HomeMy WebLinkAbout20012302.tiff STATE OF COLORADO
DEPARTMENT OF HEALTH CARE POLICY& FINANCING t ` ' �oF cot o
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1575 Sherman Street t �E7 ri A'o
Denver,CO 80203-1714 e s o-
(303)866.2993 t I .1 *- *`�
(303)866-4411 FAX - - - 'ravb'.
(303)866-3883 TTY
Bill Owens
- Governor
Karen Reinertson
Executive Director
TO: Options for Long Term Care Agencies
County Commissioners
FROM: Peggy Spaulding
DATE: August 6, 2001
SUBJECT: Proposed Rule MSB-01-05-04-A
Enclosed are proposed rules that will be presented for 1st Reading to the Medical Services
Board on August 10, 2001 in Denver at 1575 Sherman Street, Room 4 A/B.
This proposed rule would allow non-contiguous counties to join as a Single Entry Point
(SEP) agency. The choice would be given at the local level as to which Single Entry
Point agency the county would like to join with for Single Entry Point. The county must
petition the state showing the reason why the county would like to join with a non-
contiguous SEP agency based upon the best interest of the clients and state.
Please review this proposal and feel free to contact Peggy Spaulding at 303-866-2883
with any comments.
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"The mission of the Department of Health Care Policy&Financing is to purchase cost effective
health care for qualified,low-income Coloradans"
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TITLE OF PROPOSED RULE: Single Entry Point Multi-District Criteria
RULE#: MSB-01-05-04-A
DIVISION/CONTACT PERSON/PHONE: Long Term Care/Peggy Spaulding/303-866-2883
STATEMENT OF BASIS AND PURPOSE
1. Summary of the basis and purpose for the rule or rule change. (State what the rule says or does
and explain why the rule or rule change is necessary.)
According to the current regulations, a county must have a monthly average of 200 SEP clients or more to
be a stand alone SEP. If the county does not have a monthly average of 200 SEP clients or more, the
county must join with another county that is contiguous. This rule allows choice at the local level as to
which SEP agency the county would like to join with. The county must petition the state showing the
reason why the county wants to join a non-contiguous SEP agency based upon the best interest of the
clients and state.
2. If emergency, give reasons.
3. Authority for Rule.
Federal:
State: 25.5-1-301 through 25.5-1-303, C.R.S. (2000): Medical Services Board - creation,
organization, powers and duties-scope of authority-rules.
26-4-522(3), C.R.S. (2000) Single entry point system — authorization - phases for
implementation- services provided.
4. Divisions,Boards, Councils,Associations, and other groups who have reviewed this rule.
Long Term Care Division, Medicaid Advisory Committee for Persons with Disabilities, Option for Long Term
Care Agency Association, Colorado County Inc.
Attachments:
OP-5 (Regulatory Analysis)
OP-6(Overview of Proposed Rule)
MSB OP-2 (Rev. 2/97)
Initial Review Final Adoption
Proposed Effective Date Emergency Adoption
DOCUMENT #
TITLE OF PROPOSED RULE: Single Entry Point Multi-District Criteria
RULE#: MSB-01-05-04-A
DIVISION/CONTACT PERSON/PHONE Long Term Care/Peggy Spaulding/303-866-2883
REGULATORY ANALYSIS
1. Groups of persons affected (indicate who benefits and who bears the costs of the proposed rule):
Single Entry Point Agencies would benefit by having the choice at the local level of which county
they would like to join with based upon the best interest of the clients and state approval.
There would be no cost.
2. Quantitative/qualitative impact, economic or otherwise (include short-term and long-term
consequences)and the effect of inaction:
There will be no increased cost to the Department.
3. Estimated implementation and enforcement cost(s)and workload impact. If this rule is the result of
new legislation, please identify the legislation and its appropriation, and if the cost analysis
indicates a change from the appropriation, state why this has occurred and what action will be taken
to mitigate this:
There will be no workload impact, unless several counties decide to change.
4. Other options seriously considered and the reason(s) for rejection (include less costly or less
intrusive options):
Not change rule,would not allow local level choice.
MSB OP-5 (Rev. 6/99)
TITLE OF PROPOSED RULE: Single Entry Point Multi-District Criteria
RULE#: MSB-01-05-04-A
DIVISION/CONTACT PERSON/PHONE: Long Term Care/Peggy Spaulding/303-866-2883
OVERVIEW OF PROPOSED RULE
Compare and/or contrast the content of the current regulation and the proposed change.
Section Numbers Current Regulation Proposed Change
8.391.11 B Counties composing multi- Adds or shall petition the state
county district shall be for non-contiguous multi-
contiguous. county districts based upon
the best interest of the clients
and state.
8.391.12 A County join a neighboring Deleted neighboring
district
MSB OP-6(Rev. 2/97)
LONG TERM CARE SINGLE ENTRY POINT SYSTEM 8.391-8.391.10
8.391 SINGLE ENTRY POINT DISTRICT DESIGNATION
.10 Designation process
Rev. eff A. The state department shall provide information on the district
9/01/96 designation process to the county commissioners of the state.
Rev. eff. B. The county commissioners of each county shall submit to
9/01/96 the state department their recommendation for the designation of
their county as a single entry point district or as one county in a
multi-county district.
1. When a proposed district includes more than one county, the
combined boards of county commissioners shall submit their
recommendation to the state department.
2. The letter of recommendation submitted by the county
commissioners shall include the following information:
a. The geographic boundaries of the proposed single
entry point district;
b. The organizational structure, operational methods and
decision-making process of the board(s) of county
commissioners;
c. Assurances that the proposed district meets all criteria
set forth in state department rules for single entry
point district designation;
d. The designation of a contact person for the proposed
district; and
e. A resolution supporting the recommendation, passed
by the county commissioners of each county in the
proposed district.
THIS REVISION: VIII-96-6 LAST REVISION: VIII-91-12 REVISION
NUMBER
Adopted: 7/12/96 Adopted: 12/06/91 1
Effective Date: 9/01/96 Effective Date: 1/01/92
LONG TERM CARE SINGLE ENTRY POINT SYSTEM 8.391.10 - 8.391.11
Rev. eff. C. The state department shall approve the recommendation of a
9/01/96 proposed district's county commissioners, provided the proposed
district meets the single entry point district designation criteria set
forth in state rules.
Rev. eff. D. In the event county commissioners do not make a timely
9/01/96 recommendation for district designation, the state department shall
designate districts, in accordance with the district designation
criteria.
.11 District designation criteria
Single entry point districts shall meet the following criteria:
Rev. eff. A. All counties shall be included in the single entry point system.
9/01/96
B. Counties composing a multi-county district shall be contiguous or
shall petition the state for non-contiguous multi-county districts
based upon the best interest of the clients and state.
Rev. eff. C. A single county may be designated a district provided the county
9/01/96 serves a monthly average of 200 or more clients from the following
community-based programs: Adult Foster Care, Home Care
Allowance, Home and Community-Based Services for the Elderly,
Blind and Disabled (HCBS-EBD), Home and Community-Based
Services for Persons Living With Acquired Immune Deficiency
Syndrome (HCBS-PLWA), Home and Community-Based Services
for People with Brain Injury (HCBS-BI), and/or Older American's
Act case management services.
D. Multi-county districts shall not be required to serve a minimum
number of clients.
E. Each district shall have at least one full-time case manager employed
by the single entry point agency that serves the district.
Rev. eff. F. Each district shall assure adequate staffing by the district's single
9/01/96 entry point agency to provide coverage for all case management
functions and administrative support, in accordance with state
department rules(Section 8.393).
THIS REVISION: VIII-96-6 LAST REVISION: VIII-91-12 REVISION
NUMBER
Adopted: 7/12/96 Adopted: 12/06/91 1
Effective Date: 9/01/96 Effective Date: 1/01/92
LONG TERM CARE SINGLE ENTRY POINT SYSTEM 8.391.12- Concl.
8.391 SINGLE ENTRY POINT DISTRICT DESIGNATION (Continued)
.12 Changes in district designation
A. The county commissioners from one or more counties in a district
may request that their county join a neighboring district provided the
following criteria are met:
1. The county commissioners assure that both districts involved
will continue to meet the district designation criteria; and
2. The change in district designation is supported by the county
commissioners of the counties in both districts involved in
the change.
B. The county commissioners shall notify the state department six
months prior to the proposed change in district designation.
C. The state department shall approve the proposed change in district
designation provided each district continues to meet district
designation criteria.
D. Any change in district designation shall require amendments to the
single entry point agency contract for each district involved.
E. In the event an approved change in district designation results in the
termination of a single entry point agency contract, an alternate
agency shall be selected in accordance with the state department's
rules for single entry point agency termination or non-renewal of
contract.
F. Single entry point districts may transfer parts of a county to another
district,provided all of the following criteria are met:
1. The county commissioners of both districts and the state
department shall approve of the transfer.
2. The transfer shall occur at contract renewal time.
3. Both districts shall continue to meet district designation
criteria.
4. Reimbursement for single entry point functions shall be
negotiated between both districts and the state department.
THIS REVISION: VIII-91-12 LAST REVISION: New Material REVISION
NUMBER
Adopted: 12/06/91 Adopted:
Effective Date: 1/01/92 Effective Date:
LONG TERM CARE SINGLE ENTRY POINT SYSTEM 8.391.20-8.391.21
8.391.20 SINGLE ENTRY POINT AGENCY SELECTION
Rev. eff. Each single entry point district may submit its recommendation for a
9/01/96 single entry point agency upon a change in a district designation, upon
termination of an existing single entry point agency, or upon expiration of an
existing single entry point agency's contract.
A. The district's recommendation for a single entry point agency shall
be approved by the state department provided the proposed single
entry point agency meets all agency selection criteria.
B. The state department shall contract with approved single entry point
agencies.
1. The term of contract with a single entry point agency shall be
five years.
2. Each single entry point agency shall be monitored by the
state department and/or its designee and shall be certified
annually, based on its compliance with performance
standards.
3. Contracts may be renewed if the agency is in compliance
with all performance standards.
4. In the event of a change in the district designation, the
contract with the single entry point agency serving the district
may be amended or terminated.
Rev. .21 Single entry point agency selection by the state department. If no agency
eff. has been recommended by a single entry point district, the state
9/01/96 department shall select a single entry point agency to serve the district by
conducting a request for proposal (RFP) process, or by conducting a sole
source procurement, or by other means, in accordance with state department
rules.
THIS REVISION: VIII-96-6 LAST REVISION: VIII-91-12 REVISION
NUMBER
Adopted: 7/12/96 Adopted: 12/06/91 1
Effective Date: 9/01/96 Effective Date: 1/01/92
LONG TERM CARE SINGLE ENTRY POINT SYSTEM 8.391.22-Concl.
8.391.20 SINGLE ENTRY POINT AGENCY SELECTION (Continued)
Rev. .22 Agency termination or non-renewal of contract. The contract with a single
entry point agency may be terminated or not renewed by either party for
various reasons including, but not limited to, failure to achieve or maintain
financial viability and non-compliance with performance standards adopted
by the state department. In the event the contract with a single entry point
agency is terminated or not renewed,the following process shall apply:
A. The single entry point agency shall notify the state department sixty
(60)days prior to terminating its contract.
B. In the event the state department is terminating the contract, the state
department shall notify the single entry point agency and the district's
contact person sixty(60)days prior to the termination.
C. The county commissioners for the district shall recommend a new
single entry point agency within ninety(90)days after notification.
D. Extensions may be granted if the district has not recommended a new
single entry point agency within ninety(90) days.
E. The state department shall approve the district's recommendation,
provided the proposed single entry point agency meets all criteria for
agency selection.
F. The county commissioners of the district, upon approval by the state
department, shall make arrangements to provide case management
services to clients within the district during the interim period
between the termination of the single entry point agency's contract
and the selection of an alternate agency.
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