Waiver Implementation Council

Improving Home and Community-Based Services for

Adults with Intellectual and Developmental Disabilities

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March 22, 2018

Facilitator: Kimberley Smith

Welcome

• Introductions

• Housekeeping

➢Please feel free to step out if you need to

▪ The restroom is in the hallway to the right

➢Please keep your cell phone on silent or

vibrate

➢Please sign in and add your current contact

information to the sign in sheet

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Agenda

11:00 am Overview of Today’s Meeting

11:15 am WIC Role and ChargeReview June WIC Meeting Summary

11:20 am Waiver Redesign Refresher and Update

11:35 am Budget Considerations

12:20 pm Review Submitted Questions Group Breakout: WIC Planning

12:50 pm Public Comment

1:00 pm Adjourn

• June 28th Meeting Summary

• Waiver Submission Timeline

• R-19 Budget Request

• WIC Proposed Calendar for Discussion

• Statute, Rules, and Waivers Crosswalk

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Materials

Future Discussions

• Service and Coverage Standards Content

• Rates Setting Process

• Provider Qualifications

• Unit Limitations

• Self-Direction

Today’s Meeting

• Update

• Budget Request and Process

• Timeline

• WIC Planning

• Submitted Questions

Meeting Scope

Our Mission

Improving health care access and

outcomes for the people we serve

while demonstrating sound

stewardship of financial resources

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Office of Community Living Vision

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ACCESS RECEIVECOORDINATE

Streamline Access

to Services

Improve Service

Coordination

Increase Service

Options and Quality

Council Role & Charge

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Provide ongoing guidance and advice

on the development and

implementation of a redesigned waiver

to support adults with intellectual and

developmental disabilities.

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Implementation Council Purpose

Implementation Council Role

• Consultation and advice

➢ Examine redesign concepts

➢ Suggest improvements through new ideas and

perspectives

➢ Provide solution-oriented feedback

• Stakeholder ambassadors

➢ Identify other stakeholder groups/experts

➢ Create partnerships

➢ Disseminate and collect information

➢ Communicate with a broader audience

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• Treat each other with respect and honor one

another as whole individuals

• Value diversity in experiences and perspectives

➢ Robust examination and discourse improves our work

• Engage with each other as partners

➢ Direct communication

➢ Solution-oriented collaboration

• Feedback Options

➢ Index cards

➢ Group break out

➢ Parking lot

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Working Agreements

June 28, 2017

Waiver Implementation Council Meeting Summary

For Our Stakeholders

Committees, Boards, and Collaboration

Waiver Implementation Council

Past Meeting Materials

June 28th 2017

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Review Meeting Summaries

Refresher

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• Current Waivers

➢ Inflexible and outdated

➢ Individuals and families want greater control and

authority

➢ Encourage a caretaker role

➢ No alternative service delivery options

➢ History of waiting lists

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Waiver Redesign: Why?

• Design services to ensure:

➢ People get the right service, in the right amount, in the right

place at the right time, per their individual preferences, goals,

aspirations & needs

➢ The redesigned waiver is sustainable long into the future &

people get equitable access to the waiver

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Our Charge

• Online Forum

• Service Coverage Standards Progress

• OCL Reorganization- we now have a full team

• Contracted Work➢ Rates Cost Factors Survey

➢ Residential Habilitation Microservices Survey and Analysis

➢ Utilization Claims Review

➢ Facilitator/Stakeholder Engagement

➢ Provider Qualifications and Quality Recommendations

• R-19 Budget Request

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Our Work in 2017-2018

Update

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Incorporated WIC feedback and contractor work into

service coverage standards

July 2017-March 2018

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Learned about complexity of the

delivery model

Understood that billing 15 minute units would be arduous and non-

representative

Identified additional actuarial work (R19) needed to analyze utilization of the

combined population

Redesigned Residential Habilitation

Service

Residential Habilitation Service

Analysis

• The Department submitted a budget request on

November 1, 2017

• Funding from FY 2018-19 Priority R-19, IDD Waiver

Consolidation Administrative needed for…

➢ Data and actuarial analysis.

➢ Transition plan development and ad hoc analysis.

➢ Stakeholder engagement.

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R-19 Budget Request

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NEW

WAIVER

Amend the

existing

HCBS DD

waiver

Not in compliance

with the Final Rule

(CFCM 2022)

Faster but more complex

with a challenging

timeline

HCBS Final Rule

HCBS Final Rule - 79 Fed. Reg. 2948 (2014)

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Waiver Implementation Timeline

Q4

FY 17-18

Service Coverage Standards

Drafts Finalized

Q1

FY 18-19

Contractor work

begins

Q3-Q4

FY 18-19

CMS Public Comment

Q4

FY 18-19

Response and

Incorporate Public

Comment

Q1

FY 19-20

Waiver Submission

to CMS

Q1

FY 19-20

Provider Training

and Enrollment

Q3

FY 19-20

Waiver Approved

and Transition

Begins

Fiscal Year Key

• FY 17-18 – July 1st 2017-June 30th 2018

• FY 18-19 – July 1st 2018-June 30th 2019

• FY 19-20 – July 1st 2019-June 30th 2020

• FY 20-21 – July 1st 2020-June 30th 2021

Quarter Key

• Q1 – July – September

• Q2 – October – December

• Q3 – January – March

• Q4 – April - June

Budget Considerations

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Estimating the Cost of IDD

Waiver Consolidation

Presented by: Jill Schnathorst

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March 22, 2018

Challenges in Estimating Waiver

Consolidation

• Variation in Need

• Residential Habilitation

• HCBS-DD Waiting List

• Funding

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Challenge 1: Variation in Need

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11.62%

20.97%

15.50%16.00%

21.41%

14.50%

1 2 3 4 5 6

HCBS-DD Percent of Population at Each SIS/Support Level

37.43%

32.09%

10.01%

7.34% 7.32%

5.80%

1 2 3 4 5 6

HCBS-SLS Percent of Population at Each SIS/Support Level

Challenge 1: Variation in Need

• How to limit services

➢ Service Plan Authorization Limits?

➢ Unit Limits?

• FY 2018-19 R-19 “IDD Waiver Consolidation and

Administrative Funding” Budget Request

➢ Stakeholder Engagement

➢ Data and Actuarial Analysis

➢ CMS Waiver Application Support

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Challenge 2: Residential

Habilitation

• Approximately 93% of HCBS-DD clients in FY 2016-

17 used Residential Habilitation services

• $225 Million paid in FY 2016-17 for HCBS-DD

Residential Habilitation services

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Challenge 2: Residential

Habilitation

SIS/Support Level Residential Habilitation

Cost per Utilizer

Level 1 $24,804

Level 2 $36,938

Level 3 $44,122

Level 4 $53,169

Level 5 $59,483

Level 6 $73,015

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Challenge 3: HCBS-DD Waiting List

• FY 2017-18 R-I-1 “Elimination of the IDD Waiting

List” budget request

➢ $190 million annually once fully eliminated

• Major Assumptions

➢ All clients would be enrolled by July 1, 2020

➢ 2,310 on the waitlist September 2016

➢ Offsets to costs

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Challenge 3: HCBS-DD Waiting List

• 70% receive services in HCBS-SLS

• 19% receive no Medicaid services

• 6% receive services in HCBS-EBD

• 5% receive only State Plan services

• As of February 2018 approximately 2,800 people

are waiting for HCBS-DD services with ASAP status

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Challenge 4: Funding

• There was no funding appropriated for services in

HB 15-1318 “Consolidate Intellectual and

Developmental Disabilities Waivers”

• No reserve funding from under utilization

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Challenge 4: Funding

• State Budget Process

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Internal Approval April/May

Submit to Governor’s Office August

Submit to Joint Budget

Committee

November

Briefing and Hearing December

Figure Setting March

Funding Available July 1

Questions or Concerns?

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Submitted Questions

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Question:

Can we get clarification on the timelines for

implementation of the:

1) Combined Waiver

2) New Assessment Tool

3) Settings Final Rule in Colorado

4) No Wrong Door Program

5) Conflict-Free Case Management?

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Financial Eligibility Reform

Medicaid Buy-In Expansion

Waiting List(s) Elimination

No Wrong Door (NWD)

STREAMLINE

ACCESS TO SERVICES

INCREASE SERVICE

OPTIONS AND QUALITY

IMPROVE SERVICE

COORDINATION

CHRP – Cut Child Welfare

RequirementCDASS & IHSS Expansion

Housing & Transportation

Person-Centered Support

Planning ProcessSelf-Direction Tools

Person-Centered Budgets

Waiver Redesign

Intensive Case Management for

Regional Center Transitions

Employment First + WIOA

HCBS Settings Rule Compliance

GJRC Relocation

Cross System Crisis Response

Regional Center Task Force

Community First Choice

(State Plan Option)

Colorado Choice Transitions (CCT)

Case Management Redesign

New Functional Assessment Tool

CHRP CCB Case Management

• Background Checks

• Conflict-Free Case Management

• Rate Setting

• COMMIT/Revalidation

• CCB Transparency

OPERATIONAL EXCELLENCE INTIATIVES

• Electronic Visit Verification

• Mandatory Reporting

• CHRP Transfer

• eLTSS Record + Personal Health Record

• OCL Re-org

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General Timelines for Initiatives

Conflict-Free Case ManagementDeadline

HCBS Settings Final Rule Compliance

No Wrong Door (NWD)

New Assessment Tool

Combined Waiver Submit to CMS July 2019

Piloting through Fall 2019

March 2020

Piloting through FY 2018-19

June 30, 2022

FY 2018-19 FY 2019-20 FY 2020-21 FY 2021-22

Question:

How is the Department going to

encourage participation on the

Online Forum?

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Group Breakouts: WIC Planning

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How to give feedback in the most efficient and timely way for Service Coverage Standards (Mar-May 2018)?

What will the charge be for the next iteration of the WIC (July 2018)? (Think about WIC meeting topics June 2018-June 2019.)

How should we get people engaged on the online forum to make it fully functional?

How do we increase WIC membership to represent people waiting for services and direct service providers?

Questions to Guide Discussion

Group Report Out on Solutions

and Suggestions

Discussion Period

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Next Steps

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Public Comment Period

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Wrap Up

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