As used in this part 17, unless the context otherwise requires:
(1) Authorized representative means a person designated by the member receiving services, or by the parent or guardian of the member receiving services, if appropriate, to assist the member in acquiring or utilizing long-term services and supports pursuant to this article 6 and article 10 of this title 25.5. The extent of the authorized representative's involvement must be determined upon designation.
(2) Case management agency means a public or private not-for-profit or for-profit organization contracted with the state of Colorado to provide case management services and activities.
(3) Case management services means the assessment of an individual's need for long-term services and supports; the development and implementation of a person-centered support plan for the member; the coordination, monitoring, and delivery of long-term services and supports; the evaluation of service effectiveness; and the reassessment of the member's needs, all of which must be performed by a case management agency or an entity.
(4) Case manager means a person who provides case management services and activities pursuant to this article 6 and article 10 of this title 25.5 for members receiving long-term services and supports.
(5) Community-centered board means a private for-profit or not-for-profit organization that is an administrator of locally generated funding pursuant to section 25.5-10-206 (6) and acts as a resource for persons with an intellectual and developmental disability or a child with a developmental delay.
(6) Conflict-free case management means case management services and activities provided to a member enrolled in a home- and community-based services waiver by an entity other than the entity providing direct long-term services and supports, except as otherwise allowed pursuant to 42 CFR 441.301 (c)(1)(vi). Service providers, case management agencies, and entities are responsible for ensuring employees meet the requirements of this article 6.
(7) Defined service area means the geographical area determined by the state department to be served by a case management agency.
(8) Entity means a public or private not-for-profit or for-profit organization, which may include a community-centered board, that has a contract or agreement with the state of Colorado to perform specific functions.
(9) Intellectual and developmental disability has the same meaning as set forth in section 25.5-6-403 (3.3)(a).
(10) Long-term services and supports means the services and supports used by members of all ages with functional limitations and chronic illnesses who need assistance to perform routine daily activities.
(11) Member means any person enrolled in the state medical assistance program, articles 4, 5, and 6 of this title 25.5, or the children's basic health plan, article 8 of this title 25.5.
(12) Person-centered support plan means a long-term services and supports plan that is directed by the member, or the member's legal guardian, and prepared by the case manager to identify the supports needed for the member to achieve personally identified goals and is based on respecting and valuing member preferences, strengths, and contributions.
(13) Person with an intellectual and developmental disability has the same meaning as set forth in section 25.5-6-403 (3.3)(b).
(14) Service provider means an agency or individual certified by the state department and enrolled to provide one or more long-term services and supports.
(15) Waiting list has the same meaning as set forth in section 25.5-10-202 (38).
Source: L. 2021: Entire part added, (HB 21-1187), ch. 83, p. 313, � 1, effective September 7.
25.5-6-1703. Case management system - defined service areas - case management services - only willing and qualified provider exemption - rules. (1) No later than July 1, 2024, the state board shall adopt rules providing for the establishment of a case management system that consists of case management agencies throughout the state for the purpose of enabling individuals in need of long-term care to access appropriate long-term services and supports. Members in need of specialized assistance may be referred to other services outside of long-term services and supports, as necessary for additional care coordination.
(2) No later than December 31, 2021, the state department shall work with stakeholders to develop a timeline for the implementation of this part 17.
(3) (a) No later than December 31, 2022, the state department shall issue a competitive solicitation in order to select case management agencies pursuant to subsection (1) of this section. The competitive solicitation must include a reimbursement structure developed through a fiscal analysis.
(b) No later than January 31, 2023, the state department shall provide an update on the status of the implementation of this part 17 to the joint budget committee of the general assembly as part of its annual presentation to that committee.
(4) The state department shall utilize a stakeholder process to identify defined service areas for case management agencies across the state.
(5) A case management agency may provide case management services to private paying individuals on a fee-for-service basis and shall provide case management services to members of publicly funded long-term services and supports programs, including but not limited to programs created pursuant to this article 6 and article 10 of this title 25.5.
(6) Where applicable, the state department is authorized to seek a federal exemption from conflict-free case management requirements for defined service areas within the state where the only willing and qualified entity to provide case management services is also the only willing and qualified entity to provide home- and community-based services in that defined service area.
(7) The state board shall utilize a stakeholder process when promulgating rules to implement this section.
Source: L. 2021: Entire part added, (HB 21-1187), ch. 83, p. 315, � 1, effective September 7.
25.5-6-1704. Intellectual and developmental disability determination - functional eligibility determination - rules. (1) Intellectual and developmental disability determination. Any person may request an evaluation to determine whether the person has a developmental delay or an intellectual and developmental disability and is eligible to receive long-term services and supports pursuant to this article 6 and article 10 of this title 25.5. The person must request a developmental delay determination or intellectual and developmental disabilities determination from the case management agency or the entity in the defined service area where the person resides.
(2) Functional eligibility determination. Pursuant to the contract with the state department, a case management agency shall determine whether a person is eligible to receive long-term services and supports pursuant to this article 6 and article 10 of this title 25.5. A case management agency or an entity shall develop a person-centered support plan for persons eligible for long-term services and supports for home- and community-based services and state general-funded programs.
(3) The state board shall promulgate rules pursuant to article 4 of title 24 setting forth the procedure and criteria for determination of eligibility and person-centered support plan development. The procedure and criteria must be uniform in nature and applied throughout the state in a consistent manner.
(4) Subject to available appropriations pursuant to section 25.5-10-206 and to the capacity of a service provider, the person must be provided options for long-term services and supports within the defined service area that can appropriately meet the person's identified needs, pursuant to this section.
Source: L. 2021: Entire part added, (HB 21-1187), ch. 83, p. 316, � 1, effective September 7.