cms approval for colorado 0709 targeted case management approval

8/14/2019 CMS Approval for Colorado 0709 Targeted Case Management Approval

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DEPARTMENT OF HEALTH AND HUMAN SERViCESCENTERS FOR MEDICARE & ~ ~ E D I C A i D SERVICES FORM APPROVEDOMB NO 093801931 TRANSMITTAL NUMBER: ! 2. STATETRANSMITTAL AND NOTICE OF APPROVAL OFSTATE PLAN MATERIALFOR: CENTERS FOR MEDICARE & MEDICAID SERVICES

08-009 I COLORADO3. PROGRA-MioENTIFicAllON:TlTLE XIXOF"THES-6cIALSECURITY ACT (MEDICAID)

TO: REGIONAL ADMINISTRATORCENTERS FOR MEDICARE &MEDICAID SERVICESDEPARTMENT OF HEALTH AND HUMAN SERVICES4. PROPOSED EFFECTIVE DATE07101/09

5. TYPE OF PLAN MATERIAL (Check One):NEW STATE PLAN AMENDMENT TO BE CONSIDERED AS A NEW PLAN X AMENDMENT

COMPLETE BLOCKS 6 THRU 10 IF THIS IS AN AMENDMENT (Separate transmittal for each amenclment) ----+-~ F E D E R A C S - T ATUTE/REGULATION-CITATION-------------- - TFEDERAL BUDGETIMPAC'r-- -------------------------42 CFR Parts 431, 440, and 441, as amended by the proposed a. FFYA4...9J.LQ.,g_ L : ? , 3 2 ? , . ~ 1 . Q J __interim final regulations published December 4,2007 (Federal b. FFY_09-1 a__ om $.. __9.289,963 _om_omRegister, Volume 72, No. 232, Pages 68077-68093)8. PAGE NUMBER OF THE PLAN SECTION OR ATTACHMENT 9. PAGE NUMBER OF THE SUPERSEDED PLANSupplement 1B to Attachment 3.1-A, Pages 1 to 4 SECTION OR ATTACHMENT (If Applicable)Attachment 4.19-8

10. SUBJECT OF AMENDMENTTargeted Case Management Services

11. GOVERNORS REVIEW (Check One)GOVERNOR'S OFFICE REPORTED NO COMMENT X OTHER, AS SPECIFIED

COMMENTS OF GOVERNOR'S OFFICE ENCLOSEDNO REPLY RECEIVED WITHIN 45 DAYS OF SUBMITTALGovernor's letter dated 26 January 2009

Attn: Brian Zolynas

13. TYPED NAME JSandeep Wadhwa, MD, MBA Colorado Department of Health Care Policy and Financing1570 Grant StreetI-,-o , , ~ ; : _ = _ ; : : : _ - . - ------.---..------.----.- _ ..__."" _". . .._._ .. ,,_,,,,_,,__-j Denver. CO 80203181814. TITLEMedicaid Director, Medical & CHP+ Administration Office15. DATE SUBMITTED04/0312009.--.---------------.-- .....- - - - -FO"R-REGI6"NALOFF'fCE-OSE"-6"NIV----------------- .,.-------.--

T 7 ~ D A f E R E C E T V E r 5 - - : . ; 7 3 k 1 - - - - - - - - - - - - - - - -- - - - - - r l } f D A f E 7 \ p p F r 6 v E b - - - - - J U ~ - - ; -. ~ ~ ~ ~ - - - - - - - - - - - - - - - ....

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State Plan under Title XIX of the Social Security ActMedical Assistance Program

Supplement to Attachment 3.l-APage 1 of 4Targeted Case Management Services forPersons with a Developmental Disability

Target Group: Medicaid recipients who have been determined by a Community Centered Boardto have a developmental disability and are actively enrolled in a program under contract withDevelopmental Disability Services (DDS) and the Department of Health Care Policy andFinancing, including the Home and Community Based Services waiver for the developmentallydisabled (HCBS-DD), Supported Living Services waiver (SLS), Children's Extensive Supportwaiver (CES), Early Intervention Services. Excluded are children with developmental disabilitiesor delays enrolled in the Children's HCBS waiver, HCBS Children's Residential HabilitationProgram, or adults with developmental disabilities who are enrolled in other Medicaid waiverprograms, persons residing in Class I nursing facilities or ICF-MR, or persons receiving servicesfrom Community Centered boards which are not under State contract with the DevelopmentalDisability Services and the Department ofHealth Care Policy and Financing.Areas of state in which services will be provided:X Entire State

Only in the following geographic areas (authority of section 19l5(g)(1) of the Act isinvoked to provide services less than Statewide)Comparability of services:

Services are provided in accordance with section 1902(a)(1 O)(B) of the Act.X Services are not comparable in amount duration and scope.Definition of services: Case management services are services furnished to assist individuals,eligible under the State Plan, in gaining access to needed medical, social, educational and otherservices. Case Management includes the following assistance:Targeted Case Management (TCM) services to this population will consist of facilitatingenrollment; locating, coordinating, and monitoring needed developmental disabilities services;and coordinating with other non-developmental disabilities funded services, such as medical,social, educational, and other services to ensure non-duplication of services and monitor theeffective and efficient provision of services across multiple funding sources.

-continued-

TN No. ~ 0 8 : ! . : - ~ O O ~ 9Supersedes TN N O . _ - . . - ; : : 9 ; . : : : : 8 : . . : - 0 ~ 1 ~ 1 , - Approval Date.! ~ 2 zrEffective Date July 1,2009 ~ 2 21m


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Supplement to Attachment 3.I-APage 2 of 4

Targeted Case Management services will involve at least one activity regarding the individualeach month in which Targeted Case Management services are billed for one or more of thefollowing purposes:Comprehensive assessment and periodic reassessment of individual needs to determine the needfor any medical, educational, social or other services. These assessment activities include:

taking client history; identifying the individual's needs and completing related documentation; and gathering

information from other sources such as family members, medical providers, socialworkers, and educators (i f necessary), to form a complete assessment of the individual.

Development (and periodic revision) of a specific care plan that: is based on the information collected through the assessment; specifies the goals and actions to address the medical, social, educational, and otherservices needed by the individual; includes activities such as ensuring the active participation of the eligible individual, and

working with the individual (or the individual's authorized health care decision maker)and others to develop those goals; and

identifies a course of action to respond to the assessed needs of the eligible individual.Referral and related activities:

to help an eligible individual obtain needed services including activities that help link anindividual with:o medical, social, educational providers; oro other programs and services that are capable of providing needed services, such as

making referrals to providers for needed services and scheduling appointments forthe individual.Monitoring and follow-up activities:

activities and contacts that are necessary to ensure the care plan is implemented andadequately addresses the individual's needs, and which may be with the individual,family members, providers, or other entities or individuals and conducted as frequently asnecessary, and including at least one annual monitoring, to determine whether thefollowing conditions are met:o services are being furnished in accordance with the individual's care plan;o services in the care plan are adequate; ando needs or status of the individual have changed, and if so, making necessaryadjustments in the care plan and service arrangements with providers.

continued-

TN No. ----'0=8'-'-0=0"'-9Supersedes TN NO._----o;;9"""8'-'-0"-'1,..,1'- Approval Date JUN 2 2009Effective Date July 1, 2009


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Supplement to Attachment 3.I-APage 4 of 4Case Records:Providers maintain case records that document for all individuals receiving case management thefollowing: the name of the individual; dates of the case management services; the name of theprovider agency (i f relevant) and the person providing the case management service; the nature,content, units of the case management services received and whether goals specified in the careplan have been achieved; whether the individual has declined services in the care plan; the needfor, and occurrences of, coordination with other case managers; the timeline for obtaining neededservices; and a timeline for reevaluation of the plan.Payment:Payment for TCM services under the plan do not duplicate payments made to public agenciesor private entities under other program authorities for this same purpose. The reimbursementmethodology will be based upon a market-based rate with a unit of service equal to fifteen (15)minutes according to the State's approved fee schedule.Limitations:Case Management does not include the following:

case management activities that are an integral component of another covered Medicaidservice; the direct delivery of an underlying medical, educational, social, or other service to whichan eligible individual has been referred; activities integral to the administration of foster care programs; activities, for which an individual may be eligible, that are integral to the administrationof another non-medical program, except for case management that is included in anindividualized education program or individualized family service plan consistent withsection 1903(c) of the Social Security Act; and activities for which third parties are liable to pay.

TN No. - " 0 ~ 8 . . . : : - 0 ~ 0 ~ 9Supersedes TN No._--:.N.:.,:E;;:.,W:..:..-

Approval Date JUN 2 2009Effective Date July 1, 2009


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TITLE XIX OF THE SOCIAL SECURITY ACTMEDICAL ASSISTANCE PROGRAM

State of Colorado Attachment 4. I9-BPage lof3

METHODS AND STANDARDS FOR ESTABUSHING PAYMENTRATES - TARGETED CASE MANAGEMENT SERVICES FOR PERSONS WITH A

DEVELOPMENTAL DISABIUTY

Payment for TCM services under the plan do not duplicate payments made to public agencies orprivate entities under other program authorities for this same purpose. The reimbursementmethodology is based upon a market-based rate with a unit of service equal to (15) minutesaccording to the State's approved fee schedule.Reimbursement for Targeted Case Management (TCM) services shall be provided by qualifiedcase managers and shall be the lower of the following:] . Submitted charges;2. Fee schedule as determined by the Department of Heath Care Policy and Financing.Except as otherwise noted in the plan, state developed fee schedule rates are the same for bothgovernmental and private providers of case management for persons with developmentaldisabilities and the fee schedule and any annual/periodic adjustments to the fee schedule arepublished in the Provider Bulletin. The agency's fee schedule rate is set as of July I, 2009 and iseffective for services provided on or after that date. All rates are published on the agency'swebsite.The Targeted Case Management ("TCM"), fee for services rate is based on the estimated theaverage number of hours a case manager and a case manager supervisor will spend on a caseeach month. The base for the rate is the estimated personnel related costs for these hours, andincluded consideration for non-direct cost allocations. The proposed rate is based on thefollowing assumptions.

Direct Personnel Costs: There are two sets ofwages, case manager and supervisor, inthe Targeted Case Management model. Both wages were derived from the May 2005BLS statewide wage data. These wages were adjusted for inflation by using theaverage SSI inflation rates for the past three years, which adjusted the salary by 9.7percent.

Case load: This drives the average number of hours assumed for a given case in amonth, based on a 40-hour workweek. The proposed rate assumes a caseload of 40cases per case manager, which translates to on average 3.67 hours devoted to eachclient each month.

-continued-

TN No. ~ 0 ~ 8 - ~ 0 ~ 0 ~ 9Supersedes TN No. 03-038Approval Date ' JUN 7. L\.l1J'dEffective Date July 1,2009


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Attachment 4.19-BPage 2 of3

Supervisor Span ofControl: The supervisor span of control is the number ofemployees providing direct service supervised by a supervisor. This component ofthe rate model captures the costs associated with direct supervision; other levels ofmanagement are contained in the non-direct cost allocation, Program Support: PayrollRelated. The Targeted Case Management model allows for one supervisor for everyten case managers.

Benefits Factor: The benefits factor represents taxes and benefits for the direct careemployee and the direct care supervisor. The benefits factor is calculated usingreported costs from the spring 2007 and the wage survey data. The same benefitfactor of 24 percent was used for all of the proposed rates.

Program Support--Payroll Related: This category of non-direct cost allocationscaptures salaries and benefits not captured in the direct care or supervisor of directcare components of the rate. As with all non-direct cost allocations, we calculatethese costs as a percentage of the direct care salaries and benefits. The source of allof the non-direct cost allocations is the spring 2007 targeted cost survey. Thepercentage add-on for this category of costs is 13.2 percent. The salaries and benefitsincluded are those of program managers, associate program managers, programdirectors and program secretaries.

Program Support-Non-Payroll Related: This category of non-direct cost allocationsincludes program expenses, medical professional services, staff development, stafftravel and vehicles. The percentage add-on is 12.5 percent and is based on datareported in the spring 2007 targeted cost survey.

Other Non-Direct Program Related Expenses: This category of non-direct costallocations captures general program management costs.

These costs include program administration expenses, other professional services,telephone, dues and subscriptions, insurance and other general management expenses.The percentage add-on is 18.4 percent and is based on data reported in the spring2007 targeted cost survey.

Facility Related Costs: This category of non-direct cost allocations captures costsassociated with the office space for the case manager. The 2007 cost survey askedproviders to report on costs by service-Day Habilitation, Residential Habilitationand Supported Employment. The business model for Supported Employment is theclosest in nature to Targeted Case Management, so we used the survey dataassociated with Supported Employment to develop this allocation percentage. Thepercentage is 4.0 percent and includes rent/leases, maintenance and utilities.

-continued-TN No. ' ' ' " ' o 8 ~ - " ' " ' 0 0 = 9Supersedes TN No. 03-038 Approval Date J U ~ I ? 0Effective Date July 1, 20im 9


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Attachment 4.19-8Page 3 of3

Management and General: The spring 2007 cost survey may not have captured alladministrative costs associated with providing Comprehensive Waiver services. Toreflect costs like those of the Chief Executive Officer (CEO), Chief Financial Officer(CFO) and other non-program general administration, we included an additionaloverhead percentage of 5 percent.The following table shows the build-up of the rate, based on the assumptions described above.Table 6: Reimbursement Rate by Cost Model Component Category

$105.7214.96 ervision$120.6815.93 + Program Support: Payroll Related15.09 + Program Support: Non-Payroll Related22.21 + Other Non-Direct Program RelatedExpenses4.83 + Facility Related Costs6.03 +Mana ement and General$184.77 = Rate er Month of Service

$12.60 = Rate per 15 minutes (40 people times3.666 hours = 146.64 hrs / into $184.77

TN No. ~ 0 ~ 8 ~ - 0 ~ 0 ~ 9Supersedes TN No. 03-038 Approval Date 2 1llQ.9JEffective Date July 1,2009

cms approval for colorado 0709 targeted case management approval

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