibly of adding access to behavioral services and day program and supported employment to the EBD waiver so that those on the DD waiver who have physical disabilities and autism, for example, can potentially move to the EBD waiver and free up DD spots?

Adding these services into the EBD waiver would require a legislative action that the Department does not have authority to do at this time.

2 09/18/2018 1:22 PM Carol

Meredith/ The Arc

Arapahoe & Douglas

Counties

CES I understand that the Freedom of Choice section of the waiver application is a requirement, but we need to be clear with families that there really isn’t a choice. There are no ICF’s for children in CO that I know of. We as a state need to take responsibility for the policy blunders we have made in the past (I was part of the problem!) that have created gapping holes in the system of care for children with very high medical and/or behavioral needs.

The Department thanks you for the feedback. Freedom of Choice is a Federal requirement the Department must meet to operate HCBS waivers.

mailto:[email protected]


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3 2/06/2019 2:38 PM Betty Lehman/

Lehman

Disability Planning

CES Hello:

Please advise why the CES Waiver is not removing the antiquated sleep disruption requirements.

Also, why are the behavioral disruptions limited to the three types of disturbances?

Behavioral disruptions could include other behaviors such as property destruction, self-injury, elopement, suicide ideations, and more.

Why isn’t the welfare of family members given consideration for eligibility for this Waiver, such as parent illness or exhaustion, divorce and abandonment resulting in single parenting, and more.

Why are the current behavioral disturbances given such short time intervals to occur?

What is the basis for these limited description decisions?

This information was established in 1995. We have more information 24 years later.

The Department responded to Betty on 2/22/2019 @ 9:21 am as follows:

The Department appreciates all feedback from stakeholders. The specific request to amend the targeting criteria would have an impact on the Department’s budget. Currently the Department does not have the authority to make changes of this nature. In order make a change like this the Department must follow the appropriate budgetary and legislative processes.


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4 02/06/2019 8:49 PM Lani Glaser, RN, CDDN,

CLNC

DD Hello, Thank you for the opportunity to comment on this waiver. Please refer to page 35 item b. Defining Developmental Disability Please consider adding, in addition to Prader Willi Syndrome (incidence per the CDC is 1:10,000-25,000 live births) adding FASD-Fetal Alcohol Spectrum Disorders (1:100 births) It effects more people than many IDD diagnoses combined and is often mistaken as Autism. As a Nationally Certified IDD RN, though preventable, the CDC estimates 1 in 20 students have the disorder and is the primary cause of intellectual, neurobehavioral, and learning/ neuro-functioning disabilities. This disorder carries a medical ICD-10 code Q86.0, these children, growing to be adults, typically meet the criteria of functional deficits for IDD programs. Attached are a few relevant materials, that I hope will support this addition. Left to fall in the cracks, these adults often find themselves in the justice system due to their lack of reasoning and impulse, yet can function in the community with IDD support. More data can be reviewed via NOFAS.org and SAMSHA.gov Thank you-Leilani Glaser,RN,CDDN,CLNC

Thank you for your feedback. Prader Willi Syndrome was added to the Developmental Disability definition due to statutory changes. Adding Fetal Alcohol Syndrome to the Developmental Disability definition would require legislation. The Developmental Disability definition does not exclude someone with Fetal Alcohol Syndrome from being determined to have a Developmental Disability, as long as the individual meets all other requirements.

http://nofas.org/

http://samsha.gov/


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5 02/14/2019 1:49 PM Shawna Boller/

Parent/

Guardian/ Advocate

SLS Public comments regarding the Respite Services in the SLS waiver.

Regarding the following wording:

Respite may be provided on an individual or group basis in home/private place of residence of the participant(s) or in the private residence of a respite care provider. Respite may be provided on an overnight group basis only by facilities approved to provide supervised overnight group accommodations.

I would suggest either removing the limiting wording of respite may be provided…”in home/private place of residence of participant or in the private residence of a respite care provider”….. or adding “or provided in a place of the Person Receiving Services Choice.”

Limiting the place where respite can be provided goes completely against the Final Settings Rule, against Person Centered Thinking/Planning & Personal Choice and against an individual’s right. It becomes a restriction when being provided according to the limiting wording in the draft text. If the Person Receiving Services (PRS) would like to go to a movie with the respite

Thank you for your willingness to respond to our query for feedback. We discussed your response and will be adding "in the community" as a service location in the waiver. The original wording was chosen to designate respite as a distinct service from community-based services, such as SCC or Day Habilitation, but we understand that it could be understood as limiting choice.


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provider, go for a hike, walk in the park, go for ice-cream or anything outside of being confined (during that respite time) to their home or the respite provider’s home…it should be allowed.

Respite in the Supported Living Services Waiver is a crucial part of the waiver, and while being provided on a short-term basis, because of the absence or need for relief to those persons who normally provide care for the participant, it should not restrict the person receiving the services. The way the draft currently reads, if it were a 10+ hour day, or a weekend, by definition the person receiving services would be required to remain “in home/private place of residence of the participant(s) or in the private residence of a respite care provider,” the entire time, infringing upon their basic rights to live in/participate in the community. Respectively submitted for consideration,

Shawna Boller Parent/Guardian/Advocate


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6 02/14/2019 2:40 PM Bob Halstead

SLS To whom it may concern,

Please consider changing the wording as to where respite can be provided. It makes no sense that you limit the choice of where respite care can take place at. On occasion she goes out all over town doing different things, so why limit her choices on such a valuable commodity, RESPITE. Thank you!

I suggest either removing the limiting wording of respite may be provided…in home/private place of residence of participant or in the private residence of a respite care provider….. or adding “or provided in a place of Person Receiving Services Choice.”

Limiting the place where respite can be provided goes completely against the Final Settings Rule, against Person Centered Thinking/Planning & Personal Choice and against an individual’s right. It becomes a restriction when being provided. If the Person Receiving Services (PRS) would like to go to a movie with the respite provider, go for a hike, walk in the park, go for ice-cream or anything outside of being confined (during that respite time) to their home or the respite provider’s home…it should be allowed.



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PLEASE SHARE WITH OTHERS ON LISTSERVES, EMAIL, FB, ANYTHING!

Here is the wording from the full text of DRAFT Waiver Renewal Application:

Respite services are provided on a short-term basis,because of the absence or need for relief to those persons who normally provide care for the participant.

Respite may be provided on an individual or group basis in home/private place of residence of the participant(s) or in the private residence of a respite care provider. Respite may be provided on an overnight group basis only by facilities approved to provide supervised overnight group accommodations.

The draft waiver renewals are available online for public comment starting February 7 through March 9, 2019, allowing all HCBS consumers and providers an opportunity to provide input. All comments will be taken into consideration and implemented, or a rationale for not implementing a suggestion will be provided.


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7 2/20/2019 8:20 PM Amanda Bryant, MM,

MT-BC

Board Certified

Music Therapist

Neurologic

Music Therapist-

Fellow Chair,

Colorado

Music Therapy

Legislative Task Force

CES, SLS

The Colorado community of Board Certified Music Therapists is interested in proposing a specific language change in the Medicaid Waiver programs CES and SLS.

We request that Movement Therapy and Music Therapy be separately listed under Professional Services, with appropriate credentialing for each profession.

Distinguishing these two professions as separate therapy services will eliminate confusion, and clearly state that the profession Music Therapy, and the credential ‘Board Certified Music Therapist' is distinct from the profession of Movement Therapy, and the credential required for Dance-Movement Therapists. Currently the two disciplines are jointly referenced as Movement Therapy under Professional Services in the CES and SLS waivers. We would like to avoid confusion, by recognizing two distinct therapy professions, and their appropriate credentials.

For many years Board Certified Music Therapists have dealt with confusion as case managers, consumers and families do not understand why the heading descriptor of Movement Therapy and the service of Music

Thank you for your feedback on the CES and SLS waivers. The Department will be adding the word “therapy” after music and dance in the Service Definition of Movement Therapy prior to submission of the waiver application to the Centers for Medicare and Medicaid Services (CMS).


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Therapy are linked. Most waiver consumers are actually receiving Music Therapy from Board Certified Music Therapists, even though the descriptor heading used is Movement Therapy.

Music Therapy is it’s own profession, with it’s own education, certification and continuing education requirements established by the Certification Board for Music Therapists, and the American Music Therapy Association. Currently, most CCBs in Colorado recognize that music therapy is a covered service under the description of Movement Therapy, but confusion exists.

The Colorado Music Therapy Legislative Task Force is eager to see a clear, specific wording change made to the CES and SLS waivers to eliminate confusion for consumers, caregivers, providers, and management in the Colorado Community Center Boards.

Can you please forward the link to the new drafted language for Movement Therapy in the CES, SLS, and DD waivers which are currently being reviewed, and re-written? The Colorado community of board certified music therapists


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would like to plan and submit a requested wording change.

Thank you for your time, and I remain available if you have questions about Music Therapy and our request.

8 2/04/2019 1:14 PM Marla Maxey

Foothills Gateway

CHRP DHS would like to certify foster/CHRP homes so that the PASA would not have to be a CPA.

Two of the biggest concerns from PASAs about being a CPA is they either don't have staff that meet the qualifications or they don't want to go through the process. If DHS could provide this option we may have more PASAs willing to provide residential services to Children in our area.

Thank you for the opportunity to meet with you again last week as well as to meet with providers. I wanted to follow-up with you to let you know that HCPF will move forward with adding a provider type for the HCBS-CHRP waiver for Habilitation services that will allow for a PASA (the agency will be referred to as a “Medicaid Enrolled Provider” in the waiver) to partner with the County to certify foster homes. Again, we really appreciate this creative approach and look forward to working with you further to see how this will work in practice.


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9 2/11/2019 10:45 AM

Judy Rodriguez

CHRP In preparation for the transition of CHRP to the CCBs in July, we are trying to beef up our in-county foster home resources for CHRP children. We have been in contact with Mary Griffin, State Child Welfare's Foster Home Administrator to determine if how we would like to support our CCB is acceptable to the State.

So, you are probably aware that one way a PASA could have their own foster home resources is to become a Child Placement Agency. This requires a level of work and commitment of resources that all PASAs may not have the ability to achieve.

Another way that a PASA could access foster homes is through agreement with their local county department. County Departments have the ability to certify foster homes, monitor, oversee them, assure that the State's requirements are met in the same way that Child Placement Agencies do. Counties have to approve the placement of any child in a county certified home, irrespective of whether the placement is made by another county, or by a private agency.

Thank you for the opportunity to meet with you again last week as well as to meet with providers. I wanted to follow-up with you to let you know that HCPF will move forward with adding a provider type for the HCBS-CHRP waiver for Habilitation services that will allow for a PASA (the agency will be referred to as a “Medicaid Enrolled Provider” in the waiver) to partner with the County to certify foster homes. Again, we really appreciate this creative approach and look forward to working with you further to see how this will work in practice.


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We are working on a plan that our county would recruit and certify foster homes that are interested in serving developmentally disabled children and youth. We would then have an agreement with the PASAs that are interested in providing services through the CHRP waiver around things that the PASA does that would meet training requirements for the foster parents, along with what each of our agencies would agree to do. It is my understanding that other counties are pursuing arrangements similar to what I have outlined here.

I believe there are concerns with some CCBs about whether this is allowed through the State, or if some kinds of requirements are being violated because the PASAs aren't being required to meet Child Placement Agency licensing standards. To allay these concerns, I have asked Mary Griffin to connect with you and others you think would be instrumental so that messaging about this is consistent, irrespective of who is providing the message.

Because of the amount of time that it takes to recruit, certify, etc. new homes, we are hoping to move forward with securing resources that


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would allow children served through CHRP funding to be served in our

10 2/28/2019 10:53

AM

Theresa

Jordan

SLS If person-centered thinking is the goal, then restricting respite services to "Respite may be provided on an individual or group basis in home/private place of residence of the participant(s) or in the private residence of a respite care provider. Respite may be provided on an overnight group basis only by facilities approved to provide supervised overnight group accommodations."

If we are to use person-centered thinking as a model then the statement above is contradictory. If the Final Settings Rule is followed then the PRS services has the right to recieve respite as they choose and within reason.

The wording should be such that the PRS has the choice of recieving



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respite not only in their home/private residence, the private residence of the respite care provider, but also, in the community and/or participating in activities they enjoy.

11 3/04/2019 11:15

AM

Amy

McQuinn Music

Therapist Board

Certified

Neurologic Music

Therapist

CES,

SLS As a Board Certified Music Therapist serving clients receiving services through the CES and SLS waivers, I am requesting a wording clarification under the service description of Movement Therapy under Professional Services. I request the word “therapy” be added after the word ‘music' so wording in the CES and SLS waivers reflect current practice, and eliminates confusion on who can provide services under the Movement Therapy heading.



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12 3/04/2019 1:09 PM Elizabeth Linder

CES, SLS

As a Board Certified Music Therapist serving clients receiving services through the CES and SLS waivers, I am requesting a wording clarification under the service description of Movement Therapy under Professional Services. I request the word “therapy” be added after the word ‘music' so wording in the CES and SLS waivers reflect current practice, and eliminates confusion on who can provide services under the Movement Therapy heading.


13 3/04/2019 2:37 PM Sarah

Thompson, MM, MT-BC,

CBIS Music

Therapist-

Board Certified

Neurologic Music

Therapist-

Fellow Certified

Brain Injury Specialists

Founder and

CEO of

Rehabilitative Rythms

CES,

SLS I am a Board Certified Music Therapist serving clients receiving services through the CES and SLS waivers.

I am writing to request a wording clarification under the service description of Movement Therapy under Professional Services.

I request the word “therapy” be added after the word ‘music' so wording in the CES and SLS waivers reflect current practice, and eliminates confusion on who can provide services under the Movement Therapy heading.



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14 03/04/2019 3:14 PM Kara Shobe, MM, MT-BC

Foundation

Music School

CES, SLS



15 03/04/2019 4:42 PM Kathy Eakes,

MM, MT-BC Owner/Neur

ologic Music Therapist

Elevate

Music Therapy

Services, LLC

CES,

SLS My name is Kathy Eakes, and as a Board Certified Music Therapist serving clients receiving services through the CES and SLS waivers, I am requesting a wording clarification under the service description of Movement Therapy under Professional Services. I request the word “therapy” be added after the word ‘music' so wording in the CES and SLS waivers reflect current practice, and eliminates confusion on who can provide services under the Movement Therapy heading.



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16 03/04/2019 5:52 PM Julia Whitney

Miguel, MT-

BC Music

Therapist Board

Certified

Co-Owner of Therapeutic

Music Therapy

Services,

LLC

CES, SLS



17 03/04/2019 7:57 PM Caitlin

Wadman (Britt), MT-

BC Founder and

Director

Mountain Sound Music

Therapy

CES,

SLS As a Board Certified Music Therapist serving clients receiving services through the CES and SLS waivers, I am requesting a wording clarification under the service description of Movement Therapy under Professional Services. I request the word “therapy” be added after the word ‘music' so wording in the CES and SLS waivers reflect current practice, and eliminates confusion on who can provide services under the Movement Therapy heading.



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18 03/05/2019 10:21 AM

Shelley McCluskey,

MT-BC

Music Therapist

The Child and Family

Therapy

Center of Denver

CES, SLS

My name is Shelley McCluskey, and I am a music therapist at the Child and Family Therapy Center of Denver, NFP. As a Board Certified Music Therapist serving clients receiving services through the CES and SLS waivers, I am requesting a wording clarification under the service description of Movement Therapy under Professional Services. I request the word “therapy” be added after the word "music" so wording in the CES and SLS waivers reflect current practice, and eliminates confusion on who can provide services under the Movement Therapy heading. I am hopeful this clarification will allow more clients access to appropriate services and providers who can safely address their individual needs.


19 03/01/2019

Phone

Message

10:34

AM

Amy Wilson

Board Certified

Music

Therapists

CES,

SLS As a Board Certified Music Therapist serving clients receiving services through the CES and SLS waivers, I am requesting a wording clarification under the service description of Movement Therapy under Professional Services. I request the word “therapy” be added after the word "music" so wording in the CES and SLS waivers reflect current practice, and eliminates confusion on who can provide services under the Movement Therapy heading. I am hopeful this clarification will allow



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more clients access to appropriate services and providers who can safely address their individual needs.

20 03/05/2019 3:12 PM Kate Shannon

CES, SLS



21 03/05/2019 7:19 PM Darcy Tibbles

Director

Case Management

& Quality Assurance

Developmen

tal Pathways

CES, CHRP,

DD,

SLS

These comments and the Department’s Responses are included as attachment #1.

See Attachment #1

https://www.colorado.gov/pacific/sites/default/files/Attachment%20%231-Department%20Response%20to%20Darcy%20Tibbles%20Public%20Comments%20for%20Waiver%20Renewal%202019.pdf


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22 03/06/2019 1:06 PM Mollie Hiebert

CES, SLS

As a Board Certified Music Therapist serving clients receiving services through the CES and SLS waivers, I am requesting a wording clarification for the service description of Movement Therapy under Professional Services. I request the word “therapy” be added after the word ‘music' so wording in the CES and SLS waivers reflect current practice, and eliminates confusion on who can provide services under the Movement Therapy heading.


23 03/07/2019 10:19

AM

Ashley

Brock-Baca Trauma-

Responsive Service

Array

Developer Colorado

Office of Behavioral

Health

CHRP I am very supportive of putting wraparound in the waiver as a service available for families with complex needs. Our experience in COACT Colorado has found wraparound to be an excellent method for helping families with a child or youth with IDD become more stable and achieve their family vision. We have found the functional assessment and crisis prevention plan aspects of wraparound to be especially helpful for children and youth with IDD and co-occurring mental health/behavioral needs. In a recent Community of Practice for counties specifically targeting at least 25% of their wraparound caseload for families of children with IDD and co-occurring mental health/behavioral challenges, 100% of the providers either agreed or

The Department appreciates this feedback. As the rules stand, the regulation is broad enough to be inclusive of both the Colorado Cross-Systems Training Institute and the National Wraparound Implementation Academy as well as the START National Training Institute. All of which uphold stakeholder support, a provider network in Colorado, and fidelity measures for their given model. This inclusiveness is meant to meet the diverse and regionally specific needs of constituents across the state. As members begins utilizing this new benefit, the Department intends to evaluate if outcomes differ across training programs and if the rule will need to be adjusted.


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strongly agreed that wraparound was both effective and practical for serving families of children with IDD and co-occurring mental health/behavioral challenges.

However, I think it is important that the rules for this waiver specify that the wraparound process must be monitored for fidelity to the principles, action steps, and theory of change for wraparound. As with any other evidence-based program or service, wraparound must be done to fidelity to achieve positive outcomes. If the Colorado process for credentialing wraparound staff through the Colorado Cross-Systems Training Institute is utilized, fidelity monitoring is built in to that process. But if other training or credentialing programs are utilized, that will not necessarily be the case, and then you run the risk of having "wraparound" not being done to fidelity and thus getting poor outcomes.

Additionally, I think the intensive support services need to include more specific support and coaching to the caregivers to help the caregivers gain the following skills: 1) learning to read the child's non-verbal and verbal behavior so theycan be attuned and responsive to

The Department appreciates this feedback and will take this into consideration for future revisions. At this point, the Department anticipates that these needs may be meant through other agencies, funding sources, and processes. The Department anticipates that the need for such education and coaching could be identified and supported through the Wraparound process with the expectation that local resources may be utilized to meet this need.

https://coloradocsti.org/

https://coloradocsti.org/


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their underlying needs and impending dysregulation 2) learning to regulate their ownemotions in order to not escalate thechild (i.e., not letting the child'sbehaviors trigger them)3) learning to de-escalate the childwhen the child becomesdysregulated

Most of the improvement in crisis behaviors with the population of children who will be served by this waiver can be expected to come from the adults who care for the child becoming more attuned and responsive to the child's needs. That is how children (eventually) learn to self-regulate - by an attuned adult showing responsiveness and engaging in interactive co-regulation. This type of service is often identified as need for families with a child with IDD who are in wraparound in the state currently, but it is very difficult to find a service that meets this need. We are working with university partners to develop a caregiver coaching curriculum for this purpose, though (specific to children and youth with IDD).


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24 03/07/2019 11:22 AM

Julie Reiskin Executive

Director

Colorado Cross-

Disability Coalition

CES, DD,

SLS

These comments and the Department’s Responses are in the following attachments: - General Comments – Attachment#2- CES Comments – Attachment #3- DD Comments – Attachment #4- SLS Comments – Attachment #5

25 3/07/2019 11:35 AM

Tammy Phillips

Social

Caseworker III

Larimer County

CHRP These comments and the Department’s Responses are in Attachment #6

26 03/07/2019 11:59

AM

Leslie

Rothman Mountain

View Consulting

CES,

CHRP, DD,

SLS

These comments and the Department’s Responses are in Attachment #7

27 03/07/2019 3:42 PM Heidi Haines

Director of Advocacy

The Arc of

Colorado

CES,

DD, SLS

These comments and the Department’s Responses are the following attachments: - CES Comments – Attachment #8- DD Comments – Attachment #9- SLS Comments – Attachment #10

See Attachment #7

See Attachment #8 See Attachment #9 See Attachment #10

See Attachment #6

See Attachment #2 See Attachment #3 See Attachment #4 See Attachment #5

https://www.colorado.gov/pacific/sites/default/files/Attachment%20%234-Department%20Response%20to%20CCDC%20Public%20Comments%20for%20DD%20Waiver%20Renewal%202019.pdf

https://www.colorado.gov/pacific/sites/default/files/Attachment%20%239-Department%20Response%20to%20Arc%20Public%20Comments%20for%20DD%20Waiver%20Renewal%202019.pdf

https://www.colorado.gov/pacific/sites/default/files/Attachment%20%238-Department%20Response%20to%20Arc%20Public%20Comments%20for%20CES%20Waiver%20Renewal%202019.pdf

https://www.colorado.gov/pacific/sites/default/files/Attachment%20%237-Department%20Response%20to%20Leslie%20Rothman%20Public%20Comments%20for%20Waiver%20Renewal%202019.pdf

https://www.colorado.gov/pacific/sites/default/files/Attachment%20%236-Department%20Response%20to%20Larimer%20County%20Public%20Comments%20for%20CHRP%20Renewal%202019.pdf

https://www.colorado.gov/pacific/sites/default/files/Attachment%20%235-Department%20Response%20to%20CCDC%20Public%20Comments%20for%20SLS%20Waiver%20Renewal%202019.pdf

https://www.colorado.gov/pacific/sites/default/files/Attachment%20%233-Department%20Response%20to%20CCDC%20Public%20Comments%20for%20CES%20Waiver%20Renewal%202019.pdf

https://www.colorado.gov/pacific/sites/default/files/Attachment%20%232-Department%20Response%20to%20CCDC%20Public%20Comments%20for%20DD%2C%20CES%2C%20SLS%20Renewal%202019.pdf

https://www.colorado.gov/pacific/sites/default/files/Attachment%20%2310-Department%20Response%20to%20Arc%20Public%20Comments%20for%20SLS%20Waiver%20Renewal%202019.pdf


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28 03/07/2019 10:33 PM Anonymous

(Submitted

by Gerrie Frohne)

DD My thoughts on DD waiver renewal are that the daily rates are criminal because they're under $8.00 per hour (level 5) daily rate, for 24 hours of absolutely needed services.. Can't assure quality of care under minimum wage!

The Department thanks you for the feedback. The Department works with providers to improve access to waiver services. This includes analyzing rates of direct service providers.

29 03/07/2019 10:48 PM Grace

Hunter

CES,

DD, SLS

It would have been nice to be able to do therapies that work for the person. Example: When my son was on the CES waiver, horse therapy was covered, on DD it was not. He did get to do music therapy. He got massage therapy covered on the CES waiver, but on the DD waiver it was not covered. OT and PT were covered under the state plan, until he was 21, after that I know that they would have become an issue.

I think it would work better for all the waivers, to allow all the therapies to be covered, PT, OT, Speech, Music, massage, horse etc., and perhaps have a dollar amount allowed per year, or per month, and let the families decide which therapies would benefit the child/adult the most, rather than having some covered on some waivers and others covered on other waivers, it is just silly the way it is

Thank you for your feedback. PT, OT and Speech are all services offered under the State Plan to members of all ages. As such, they cannot be covered under the waiver. The therapy services available to individuals on the HCBS waivers vary by waiver, as each waiver is designed to target a specific population, and services are tailored their needs. We appreciate your input as the Department is always reviewing how we can improve our waiver services.


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right now. The families, or the individual should be able to decide which are most beneficial to each situation, then budget and do the ones that benefit the most.

30 03/07/2019 10:52 PM Anonymous

(submitted by Gerrie

Frohne)

DD, SLS

SLS:

1.Diaper wipes should be a coveredbenefit under SLS as the need exists.2.The hours in the categories shouldnot be limited but should meet eachindividual's needs.

DD Waiver: 1. Day Program hours should

not be less than the SLS dayprogram hours. Individualsshould be able to get out fivedays a week and interact withtheir peers and the public.

2. The state should developmore providers for thiscategory for all aspects of thewaiver (in-home, out-of-home, day program, CNA,RN, etc.); most providerswant to support only thefamily caregiver model.

3. The hours in the categoriesshould not be limited butshould meet each individual'sneeds.

1. While wipes are not a coveredbenefit under the DME state planbenefit, they may be covered with anEPSDT exception request for allmembers under age 21. If the wipesare denied with the EPSDT exceptionrequest, they may be covered underthe Specialized Medical Equipmentand Supplies (SMES) benefit ifavailable through the member’swaiver. Wipes may also be fundedunder the SMES benefit if themember has a documented provideraccess issue by noting which DMEsuppliers were contacted and theirresponses. Either the denial or theaccess documentation should benoted in the BUS and kept on file atthe agency in case of an audit, andmust be updated yearly with the newservice plan. This will help conservewaiver funds for other services, aswell as allowing access to medicallynecessary wipes for individuals noteligible for an HCBS waiver. Accessto wipes is available through theSMES benefit within the SLS waiverfor members age 21 and up without


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these steps, through the typical service planning process.

2. The waiver services are intendedto meet an individual’s needs.Allocations may be restricted as apart of waiver oversight such as theprevention of duplication of services.Case Managers are required toprovide this oversight and ensure theclient’s needs are met.

DD Waiver:

1. Day Habilitation and Employmentservice limitations for both DD andSLS are not to exceed 7,112 units.

2. The Department thanks you forthe feedback. The Department workswith providers to improve access towaiver services.

3. The waiver services are intendedto meet an individual’s needs.Allocations may be restricted as apart of waiver oversight such as theprevention of duplication of services.Case Managers are required toprovide this oversight and ensure theclient’s needs are met.


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31 03/07/2019 10:56 PM Anonymous

(submitted

by Gerrie Frohne)

CES, CHRP,

DD,

SLS

1. Change the state level & the CCBterminology of “case manager” tosomething more respectful &accurate.- People aren’t “cases”- Change “manager” because itimplies TOO MUCH POWER over anindividual/family when the actual jobshould be educational & advisory.- Not sure I can come up with thebest terminology but somethingsimple like “waiver advisor” couldwork.

2. For every waiver - REQUIRE thatevery CCB start by telling afamily/individual1- how much money their child orloved one are eligible for thru thewaiver (If it’s a range tell them therange.)2- giving the family a list of theeligible uses of the funding. Helpfamilies understand they are workingoff of a prioritized budget.

It took many many years before I knew enough to ask for specifics on the funding eligibility. Perhaps it’s different now as my son is now in his mid 40’s & maybe this info is provided, but I’m guessing it isn’t consistent across the state and why shouldn’t it be? Financial Disclosure should be required at HCPF level & thru the CCB system so families can

1. Thank you for your feedback. TheDepartment can consider this butwould require stakeholderengagement as well to make thischange. The work is casemanagement, which is also theFederal term and definition.

2. Individuals aren’t eligible formoney, they are eligible for services.Support Levels in the HCBS-SLSwaiver assist in determining thescope, frequency, and duration ofthe services an individual receives. InHCBS-CES individuals are eligible forscope, frequency, and duration ofservices up to a limit.


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make the best informed decisions. If case managers can understand the funding process it why shouldn’t families be able to understand? If families need more info/education require that CCBs or Arcs provide it on a regularly scheduled basis & make it CONSISTENT across the state.

32 03/07/2019 10:58 PM Jessica

Spangler

CES They should make an exception to the CES night intervention requirements under some circumstances. Some suggestions: children who are adopted from foster care, as this would encourage adoption of special needs kids from foster care. Children who meet the daytime requirements for CES and have a sibling who requires night interventions and is not on CES (thus family is dealing with all of the needs but does not qualify.) Parents of kids with challenging behaviors, significant medical costs, who do not qualify for buy in because they are over 300% FPL and do not qualify for childrens waiver because not enough physical interventions needed. IE, I know a mom who is paying $300 a week for her sons medications and he has extremely challenging aggression during the day and she is on a wait list of over one year for FSSP and qualifies for absolutely nothing.

Thank you for your comment. Changing the eligibility criteria for the CES waiver regarding nighttime criteria would allow for increased enrollments onto the waiver and thereby expanding the waiver. The Department does not have the authority to implement changes, or exceptions, to the eligibility criteria that would impact the budget without legislative action.


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33 03/07/2019 11:01 PM Anonymous

(submitted

by Gerrie Frohne)

CES I am extremely grateful for the CES waiver but I have these suggested improvements.

1. Wheelchair van- I find itfrustrating that the waiver will payfor a conversion but not a van that’salready been converted. If you needa van why do they care if youconvert your van or buy one that hasalready been converted. If it is amonetary issue could they determinehow much a conversion costs say$15k and allow you to put thattoward a van that has already beenconverted. I wanted to go to thedealer and try out the ramps andknow what I was getting. These areextremely expensive vehicles that arenot s luxury but are a necessity- anyhelp with purchase, replacement andrepairs would be really helpful.

2. Respite and overlap with therapyprohibited.- Your respite providershould continue to be paid even if atherapist is working with thechild. My son has therapy 4 days aweek after school. When I can’t bethere I hire a respite provider to staywith him. The respite provider cannotleave just because a therapist showsup but they both can’t bill for thathour. I have been told that you can’tpay out of pocket to supplement aMedicaid provider. But we have no

1. The Department currently allowsthe use of the Vehicle Modificationbenefit for the purchase of themodification component of analready-converted vehicle. TheDepartment also approves VehicleModification benefit funds to repairdamage caused by a CES or SLSmember that poses an ongoingsafety concern or reducesindependence, as well as repairs ormaintenance to the modified portionof the vehicle caused through typicaluse, when not covered by warranty.These repairs may also includemodifications to prevent futuredanger to the person and damage tothe property. Purely cosmetic workor vehicle repairs unrelated to thedisability, such as engine work, maynot authorized.

2. Respite service is provided on ashort-term basis, because of theabsence or need for relief tocaregivers of the participant. Respiteis not to be billed at the same timeas therapy services, with systemlimitations in place. Medicaidproviders may bill for the same timespan only when the service beingprovided are not duplicative. TheDepartment will continue to reviewthe practical utilization of this serviceby families and how we can make


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choice. We can’t have them there unpaid. This is especially difficult when we are out of town for a week. It’s a scheduling nightmare. I have to decide if I pay out of pocket in which case they have to log in and out when a therapist comes and goes or do I cancel all therapies that week (which is unfair to my child and the therapists). I can understand why the CNA and therapy can’t overlap. (Although when there is housekeeping duties for the CNA this could be done while the therapist is working with the client this first really make sense either.) But, It doesn’t make sense why respite and therapy can’t overlap. If the child needs a diaper change during that therapy visit the therapist doesn’t do that- the respite provider would. The respite provider might be folding laundry, preparing a feeding, etc. If they can’t leave the premise -whether it be for home therapy or an office visit -they should be paid.

3. It would be helpful if you coulduse respite funds to pay whomeveryou choose to stay with your child. Ihave family members who know myson, love my son, take great care ofhim and are willing to help outoccasionally while we need a nightoff etc. but they have other jobs anddon’t have time to take off work to

the Respite service more person centered.

3. The Department is responsible forthe health, safety and welfare of itsrecipients. In order to ensure qualityservices are rendered by qualifiedindividuals, provider qualificationsand training requirements must be inplace. At this time there is not a self-directed service delivery option forrespite care.


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go thru the agencies mandatory trainings (which are generally during the business day) and hiring practice. So I can’t use respite funds to pay them. Every year I pay hundreds of dollars out of pocket because of the rules around using the respite care are so restrictive. I have found the same circumstance with paras who work with my son at school who would be willing to provide respite but since they have to be hired and trained by an agency they can’t fit that into their schedule without taking off work. So we pay out of pocket. Would CDASS solve this?

At the end of the plan year I always end up with unused respite hours while I have paid hundreds out of pocket for respite. Finding a provider who has been hired by an agency is difficult. Frustrating.


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34 03/08/2019 11:43 AM

Bruce and Caryn Sala

Slawinski

SLS Dear CMS,

Please leave our daughter’s SLS Waiver alone. We do not want you to have the ability to change or amend our Daughter’s services anytime you would feel like it. My daughter is 39 with Tuberous Sclerosis. Alot of health impairments, Seizures, A Sega in her brain, 32 surgeries and Autism.

We do not want her services to be lowered or taken away from her in the next 5 yrs. We came here from Texas where the services were terrible and when we moved to Aurora the services were much better. We have already had some of the services she was promised taken away in the past 3 yrs and DO NOT WANT TO LOSE ANYMORE!

Thank you for your time in this matter.

Thank you for your feedback. The Department is committed to ensuring no services change due to the waiver renewals.


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35 03/08/2019 12:53 PM Ellen Jensby, JD

Senior

Director of Public Policy

& Operations

Alliance

CES, DD,

SLS,

CHRP

These comments and the Department’s Responses are in Attachment #11

See Attachment #11

https://www.colorado.gov/pacific/sites/default/files/Attachment%20%2311-Department%20Response%20to%20Alliance%20Public%20Comments%20for%20Waiver%20Renewal%202019.pdf

Documents

Listening Log Home and Community Based Services (HCBS ... · Listening Log – HCBS Waiver Renewals Page 6 of 33 Published April 5, 2019 . Comment Number Date Received Time Received