HomeMy WebLinkAbout20230543.tiffRESOLUTION
RE: APPROVE REQUEST FOR PROPOSAL (RFP) FOR CASE MANAGEMENT AGENCY
(CMA) ACTIVITIES AND STATE GENERAL FUND PROGRAM SERVICES, AND
AUTHORIZE CHAIR TO SIGN
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS, the Board has been presented with a Request for Proposal (RFP) for the
Case Management Agency (CMA) Activities and State General Fund Program Services from the
County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld
County, on behalf of the Department of Human Services, to the Colorado Department of Health
Care Policy and Financing, with further terms and conditions being as stated in said request for
proposal, and
WHEREAS, after review, the Board deems it advisable to approve said request for
proposal, a copy of which is attached hereto and incorporated herein by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of
Weld County, Colorado, that the Request for Proposal (RFP) for the Case Management Agency
(CMA) Activities and State General Fund Program Services from the County of Weld, State of
Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the
Department of Human Services, to the Colorado Department of Health Care Policy and Financing,
be, and hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized
to sign said request for proposal.
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 27th day of February, A.D., 2023.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
ATTEST: daitiwo `J;
Weld County Clerk to the Board
BY:
Deputy Cler
APPROVED AS TO FOR
A +,County Attorney
Date of signature: 03
Mikean, Chair
cc: E-1 S O
03/10/23
2023-0543
HR0095
PRIVILEGED AND CONFIDENTIAL
MEMORANDUM
DATE: February 14, 2023
TO: Board of County Commissioners — Pass -Around
FR: Jamie Ulrich, Director, Human Services
RE: Response to the Request for Proposal (RFP) to
perform as a Case Management Agency (CMA) for
the Colorado Department of Health Care Policy &
Financing (HCPF)
Please review and indicate if you would like a work session prior to placing this item on the
Board's agenda.
Request Board Approval of the Department's Response to the Request for Proposal (RFP)
to perform as a Case Management Agency (CMA) for the Colorado Department of Health
Care Policy & Financing (HCPF). The Weld County Department of Human Services
(WCDHS) is requesting approval to submit a proposal to the Colorado Department of Health
Care Policy & Financing (HCPF) in response to the Case Management Agency (CMA) services
RFP solicitation.
A work session was held on August 24, 2022, with the Weld County Board of County
Commissioners, and approval was given to the Department to apply to become the region's Case
Management Agency in order to come into compliance with HB 17-1343. As discussed in the
work session, if Weld County is selected to be the CMA in Weld County, additional staff would
be required to complete the essential functions of additional programs and services. The RFP
includes a conservative 35 additional staff based on the available data used to comprise the
response to the RFP. As expected, numbers of clients and associated services may increase and
would be reevaluated after implementation for consideration in future budget years to ensure the
program operates within the available state/federal funds avoiding the need of County funds.
Facilities is aware of the grant submission and potential increase of staff if awarded. Official
planning will occur upon award, an estimated 10 staff would be able to be immediately
accommodated within existing structure of Area Agency on Aging (AAA).
Program reimbursement will be on a Fee For Service monthly payment schedule and the
estimated budget to operate the CMA services are as follows:
CMA Services
Projected Budget
Total Costs
$5,952,707.65
$6,533,534.61
Total Revenues
Over/(Under)
($ 580,826.96)
Pass -Around Memorandum; February 14, 2023 - CMS ID Page 1
2023-0543
oZiz1 HV2-00ctS
PRIVILEGED AND CONFIDENTIAL
The RFP response is due by Tuesday, February 28, 2023, and if awarded, the contract will be for
an eight (8) year period with an option to extend beyond the initial term.
I do not recommend a Work Session. I recommend approval of this Request for Proposal
submission, authorize the Chair to sign the Appendix E Anti -Collusion Affidavit, and authorize
WCDHS to submit electronically.
Approve Schedule
Recommendation Work Session Other/Comments:
Perry L. Buck, Pro -Tern
Mike Freeman, Chair
Scott K. James
Kevin D. Ross
Lori Saine
Pass -Around Memorandum; February 14, 2023 - CMS ID Page 2
Cheryl Hoffman
From:
Sent:
To:
Subject:
Yes
Kevin Ross
Kevin Ross
Wednesday, February 15, 2023 12:22 PM
Cheryl Hoffman
Re: PA FOR ROUTING: AAA Case Management Agency RFP Submittal (CMS TBD)
From: Cheryl Hoffman <choffman@weld.gov>
Sent: Wednesday, February 15, 2023 10:57:29 AM
To: Kevin Ross <kross@weld.gov>
Cc: Cheryl Hoffman <choffman@weld.gov>
Subject: FW: PA FOR ROUTING: AAA Case Management Agency RI=P Submittal (CMS TBD)
Kevin,
Approve?
Cheryl L. Hoffman
Deputy Clerk to the Board
1150 O Street/P.O. Box 758
Greeley, CO 80632
Tel: (970) 400.4227
choffman@weld.gov
From: Lesley Cobb <cobbxxlk@weldgov.com>
Sent: Tuesday, February 14, 2023 12:07 PM
To: Cheryl Hoffman <choffman@weld.gov>
Cc: Karla Ford <kford@weldgov.com>; Bruce Barker <bbarker@weldgov.com>; Cheryl Pattelli <cpattelli@weld.gov>;
Chris D'Ovidio <cdovidio@weld.gov>; Esther Gesick <egesick@weld.gov>; Lennie Bottorff <bottorll@weldgov.com>; HS -
Contract Management <HS-ContractManagement@co.weld.co.us>
Subject: PA FOR ROUTING: AAA Case Management Agency RFP Submittal (CMS TBD)
Good morning Cheryl,
Please see the attached PA approved for routing: AAA Case Management Agency RFP Submittal (CMS TBD).
Thank you!
Lesley Cobb
Contract Management and Compliance Supervisor
Weld County Dept. of Human Services
315 N. 11th Ave., Bldg A
PO Box A
Greeley, CO 80632
E (970) 400-6512
(970) 353-5212
`� cohhxxlkfi�weldgov.coni
1
Cheryl Hoffman
From:
Sent:
To:
Cc:
Subject:
yes
Lori Saine
Weld County Commissioner, District 3
1150 O Street
PO Box 758
Greeley CO 80632
Phone: 970-400-4205
Fax: 970-336-7233
Email: Isaine@weldgov.com
Website: www.co.weld.co.us
In God We Trust
Lori Saine
Thursday, February 16, 2023 2:06 PM
Cheryl Hoffman; Perry Buck
Karla Ford
RE: Please reply - Pass Around for HSD
Confidentiality Notice: This electronic transmission and any attached documents or other writings are intended only for
the person or entity to which it is addressed and may contain information that is privileged, confidential or otherwise
protected from disclosure. If you have received this communication in error, please immediately notify sender by return
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contents of this communication or any attachments by anyone other than the named recipient is strictly prohibited.
From: Cheryl Hoffman <choffman@weld.gov>
Sent: Thursday, February 16, 2023 7:19 AM
To: Perry Buck <pbuck@weldgov.com>; Lori Saine <Isaine@weldgov.com>
Cc: Cheryl Hoffman <choffman@weld.gov>; Karla Ford <kford@weldgov.com>
Subject: Please reply - Pass Around for HSD
Good morning,
Could you please review and let me know if you approve?
Thanks!
Cheryl L. Hoffman
Deputy Clerk to the Board
1150 0 Street/P.O. Box 758
Greeley, CO 80632
1
DEPARTMENT Solicitation Number
RFP UHAA 2023000170
Case Management Agency Activities
and
State General Fund Program Services
Submitted by
The Weld County
Area Agency on Aging Division
Single Entry Point
EXECUTIVE SUMMARY 5
W-9 - COUNTY OF WELD 8
OFFEROR'S RESPONSE 0: DESIGNATED SERVICE AREA 9
OFFEROR'S RESPONSE 1: MANDATORY QUALIFICATIONS 9
OFFEROR'S RESPONSE 1.A: LEGAL BUSINESS INFORMATION 9
OFFEROR'S RESPONSE 1.B: CMA REQUIREMENT ATTESTATION 10
OFFEROR'S RESPONSE 1.C: MANDATORY AND EXPERIENCE REQUIREMENTS 10
OFFEROR'S RESPONSE 1.D: CONFLICT FREE CASE MANAGEMENT ATTESTATION 25
OFFEROR'S RESPONSE 1.E: CONTRACT START DATE ATTESTATION 25
OFFEROR'S RESPONSE 1.F: SUBRECIPIENT OBLIGATIONS ATTESTATION 26
OFFEROR'S RESPONSE 1.G: TCM PROVIDER ENROLLMENT ATTESTATION 27
OFFEROR'S RESPONSE 1.H: TCM SERVICES ATTESTATION 27
OFFEROR'S RESPONSE 1.1: TCM BILLED THROUGH MMIS ATTESTATION 28
OFFEROR'S RESPONSE 1.J: HCA ATTESTATION AND FUNDS PROCEDURE 28
OFFEROR'S RESPONSE 2: ORGANIZATIONAL EXPERIENCE 30
OFFEROR'S RESPONSE 2.A: EXPERIENCE ASSISTING PEOPLE 31
OFFEROR'S RESPONSE 2.B: PHYSICAL OFFICE AND STAFFING COVERAGE 46
OFFEROR'S RESPONSE 2.C: LOCAL AND REGIONAL KNOWLEDGE 49
OFFEROR'S RESPONSE 2.D: EXPERIENCE WITH SIMILAR PROJECTS 52
OFFEROR'S RESPONSE 3: LTSS EXPERIENCE 53
OFFEROR'S RESPONSE 3.A: NAME AND LOCATION OF PROJECT 53
OFFEROR'S RESPONSE 3.B: POPULATIONS SERVED 54
OFFEROR'S RESPONSE 3.C: POPULATION SERVED WAS MEDICAID, NON -MEDICAID, OR BOTH 57
OFFEROR'S RESPONSE 3.D: PRIMARY SERVICES INCLUDED IN THIS PROJECT 57
OFFEROR'S RESPONSE 3.E: ACTIVITIES IN RURAL AND FRONTIER AREAS, IF APPROPRIATE 57
OFFEROR'S RESPONSE 3.F: EXPERIENCE SERVING PEOPLE WITH DISABILITIES, MARGINALIZED POPULATIONS,
LOW-INCOME INDIVIDUALS AND STRATEGIES FOR INCREASING ACCESS TO HISTORICALLY UNDERSERVED
POPULATIONS 58
OFFEROR'S RESPONSE 3.G.: ANY CORRECTIVE ACTION PLANS/PLAN OF CORRECTION RELATING TO CONTRACT
NON-COMPLIANCE AND/OR DEFICIENT CONTRACT PERFORMANCE TO INCLUDE BUT NOT LIMITED TO 60
OFFEROR'S RESPONSE 3.H.: ADVERSE CONTRACT ACTIONS AND/OR PROJECT -ASSOCIATED LITIGATION
(INCLUDING TERMINATIONS AND/OR CANCELLATIONS) IN WHICH THE OFFEROR WAS (OR IS) INVOLVED; 63
Page 12
OFFEROR'S RESPONSE 3.1.: A PROJECT CONTRACT MANAGER NAME WITH CONTACT INFORMATION 63
OFFEROR'S RESPONSE 3.J.: ATRANSITION COORDINATOR NAME WITH CONTACT INFORMATION 64
OFFEROR'S RESPONSE 4: SUFFICIENT PERSONNEL 64
OFFEROR'S RESPONSE 4.A: INTERNAL ORGANIZATION STRUCTURE 64
OFFEROR'S RESPONSE 4.B: PROVIDING QUALIFIED KEY PERSONNEL 85
OFFEROR'S RESPONSE 4.C: TRAINING ALL OTHER PERSONNEL 86
OFFEROR'S RESPONSE 4.D: REPLACING KEY PERSONNEL 103
OFFEROR'S RESPONSE 4.E: SUBCONTRACTOR 105
OFFEROR'S RESPONSE 4.F: MAINTAINING SUFFICIENT STAFFING LEVELS 106
OFFEROR'S RESPONSE 5: CASE MANAGEMENT OBLIGATIONS 121
OFFEROR'S RESPONSE 5.A: BUSINESS FUNCTION OF CMA 121
OFFEROR'S RESPONSE 5.B: MAINTAINING RELATIONSHIPS (E.G., RAEs, CCBs, MEDICAID ASSISTANCE
SITES( 133
OFFEROR'S RESPONSE 5.c: COMPLAINT AND GRIEVANCES 140
OFFEROR'S RESPONSE 5.D: REQUIRED TRAINING FOR CASE MANAGERS 144
OFFEROR'S RESPONSE 5.E: CONTINUOUS QUALITY IMPROVEMENT 152
OFFEROR'S RESPONSE 5.F: DISABILITY AND CULTURAL COMPETENCY 169
OFFEROR'S RESPONSE 5.G: COMMUNITY ENGAGEMENT AND COORDINATION 170
OFFEROR'S RESPONSE 5.H: HIPPAAND PHI TRAINING 176
OFFEROR'S RESPONSE 5.1: APPEALS TRACKING AND TIMELINES 177
OFFEROR'S RESPONSE 5J: CIRS 180
OFFEROR'S RESPONSE 5.K: INVESTIGATIONS 184
OFFEROR'S RESPONSE 5.L: HUMAN RIGHTS COMMITTEE 187
OFFEROR'S RESPONSE 6: PRE -ENROLLMENT FOR LTSS 189
OFFEROR'S RESPONSE 6.A: ASSESSING A MEMBER NEEDS 189
OFFEROR'S RESPONSE 6.B: PROVIDING OVERSIGHT AND ASSESSING QUALITY 194
OFFEROR'S RESPONSE 6.C: OHCDS EXPERIENCE 198
OFFEROR'S RESPONSE 6.D: EXPERIENCE CONDUCTING EACH FUNCTION 199
OFFEROR'S RESPONSE 6.E: EXPERIENCE MEETING TIMELINE REQUIREMENTS 206
OFFEROR'S RESPONSE 6.F: PLAN TO MEET TIMELINE REQUIREMENTS 208
OFFEROR'S RESPONSE 6.G: REIMBURSEMENT FOR MISSING TIMELINES 214
OFFEROR'S RESPONSE 7: STATE GENERAL FUND OBLIGATIONS 215
Page ( 3
OFFEROR'S RESPONSE 7.A: MEETING FSSP AND STATE SLS REQUIREMENTS 215
OFFEROR'S RESPONSE 7.B: FAMILY SUPPORT COUNCIL 221
OFFEROR'S RESPONSE 7.C: SUBCONTRACTOR AGREEMENTS 222
OFFEROR'S RESPONSE 7.D: ENSURING SUFFICIENT DOCUMENTATION 223
OFFEROR'S RESPONSE 7.E: ADVERTISING FOR FSSP 227
OFFEROR'S RESPONSE 7.F: STATE FUNDS USE ATTESTATION 228
OFFEROR'S RESPONSE 8: ADMINISTRATIVE REPORTING 229
OFFEROR'S RESPONSE 8.A: MEMBER ENGAGEMENT 229
OFFEROR'S RESPONSE 8.B: CLOSE Our EXPERIENCE 235
OFFEROR'S RESPONSE 8.C: OTHER CLOSE OUT AND STARTUP EXPERIENCE 236
OFFEROR'S RESPONSE 8.D: INTERNAL FINANCIAL CONTROLS 237
OFFEROR'S RESPONSE 8.E: LONG-RANGE PLAN 238
ATTACHMENT A - WELD COUNTY SINGLE ENTRY POINT CERTIFICATION 248
ATTACHMENT B - IT CISP ATTESTATION 249
ATTACHMENT C - FY18 - FY22 QIS RESULTS AND CORRECTIVE ACTIONS FOR WELD COUNTY
SEP 250
Page 14
Executive Summary
The County of Weld, Area Agency on Aging Division, is pleased to submit this
proposal to the Department of Health Care Policy and Financing to perform
as the Case Management Agency for Defined Service Area 9 (Weld County).
This proposal provides a detailed account of how our agency fulfills the
qualifications and mandatory experience requirements, while also outlining
our plans to exceed the requirements set forth in this Solicitation.
The Weld County Department of Human Services (WCDHS) operates as a
government department, providing a stable and longstanding framework to
support our business practices, programs, and community. Weld County
provides oversight and support in several areas to promote a fiscally
responsible, efficient, and effective business model, which enables us to
successfully deliver various services to our community. One such service
entity is the Weld County Area Agency on Aging (WC AAA), which operates
under the umbrella of WCDHS. The WC AAA provides thoughtful and
comprehensive assistance to individuals seeking Long -Term Services and
Supports and it encompasses the Options for Long -Term Care Single Entry
Point (SEP), Long -Term Care Medicaid Eligibility, Older Americans Act, and
Adult Protective Services. With our extensive experience in delivering a
variety of programs and case management, our unique structure facilitates
efficient financial and functional eligibility determination processes, person -
centered case management, and inclusive referrals for services.
The Weld County SEP, referred to as the Weld County Case Management
Agency (WC CMA) throughout the rest of this bid, currently serves as a case
management agency for the Department, delivering Long -Term Services and
Supports to members in our community for the past thirty (30) years. WC
CMA is committed to providing quality care and exceptional case
management services to our LTSS members and their families. If awarded
the contract for Service Area 9, we will continue to implement and oversee
member engagement, communication, cultural responsiveness, language
assistance, and individual and member rights in a comprehensive and
person- and family -centered manner. A person- and family -centered
approach to case management and member and family interactions is deeply
Page 15
embedded in our work culture through years of training and on the ground
implementation.
WC CMA appreciates the opportunity to be the sole case management
agency in our community. With all Home and Community -Based Services
(HCBS) waivers and non-HCBS programs housed within our Human Services
Department, individuals in Weld County will have one centralized location for
a multitude of services and benefits, which will enhance access, efficiency,
and quality. We are dedicated to ensuring individuals are connected to the
most appropriate programs and services, and providing exceptional case
management to our community, which includes federal compliance, quality,
simplicity, stability, and accountability.
WCDHS has a core set of department values that we strive to incorporate
into every facet of our work: Communication, Innovation, Integrity,
Accountability and Service. These values have been operationalized by our
division and are consistently upheld across all our programs. We foster an
environment of creative solutions and are committed to continuously
improving our services. Our organization invests in staff development, hires
qualified personnel, and provides the necessary support to achieve our goals
and provide person -centered services to our members. By ensuring that all
staff at every level of our division are engaged, motivated, and highly
qualified, we can stay up to date with the latest research, legislation, and
best practices.
Our agency's mission, vision, department values and Weld County guiding
principles speak of the importance we place on community engagement and
service coordination. It is a fundamental component of what we do and a
strong part of our culture. WC AAA, including the WC CMA, has an extensive
network of community partners. We value these relationships and the
opportunity it brings to share available resources and routinely collaborate
regarding service provision for our shared individuals. We believe community
partnerships, strong relationships with our members and their families, and
collaboration are vital to inclusive and successful case management. We are
continuously evaluating the needs of our members, the resources in our
community, and identifying opportunities for collaboration to enhance
service provision. We pride ourselves in our commitment to our community.
Page 16
WC CMA is an ideal choice to perform as the Case Management Agency for
Service Area 9. We have demonstrated successful performance, extensive
experience, financial stability, collaborative professional and member
relationships, and an unwavering commitment to our community. We are
experienced and accomplished with change management. We have
successfully coordinated and guided multiple programmatic changes, ranging
in size and complexity. We understand the importance of thoughtful
planning, communication, inclusivity, comprehensive training, and the need
for or setting clear goals. We also expect and model flexibility, which assists
our organization with adapting to change. If awarded this contract, WC CMA
is prepared to engage and partner with all stakeholders and will work to
ensure continuity of services, member satisfaction, and compliance with
statutory and Department requirements.
WC CMA possesses the capacity and resources to transition efficiently and
effectively into a single Case Management Agency for Service Area 9. Our
multi -faceted plan considers several factors, including but not limited to
budget, organizational structure, retention and recruitment, training,
compliance with federal, state, and contractual requirements, and
communication with our internal and external community partners, the
Department, and our valued members and their families.
Weld County has a proven history of providing exceptional service in the
rapidly growing system of Long -Term Service and Supports. This proposal
will demonstrate that WC CMA has the experience and dedication to expand
its case management services to a broader population and is a committed
and dedicated partner with the Department to deliver outstanding services.
Our goal is to continue providing timely and dedicated assistance in a
genuine and effective manner. We value the opportunity to continue serving
our community as a Case Management Agency for Service Area 9.
Offeror's Contact Person Kelly Morrison, Weld AAA Division Director
970-400-6786
kmorrison(Tweld.gov
CORE VSS #: VC00000000014294
Page 17
W-9 — COUNTY OF WELD
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Under penalties of perjury, l certify that,
1. The number shown on this form lo my correct taxpayer Identification number (or I am waiting fora number to be Issued to me, and
2.1 am not subject to backup witNtoWstg because: (a) I am exempt from backup withholding. or (b) I have not been Wltisd by tie Internal Revenue
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H I �jt_. /9_4- Dm.. January 3, 2023
General Instructions • Form 1099.ON (dividends. including those from stocks or mutual
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Section references are to the Internal Revenue Code unless otherwise • Form 1088-MISC vanloua of income,
noted. proceeds) ( types prizes, aware, or gross
Putt. developments. For the lateral Information about developments • Form 1099-t3 (stock or mutual fund sales and certain open
related to Form W-9 and Its instructions, such m legidatan enacted transactions by brokers)
alter they were published, go to www.lrs gov/Formlfyg. • Forth 1099-S (proceeds from real estate transactions)
Purpose of Form • Farm 1099-K (merchant card and third party network trarsacticne)
An individual or entity (Form W-9 requester) who is required to file an • Farm 1098 (home mortgage interest, 1088-E (student loan interest,
Information return with the IRS must obtain your correct lawyer 1098-T (tuition)
Identification number (TIN) w 4t ch maybe your social aecurty number • Form 1 o.9. (canceled debt)
(SSN). Individual taxpayer idertiflcetitxt number jrtTNj adoption • Form 10994 ...don or abandonment of secured
taxpayer identification number ()TIN), or employer Identifi titan number woPertr)
(EIN), to report on an Information return the amount paid to you, or other Use Form W-9 only if you area U.S. portion (Including a resident
amount reportable on an information return. Examples of Information alien), to provide your correct TIN.
velum. include. but ere not limited to. the following. 1F you do not return Form W-9 to. requester with a T1N you cUght
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later.
Cat. No. 10231X Form W-9 (Rev. 520191
Page 18
OFFEROR'S RESPONSE 0: Designated Service Area
Please list the Designated Service Area(s) your organization is
submitting a proposal for:
Designated Service Area 9 (Weld County)
OFFEROR'S RESPONSE 1: Mandatory Oualifications
Provide details that demonstrate how Offeror meets all mandatory
experience and/or qualification requirements. Offeror's response
must list each stated experience and/or qualification requirement
separately and follow the listed requirement with the details that
demonstrate how Offeror meets that specific requirement. Provide
documentation demonstrating how the Offeror meets all mandatory
qualification requirements including, at a minimum, the following
information.
OFFEROR'S RESPONSE 1.a: Legal Business Information
Offeror's legal name and address, number of years in business under
this legal name, total number of employees, including contracted
staff, and the organization's location(s).
Legal Name: The County of Weld
Legal Address: 1150 O Street
Greeley Colorado 80632
Years in Business: Weld County-1891(132yrs)
WCDHS SEP-1993 (30yrs)
Total Number of Employees: Weld County- 1868
WCDHS SEP - 33
Organization Location(s): 315 North 11th Avenue
Building C
Greeley Colorado 80631
Page 19
OFFEROR'S RESPONSE 1.b: CMA Requirement Attestation
Attestation that the Offeror meets the requirements of a CMA.
As per Solicitation RFP UHAA 2023000170 (RFP), Section 2.1.1.1, Weld
County Area Agency on Aging, Single Entry Point (WC CMA) attest and
confirm to meeting the definition and requirements of a Case Management
Agency (CMA) set forth in C.R.S 25.5-6-1702 et seq. and Section 10 CCR
2505-10-8.519 et seq. WC CMA is the Colorado Department of Health Care
Policy and Financing's (Department) certified (see Technical Proposal
Attachment A) and contracted (Contract Number 21-160398) Weld County
has been the Single Entry Point agency for thirty (30) years and has met all
applicable state and federal requirements. Currently WC CMA provides case
management services to individuals through five (5) Home Community
Based Service (HCBS) waivers and five (5) non-HCBS programs:
o HCBS Community Mental Health Supports Waiver (HCBS-CMHS)
o HCBS Waiver for Children with a Life Limiting Illness (HCBS-CLLI)
o HCBS Waiver for Complimentary and Integrative Health (HCBS-
CIH)
HCBS Waiver for Persons who are Elderly, Blind and Disabled
(HCBS-EBD)
HCBS Waiver for Persons with Brain Injury (HCBS-BI)
o Hospital Back -Up Program (HBU)
o Long Term Home Health (LTHH)
o Nursing Facilities (NF)
o Program for All -Inclusive Care for the Elderly (PACE)
o Home Care Allowance (HCA)
OFFEROR'S RESPONSE 1.c: Mandatory and Experience Requirements
Provide details that demonstrate how Offeror meets all mandatory
experience and qualification requirements.
• Offeror's response should list each stated experience and
qualification requirement separately and follow the listed
requirements with the details that demonstrate how the Offeror
meets that specific requirement.
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As the existing Department contracted and certified Single Entry Point (SEP)
for Weld County, WC CMA currently meets or exceeds all the CMA
qualifications and requirements identified in RFP Sections 2.1.1.1 and
2.1.1.2, and 10 CCR 2505-10-8.519 et seq.
Per 10 CCR 2505-10-8.519.2.A.1, WCDHS maintains a publicly accessible,
American Disabilities Act (ADA) compliant physical office within Weld
County that is open during regular business hours, Monday through
Friday. All WC CMA staff have full-time dedicated office spaces on the
third (3rd) floor and are available five (5) days per week. Members,
families, service providers, and other visitors have dedicated parking
spaces to help ensure ease of access to the building, and front door
receptionists greet and assist all visitors. WC CMA staff provide in -person
assistance for visitors by way of designated first floor private meeting
spaces.
Per 10 CCR 2505-10-8.519.2.A.2, WC CMA is a public CMA that meets all
the state and federal requirements, reflected in thirty (30) years of repeat
SEP certifications by the Department to provide contracted waiver and
non -waiver program case management services in Weld County.
Per 10 CCR 2505-10-8.519.2.A.3, and in accordance with the case
management qualifications at 10 CCR 2505-10-8.519.5.A and 8.519.5.B,
WC CMA staff meet or exceed the staff qualification requirements to
provide case managements services.
These regulatory qualification requirements specify that any HCBS case
managers hired on or after October 8th, 2021, must have a) a bachelor's
degree, or b) five (5) years of relevant Long -Term Services and Support
(LTSS) field experience, or c) some combination of education and
experience. Currently, WC CMA employs twenty-three (23) case
managers to complete the Work in service of the SEP effort. Six (6) of
those case managers provide intake case management, seventeen (17)
provide ongoing case management services, one (1) Specialist (Lead
Case Manager). Twenty-one (21) case managers meet the bachelor's
degree requirement (three [3] have graduate degrees), and two (2) case
managers hired in 2022 meet the non -degree experience requirements,
each containing over twelve (12) years of relevant LTSS experience. Ten
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(10) case managers have experience with people with developmental
disabilities. For example, one (1) case manager worked at a Community
Centered Board, and another worked four (4) years as an Intellectual and
Developmental Disability (IDD) Care Coordinator and service provider.
All case managers comply with 10 CCR 2505-10-8.519.5.C, which states
case managers may not:
o be related to the Client.
o be related to any paid caregiver of the Client.
o be financially responsible for a Client.
o be the Clients guardian, authorized representative, or POA.
o be a provider for the Client, have an interest in, or be employed by
a provider for the same Client.
Additionally, all WC CMA Case Managers meet the case management
training requirements listed in 10 CCR 2505-10-8.519.5.E. For the past
five (5) years, WC CMA's management team has submitted case
management training tracking deliverables bi-annually to the Department
for review and contract compliance. All WC CMA staff have passed
background checks in accordance with 10 CCR 2505-10-8.519.I, and
education transcripts have been verified.
The WC CMA Management Team also meets all regulatory
qualifications for case managers at 10 CCR 2505-10-8.519.5.B and
the qualifications for supervisors at 10 CCR 2505-10-8.519.2.5.H
that states:
Case Manager supervisors shall meet the minimum requirements for
education and/or experience for Case Managers and shall have one year
of competency in pertinent case management knowledge and skills.
Consisting of a five (5) person management team, each WC CMA
manager has at least a bachelor's degree and ten (10) years of direct and
relevant experience.
The Area Agency on Aging Division Director, who is also the SEP
Administrator and Contract Manager for WC CMA, has over fifteen (15)
years' experience in Colorado waiver and non -waiver program case
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management, ten (10) years of waiver program case management and
supervisor in Arizona, and many years of experience managing multiple
programs (e.g., SEP, Area Agency on Aging), administrating multiple
contracts, developing programs, and developing and managing budgets.
The Area Agency on Aging Division Deputy Director, who is also the
Deputy SEP Administrator for WC CMA, has a master's degree, over four
(4) years of experience working at an Area Agency on Aging, and over
ten (10) years of direct case management experience with older adults
and individuals with disabilities and serious medical conditions. She has
over ten (10) years of supervisory experience, ten (10) years of
experience administrating contracts and programs, and seventeen (17)
years' experience with investigations in law enforcement and Adult
Protection Services.
The remainder of the management team consists of three (3) SEP
supervisors. Each supervisor has a bachelor's degree and over ten (10)
years of HCBS waiver and non -waiver program case management
experience. One (1) supervisor has worked for WC CMA for thirty (30)
years and has an additional two (2) years' experience providing case
management services at a mental health center. One (1) supervisor has
eighteen (18) years of SEP experience and a total of over twenty (20)
years of case management experience working with individuals of all ages
and disabilities, to include people with mental health and substance use
disorders. Lastly, one (1) supervisor has over ten (10) years of SEP
experience and four (4) years of experience sitting on the Board of
Directors for the Weld County Community Centered Board, Envision. For
the past two (2) years she has been the Board Vice President.
The WC CMA Management Team in total meets the same client conflict of
interest requirements at 10 CCR 2505-10-8.519.5.C, and all have passed
background checks in accordance with 10 CCR 2505-10-8.519.I.
Per 10 CCR 2505-10-8.519.2.A.4, although exempt from this
requirement, as the contracted and certified SEP for Weld County since
1993, WC CMA has been providing waiver and non -waiver program case
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management services to all population types in Weld County, to include
high -risk, low-income individuals.
Per 10 CCR 2505-10-8.519.2.A.5, WC CMA is a Conflict Free Case
Management Agency, and as such, does not have any fiduciary
relationship with any agency that provides HCBS waiver services, and
does not have or require a Conflict Free Case Management Waiver from
the Department for its existing contract and future contracts.
Per 10 CCR 2505-10-8.519.2.A.6, and in accordance with the
geographical designation and limitations set forth in Department Contract
Number 21-160398, WC CMA provides waiver and non -waiver program
case management services to any individual in Weld County that is
enrolled or enrolling in LTSS. The case management services that are
provided include, but are not limited to intake and referral, level of care
screen and assessment, support needs assessment, person centered
support planning, critical incident reporting, and service brokering and
monitoring.
Per 10 CCR 2505-10-8.519.A.7, since 1993, the WC CMA has and
continues to possess the administrative capacity to deliver case
management services in accordance with state and federal requirements,
our existing SEP contract with the Department, and the potential contract
associated with this solicitation. WC CMA is a part of the necessary
infrastructure, departments, divisions, and people to:
o Successfully provide case management services to the community
in accordance with state, federal, and contractual requirements.
o Establish and maintain referral networks and community partner
agreements and relationships.
o Self -monitor for contract, financial, and program compliance.
o Achieve contract objectives and performance standards.
In accordance with the Administration of a SEP requirements at 10 CCR
2505-10-8.393.1.A.1, WC CMA a) serves persons in LTSS programs as
defined in Section 8.390.3, b) has capacity to accept funding from
multiple sources, c) may utilize Subcontractors to complete SEP
functions, d) may receive funds from public or private foundations and
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corporations, and e) publicly discloses all sources and amounts of
revenue.
As a program within a county governmental system, WC CMA is nested
within a greater framework of departments and divisions that greatly
enhance the administrative capacity of the SEP effort. This nested
framework provides the WC CMA with a longstanding, stable structure to
support our business practices, programs, and the community we serve.
The Weld County Department of Human Services (WCDHS) is a large
department, so in addition to the support WC CMA receives from the
overarching county structure, there are several divisions within WCDHS
that provide oversight and guidance. This ensures consistency, quality,
compliance, and effective communication, and helps prevent duplication
of services and efforts.
The Weld County administrative capacities that support county
departments, divisions, and programs (e.g., WC CMA) are as follows:
Finance and Administration includes the offices of Human Resources,
Purchasing, Accounting, Budget, Information Technology, Geographical
Information System, Printing and Supply, Insurance, and Capital.
Human Resources (HR) assists Weld County departments in the
hiring process for new employees. In addition, HR oversees policies
and rules affecting employment, assists employees with any
employment questions, establishes job classifications, and
compensation plans. HR is also responsible for orientation of new
employees and establishing and implementing county -wide training
programs.
Accounting and Payroll (Finance) is responsible for receipt and
disbursement of Weld County's operating funds. The office accounts for
all income of the county, payments to vendors, cash balances, internal
service charges, fixed and depreciable assets, and insurance. One
important task of Finance is the processing of Weld County employees'
payroll. The Finance office pays all county employees and accounts for all
taxes and other deductions associated with the payroll.
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Central Purchasing Office administers bid proposals and ensures
efficient, open, and competitive bidding on all purchases.
Information Technology (IT) aids with hardware, software, systems
access, cyber security, IT project management. IT ensures
compliance with information technology and information security
standards and practices in accordance with state and federal law
and contracts that include safeguarding electronic Protected Health
Information (ePHI). IT assists with the implementation and support
of technology solutions and is a common thread that enables the
County business units and offices to accomplish their respective
missions. While IT is an essential, foundational element for the
County to provide certain services and is also a catalyst for
business innovation. See Technical Proposal Attachment B for Weld
County's CISP Attestation.
Public Information Office (Communications) serves residents by providing
timely and accurate information related to county government programs,
projects, news and policy items. The Public Information team publishes
news releases, newsletters, and multimedia projects as well as manages
the county's social media platforms, for all county departments. The
Board of the Chief Public Information Officer is also responsible for media
relations and assisting the Weld County Attorney's Office with Colorado
Open Records Act (CORA) requests as needed.
County Attorney's Office serves as legal advisor for the Board of County
Commissioners (BOCC) and all departments and divisions of Weld County
government. When directed by the BOCC, the County Attorney represents
Weld County, county officers, county employees, and appointed boards
and commissions and their members in suits, actions, and other legal
proceedings.
Building Department helps to protect and enhance the quality of life for
County residents through the implementation of the adopted
Comprehensive Plan, Weld County Code, and Building Codes while
providing professional, friendly, and quality customer service to the
community. The Weld County Building Code, as adopted, addresses the
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design and installation of buildings and structures through requirements
which focus on safety, design control and construction quality.
Facilities is responsible for the repair, maintenance, landscaping of the
grounds, nighttime security, and snow removal for 104 County
facilities/locations.
Weld County Board of County Commissioners (BOCCI is the statutory
head of Weld County's government. Weld County BOCC works to ensure
continuity amongst decisions and departments in the county, fiscal
responsibility, and that the voice of rural Colorado is heard and
considered.
WCDHS administrative capacities that support department divisions and
programs are as follows:
Employee Support and Resources is WCDHS' internal Liaison with the
Weld County Human Resource Department.
Contract Management and Compliance is WCDHS' internal liaison with our
county Central Purchasing Office. They handle aspects of contract
management, ensuring effective communication and consistent processes
among all the various divisions within Human Services. This prevents
duplication of services and allows for the sharing of information among
various divisions.
Fiscal is WCDHS' internal liaison with the County Finance Department.
They provide oversight and assistance to Human Services for all division
related fiscal matters which include individual division and program
budgets.
Organizational and Integrity supports operational effectiveness for the
WCDHS divisions and staff. This is accomplished through facilitating
technology needs; conducting investigations of suspected public
assistance misuse; leading client appeals and administering local level
hearings; managing Civil Rights and Discrimination Complaints, managing
incoming and outgoing mail; partnering with IdentoGO for WCDHS and
public fingerprinting needs; issuing public assistance benefits and
collecting client payments; and coordinating the safety effort through
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security guard administration and participation in the Safety Roundtables.
They handle system access requests, equipment purchase orders, and
serve as WCDHS' internal liaison with County IT.
Assistance Payments Division manages eligibility determinations for public
assistance benefits, including Health First Colorado (also known as
Medicaid), Supplemental Nutrition Assistance Program (SNAP),
Temporary Assistance for Needy Families (TANF, also known as Colorado
Works) and Adult Financial (including Old -Age Pension and Aid to the
Needy and Disabled).
Area Agency on Aging Division (Weld County AAA) assists individuals in
maintaining independence and dignity in their home and community. This
division oversees WC CMA and currently operates four (4) programs that
include:
o SEP
o Long -Term Care Eligibility
o Adult Protective Services, and
o Older Americans Act
Having these programs in the same division allows for streamlined,
effective and efficient case management processes, particularly with
applications, eligibility determinations, assessments, and service
provision.
In summary, the administrative capacity within and outside the WC CMA
unit is robust, extensive, exceedingly supportive, collaborative, and
positioned to deliver consistent and high -quality contract management
and case management services for the Department and the public.
Per 10 CCR 2505-10-8.519.A.8, WC CMA has an established community
referral system, linkages, and the ability to make community referrals for
services with other agencies.
WC CMA is an integral part of a developed and long-time established
network of community partners that continuously strive to provide
support, resources, services, referrals, assistance, and innovative
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responses to the needs of Weld County residents. Vast in scope and
depth, it consists of county government departments, divisions, programs
closely linked to the SEP, and non -government agencies such as
providers, CMAs (SEPs and Community Center Boards (CCB)), and other
entities that are outside of Weld County government who are linked
internally by shared community goals and commitments.
Referral systems and networks inside Weld County government are
systems of relationships and supports that are all joined by an actual
shared network of infrastructure and technology. WC CMA is situated
within the WCDHS, and as such, the divisions and subdivisions that
comprise this department are closely linked to the SEP effort. Within the
network of WCDHS, WC CMA has referral and resource access to several
divisions, such as the AAA, the Child Care Assistance Program,
Employment Services, Child Welfare, the Family Resource Division, and
the Financial, Food, and Medical Services Division who assists with
elderly, disabled, adult, and children's financial and medical programs.
WC CMA routinely receives LTSS program referrals from this division.
Under the umbrella of the Weld County AAA division, WC CMA is
connected to several in-house referral sources and resources, such as the
Adult Protection Unit, the Dental, Vision, and Hearing Program, the Family
Care Support Program, the In -Home Services Program, the Aging and
Disability Resources for Colorado (ADRC), the Long -Term Care
Ombudsman Program, and the Aging Well Program. The connection
between the Weld County AAA and the Weld County SEP is further
enhanced by the management structure of the Weld County AAA, which
has a Division Director that is also the administrator for the SEP contract
and program.
The non -governmental network outside of WC CMA is extensive.
Consisting of a bi-directional information, assistance, and referral network
that is collaborative and adaptive. WC CMA sends and receives referrals
from several agencies, such as Community Centered Boards (e.g.,
Envision), Children's Home and Community -Based Services (CHCBS) case
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management agencies (e.g., Access and Ability), neighboring SEPs (e.g.,
Larimer Options for Long Term Care, Adult Care Management Inc.),
Regional Accountable Entities (e.g., Northeast Health Partners), North
Range Behavioral Health, North Colorado Health Alliance, Connections for
Independent Living, low-income and senior housing providers,
transportation providers, senior centers, Colorado Legal Services, United
Way, Catholic Charities, HCBS providers of all types (e.g., personal care,
adult day centers, electronic monitoring), home health agencies, hospice
agencies, Meals on Wheels, hospitals (e.g., UC Health Greeley), Program
of All -Inclusive Care for the Elderly (PACE) (e.g., True PACE), skilled
nursing facilities (e.g., Fair Acres Manor, Life Care Center), and many
others.
If a program applicant does not qualify for a HCBS waiver, WC CMA Case
Managers direct them to other internal programs such as the ADRC or the
Older Americans Act program. Additionally, applicants may be referred to
other WCDHS programs like Prevention, Adult Protection or outside
organizations like Connections for Independent Living, Catholic Charities,
Legal Services, Northern Colorado Health Alliance, 211, Lions Club,
Seniors Helping Seniors, North Range Behavioral Health, Weld County
Food Bank, 60 Plus Rides, IntelliRide, and Meals on Wheels.
WC CMA maintains an internal fifty-one (51) page list of various
community resources and provider agencies, including those in
neighboring counties. To ensure that the information remains current, WC
CMA collaborates with other SEPs to maintain an up-to-date provider list
for the area. Additionally, WC CMA has a comprehensive resource guide
called AAA Help Source, available in English and Spanish. This guide lists
Medicaid and non -Medicaid service providers in Weld County. The guide is
updated twice a year for accuracy and published annually.
Finally, WCDHS has an established list of "Key Community Partnerships,"
which is defined as:
A working relationship, either formal or informal, that WCDHS has
formed with other agencies, service providers or organizations who
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forward the WC CMA mission, vision, and values in supporting the
citizens of Weld County. Key Community Partners work together to
share information, services or to provide other types of support.
There are over one hundred forty-eight (148) partners and partner types
on the Key Community Partnership list, which represents the sheer scope
and depth of the referral networks and relationships that WC CMA has
access to and participants in.
Per 10 CCR 2505-10-8.519.A.9, demonstrate ability to meet all state and
federal requirements governing the participation of case management
agencies in the state Medicaid program, including but not limited to the
ability to meet state and federal requirements for documentation, billing,
and auditing.
For decades WC CMA has consistently demonstrated an ability to meet all
state and federal requirements governing participation of case
management agencies in the state Medicaid program. This has been
demonstrated by a) annual SEP certifications by the Department, b)
meeting the requirements of a CMA as defined in 10 CCR 2505-10-8.391
et. seq. and 10 CCR 2505-10-8.519 et. seq., c) participation in audits, d)
decades of documenting work in accordance with contract and program
requirements, and e) co -participating in monthly billing and invoicing
system with the Department.
WC CMA has been annually recertified as the SEP for Weld County since
1993. The most recent certification was received on May 19th, 2022 (see
Attachment A), and it states:
Pursuant to Title 25.5-6-106, C.R.S. and 10 C.C.R. 2505-10 Section
8.391.4, the SEP Agency shall be certified annually in accordance with
quality assurance standards and requirements set forth in the
Department's rules. The evaluation of the agency has been reviewed
for compliance on quality of services, financial accountability and
contractual performance.
The Department of Health Care Policy & Financing, Office of
Community Living, has designated Weld County Department of Human
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Services as a SEP Agency for the period of July 1, 2022, through June
30, 2023, for the following counties: Weld County.
Recertification by the Department demonstrates WC CMA's continued
compliance with state and federal rules, and successful performance in
the areas identified in 10 C.C.R 2505-10 Section 8.391.4, which states
recertification consists of an evaluation of the agency's performance in
the following areas:
The quality of the services provided by the agency.
The agency's compliance with program requirements, including
compliance with case management standards adopted by the
Department.
The agency's performance of administrative functions, including
reasonable costs per individual receiving services, timely reporting,
managing programs in one consolidated unit, on -site visits to
individuals, community coordination and outreach and individual
monitoring.
o Whether targeted populations are being identified and served
o Financial accountability
o The maintenance of qualified personnel to perform the contracted
duties.
In addition to annual recertifications, WC CMA has participated in annual
Department Quality Improvement Strategy (QIS) reviews designed to
meet federal assurances and performance measures. Over the years WC
CMA has seen a statistically significant decrease in findings due to the
implementation of corrective actions and changes that have increased
quality in key areas. For example, in 2019, WC CMA had nine (9) QIS
findings, and in 2022, that number dropped to two (2). This change
demonstrates our ability to accept, adjust, and correct agency
performance in service of being a better case management agency, a
quality provider of case management services, and a reliable contractor
for the State of Colorado.
Department QIS efforts are one component of the auditing WC CMA
participates in. There are annual financial audits completed by state
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contractor, independent financial audits, internal quality assurance
monitoring and reviews that are conducted by the supervisors for all case
management staff, annual performance evaluations, and monthly self -
audits of the Department billing and invoicing system for SEP funding.
Lastly, WC CMA has thirty (30) years' experience documenting case
management activities in accordance with state and federal requirements,
the SEP contract, Department memos and trainings, and internal
standards and procedures. This experience includes documenting case
activities in accordance with the Record Keeping requirements in Section
8.519 et seq. and Section 8.393 et seq., such as:
Maintaining sufficient documentation of case management activities
per Section 8.519.3.A.1, in state approved information
management systems per Section 8.519.12.A and Section
8.393.1.E.1.
Being objective and understandable per Sections 8.519.12.A.2.a
and 8.393.2.H.3.a.
Documenting activities within required timeframes per Sections
8.519.12.A.2.b and 8.393.2.H.3.b.
Presenting information in a logical sequence per Sections
8.519.12.A.2.g and 8.393.2.H.3.g
Documenting information sources per Section 8.519.12.A.2.h and
8.393.2.H.3.h.
Identifying persons and agencies by name and relationship per
Section 8.519.12.A.2.i and 8.393.2.H.3.i.
Accurately completing Department prescribed forms per Section
8.519.12.A.2.j and 8.393.2.H.3.j.
Documenting justification for missed timeframes per Section
8.519.12.A.2.k and 8.393.2.H.3.k.
Adhering to Member signature guidelines per Section 8.393.1.E.2.
Creating case summaries every six (6) months or when cases are
transferred or closed per Section 8.393.2.H.4.
Per 10 CCR 2505-10-8.519.A.10, WC CMA is exempt from the one -month
reserve requirement due to being a HCBS CMA prior to August 2019, but
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nevertheless, WC CMA does have at least one -month reserve financial
capacity to maintain operations.
Per 10 CCR 2505-10-8.519.A.11, WC CMA is exempt from the one -month
reserve requirement due to being an HCBS CMA prior to August 2019,
regardless, WC CMA does have financial reserves for at least one month
of expenditures to cover costs associated with the number of clients
expected through their catchment area, including reserves to cover
salaries and costs for Case Managers.
Per 10 CCR 2505-10-8.519.A.12, WC CMA meets all insurance liability
requirements as specified in Appendix B.2 County CMA Draft Contract of
this RFP and our existing contract with the state that contains the
identical requirements, Contract Number 21-160398. Liability insurance
documentation is submitted to and reviewed by the Department annually.
Per 10 CCR 2505-10-8.519.A.13, WC CMA is exempt from this
requirement, but nevertheless, WC CMA is not an approved provider
agency providing direct services to individuals who are enrolled in HCBS
waivers.
In addition to meeting and demonstrating that WC CMA meets all Case
Manager qualifications in 10 CCR 2505-10 8.519.2, WC CMA also follows all
requirements outlined in the Code of Colorado Regulations in Section 10 CCR
2505-10 8.519.3.A. This includes maintaining sufficient documentation of its
case management activities and claims (Section 8.519.3.A.1), not providing
guardianship services for clients enrolled in an HCBS waiver (Section
8.519.3.A.2) and having access to information about public and private state
and local services, supports, and resources (Section 8.519.3.A.3).
Additionally, WC CMA is separate from the delivery of services and supports,
has a primary person responsible for case management services, and
ensures services are available on business days (Section 8.519.3.A.4, 5, and
6). The agency also maintains records for seven (7) years after a client
discharge from a waiver program and has financial management systems to
document and track services and costs (Section 8.519.3.A.7 and 8).
WC CMA has job descriptions for all positions, a website with information
about the agency, and access to relevant statutes and regulations for its
staff (Section 8.519.3.A.12, 13, and 14). The agency also provides case
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management services without discrimination and cooperates with the
Department in evaluations (Section 8.519.3.A.15 and 17). If WC CMA can no
longer provide case management services, it must provide a ninety (90) day
notice to the Department and submit a Closeout Plan detailing the transition
process (Section 8.519.3.A.18 and 19). WC CMA is responsible for verifying
that its employees meet minimum requirements and qualifications (Section
8.519.3.A.20).
OFFEROR'S RESPONSE 1.d: Conflict Free Case Management
Attestation
Attestation that the Offeror and/or its subcontractors do not have a
fiduciary relationship with any Medicaid Providers who provide
direct Medicaid services for the programs in which the CMA is
responsible for within this Solicitation unless the Offeror has
submitted and/or received approval from the Department for a
Conflict Free Case Management Waiver (CFCMW).
As per Solicitation RFP UHAA 2023000170, Section 2.1.1.4, and 10 CCR
2505-10-8.519.2.A.5, WC CMA does not have a conflict of interest in
providing both HCBS case management and direct HCBS waiver services.
WC CMA does not have a fiduciary relationship with any Medicaid Providers
who provide direct Medicaid services for the programs in which the CMA is
responsible for within this Solicitation.
WC CMA does not use subcontractors to assist in the completion of any work
associated with our existing SEP contract with the Department, but if a
future business or contract need arises that could benefit from the use of a
subcontractor(s), WC CMA will ensure all subcontractors shall not have a
fiduciary relationship with any Medicaid Providers who provide direct
Medicaid services for the programs in which the CMA is responsible.
OFFEROR'S RESPONSE 1.e: Contract Start Date Attestation
Attestation that the Offeror shall be able to begin performing the
Work under the Contract as early as November 1, 2023, or as late as
July 1, 2024, as determined by the Department in its sole discretion.
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As per Solicitation RFP UHAA 2023000170, Section 2.1.1.5, WC CMA shall
begin performing the Work under the Contract as early as November 1,
2023, or as late as July 1, 2024, as determined by the Department in its sole
discretion.
OFFEROR'S RESPONSE 1.f: Subrecipient Obligations Attestation
Attestation that the Offeror understands their obligations as a
subrecipient of a federal award and has read and understands their
obligations under 2 CFR Part 200. Offeror's response shall provide a
written attestation and agreement with each individual listed
requirement in this section:
i Understanding and agreement that funds provided via the
Contract resulting from this solicitation must be spent on
allowable activities in alignment with 2 CFR Part 200, state
regulation and the resulting Contract.
ii Understanding and agreement that any unspent funds must be
returned to the Department following the end of the Period of
Performance identified by the Department.
As per Solicitation RFP UHAA 2023000170, Section 2.1.1.6, WC CMA shall
comply with all obligations as a subrecipient identified in 2 CFR Part 200, and
in alignment with 2 CFR Part 200.344, agrees that all subawards provided to
the Offeror by way of the resulting Contract must be spent only on allowable
CMA activities in alignment with 2 CFR Part 200, state and federal
regulations, and the Contract.
As per Solicitation RFP UHAA 2023000170, Section 2.1.1.7, WC CMA attests
and agrees that any unspent funding provided via the resulting Contract, for
which there are not allowable expenditures, must be returned to the
Department following the end of the Contract Period of Performance as this
is required by law and will become a part of the final Contract resulting from
this solicitation.
As per Solicitation RFP UHAA 2023000170, Section 1.6.1, WC CMA attests
and agrees that as the CMA for service area 9, WC CMA is a subrecipient of a
federal award and as such is subject to the requirements of the Office of
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Management and Budget Uniform Guidance, 2 CFR Part 200. As a
subrecipient, the Contractor shall comply with all reporting, auditing, and
other requirements of 2 CFR Part 200).
As per Solicitation RFP UHAA 2023000170, Section 1.6.2, WC CMA attests
and agrees that as the CMA for Service Area 9, WC CMA is required to follow
all federal guidance for subawards identified in 2 CFR Part 200. This includes
but is not limited to § 200.344 (d) that states:
The non -Federal entity must promptly refund any balances of unobligated
cash that the Federal awarding agency or passthrough entity paid in advance
or paid and that are not authorized to be retained by the non -Federal entity
for use in other projects.
As per Solicitation RFP UHAA 2023000170, Section 1.6.3, WC CMA attests
and agrees that as the CMA for Service Area 9, Section § 200.344 mandates
that all subrecipients must return unused funds within the timeframe
specified by the Department following the end of the period of performance.
OFFEROR'S RESPONSE 1.g: TCM Provider Enrollment Attestation
Attestation that prior to the start of the Contract resulting from this
solicitation, that the Offeror will enroll as a Medicaid Targeted Case
Management (TCM) provider for all HCBS Waivers to include but not
limited to providing ongoing case management, monitoring, and
OHCDS activities.
As per Solicitation RFP UHAA 2023000170, Section 2.1.1.8, if awarded the
contract resulted from this solicitation, WC CMA shall enroll with the
Department's fiscal agent as a Medicaid Targeted Case Management (TCM)
provider for eligible Members enrolled in all HCBS Waivers and enroll as a
direct service provider of CHCBS case management services to include but
not limited to providing ongoing case management, monitoring, and
Organized Health Care Delivery System (OHCDS) activities for the Defined
Service Area.
OFFEROR'S RESPONSE 1.h: TCM Services Attestation
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The Offeror attests that it understands that TCM activities will not be
a part of the Contract resulting from this solicitation but instead
shall obtain Medicaid Provider Agreement approval. All Offeror's who
receive a Contract resulting from this solicitation must agree to
become a TCM provider.
As per Solicitation RFP UHAA 2023000170, Section 2.1.1.8.1, WDCHS
attests that it understands that TCM activities will not be a part of the
Contract resulting from this solicitation but instead will apply for a Medicaid
Provider Agreement. If awarded the contract resulting from this solicitation,
WC CMA agrees to become a TCM provider.
OFFEROR'S RESPONSE 1.i: TCM Billed Through MMIS Attestation
The Offeror attests that it understands that TCM is funded separate
and apart from the Contract resulting from this solicitation and must
be billed through the Colorado Interchange Medicaid Management
Information System (MMIS) as a Medicaid Provider.
As per Solicitation RFP UHAA 2023000170, Section 2.1.1.8.2, WDCHS
attests that it understands TCM activities are funded separate and apart
from the Contract resulting from this solicitation, and that services must be
billed through the Colorado Interchange Medicaid Management Information
System (MMIS) as a Medicaid provider of TCM.
OFFEROR'S RESPONSE 1.j: HCA Attestation and Funds Procedure
Attestation that the Offeror understands that it may be required,
through a separate contract agreement with the Colorado
Department of Human Services (CDHS), to enter into an agreement
with CDHS to perform duties regarding the Home Care Allowance
(HCA) program and understands that the HCA program and its
requirements are separate from those requirements listed in this
Solicitation and will not become a part of the Contract resulting from
this Solicitation.
i. Offeror's response shall include a draft procedure that
acknowledges that HCA funds and funds resulting from this
solicitation are from two different payor sources and provide
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assurances that funds will not be commingled, will be tracked
separately and that CMA funds will not be utilized to
supplement this program.
As per Solicitation RFP UHAA 2023000170, Section 2.1.1.8.9, WDCHS
attests that it may be required, through a separate contract agreement with
the Colorado Department of Human Services (CDHS), to enter into an
agreement with CDHS to perform duties regarding the Home Care Allowance
(HCA) program and understands the HCA program and its requirements are
separate from those requirements listed in this Solicitation and will not
become a part of the Contract resulting from this Solicitation.
WDCHS has been the SEP for Weld County for thirty (30) years and during
that time, WC CMA has successfully managed a separate contract with CDHS
for the HCA program. If awarded the contact for Service Area 9, WC CMA will
continue the existing timekeeping, accounting, and spending policies and
procedures that ensure the separation of HCA funds from the existing SEP
contract and the contract associated with this Solicitation.
Procedure
1. HCA funds and funds resulting from this solicitation are from two
different payor sources and shall not be commingled.
2. HCA will be tracked separately, and CMA funds will not be utilized to
supplement this program.
3 When Weld County case management staff work in the Home Care
Allowance (HCA) program, they must report it separately from the
reporting of Single Entry Point (SEP) work on their timecard.
4 Weld County uses the Banner Accounting System to track individual
programs administered by the Weld County Department of Human
Services.
5. Weld County utilizes two segments of its chart of accounts as
separating codes to differentiate between programs. The Fund Code
265995 is used to identify the Options for Long -Term Care Program as
separate from other programs.
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6. Within that Fund Code, the Single Entry Point portion of the program is
tracked using the Organization Code 61780 and the Home Care
Allowance portion of the program is tracked using the Organization
Code 61790.
7. Weld County can completely differentiate between and report on each
portion of the program, either as a combined unit or as separate
portions, as needed.
OFFEROR'S RESPONSE 2: Organizational Experience
Provide details that demonstrate how Offeror meets all
organizational experience requirements. Offeror's response should
list each stated experience requirement separately and follow the
listed requirement with the details that demonstrate how Offeror
meets that specific requirement. Additionally, this response must
include providing a detailed description of Offeror's organizational
experience and skills, including, at a minimum, specific years of
experience.
As the Department contracted and certified SEP for Weld County since 1993,
WC CMA has accumulated thirty (30) years of direct experience providing
HCBS and non-HCBS program case management services to a diverse
population of people, spanning the lifespan from birth to over one hundred
(100) years of age, that present with a multitude of disabilities, income
levels, medical needs, support networks, social needs, service and non -
service needs, and living situations.
As a county governmental entity, the comprehensive services and supports
provided by the WCDHS to address the diversity of needs its community
faces extends well beyond those of a single case management contract. For
example, WC CMA includes divisions for Employment Services, Child
Welfare, Child Care Assistance, Child Support Services, Family Resources,
Financial, Food, and Medical Services, and an AAA. Although these divisions
are partitioned from one another as necessary to maintain a degree of
autonomy, they also exist under an umbrella of a single entity that consists
of streamlined communication and interagency networks that support the
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overall efforts to fulfill the mission, which is to help maintain an individual's
independence and dignity in their home and community.
The Weld County AAA contains its own service units and programs, that
include the Long -Term Care SEP, ADRC Program and Adult Protective
Services (APS). The Division Director of the AAA is also the administrator for
the SEP contract, and she brings eighteen (18) years of experience in CO
HCBS waiver and non -waiver program case management, ten (10) years of
waiver program case management and supervisor experience in Arizona,
and years of experience managing multiple programs (e.g., SEP, AAA),
administrating multiple contracts, developing programs, and developing and
managing budgets.
Embedded in and sharing a collective, multi -divisional level of experience
covering a wide array of populations, services, and community supports and
access points, WC CMA's specific experience in the realms of HCBS and non-
HCBS program case management is deep, historical, and sweeping. WC
CMA's experience has been gained through providing intake, screening, and
referral services, service monitoring, support planning, level of care screens,
needs assessments, and other LTSS services described in this solicitation,
the existing SEP contract, and detailed in 10 CCR 2505-10-8.519 et seq. and
10 CCR 2505-10-8.393 et seq.
Experience has also been gained from thirty (30) years of working with
people in the third (3rd) largest county in Colorado, covering an area that is
four thousand seventeen (4,017) square miles, containing approximately
three hundred thirty thousand (330,000) people that are geographically
spread out across the county, and serving over three thousand five hundred
(3,500) people annually.
OFFEROR'S RESPONSE 2.a: Experience Assisting People
Experience assisting people with disabilities, marginalized
populations, low-income individuals, including children, adults, and
older adults, to obtain medical, social, educational and/or other
services. This experience must have been within the last five (5)
years. This experience shall include, but is not limited to:
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OFFEROR'S RESPONSE 2.a.i.: Intake, Screening and Referral for LTSS
programs
Since 1993, WC CMA has provided intake, screening, and referral services to
people of all ages, disabilities, and income levels who are currently on or
applying for CO HCBS waiver and non -waiver LTSS programs in Weld
County. Intake, screening, and referral services have been core LTSS
services since the inception of the CO SEP system in the early 1990's. Over
the past five (5) years, WC CMA has and continues to provide these services
to all Weld County residents in accordance with the Intake, Screening, and
Referral requirements in 10 CCR 2505-10-8.393.B, 10 CCR 2505-10-
8.519.11.B, the current SEP Contract with the Department, (Contract
Number 21-160398, Exhibit B, section 2, p. 8 of 22), and RFP Section
3.10.1.2 (p. 38). In 2022, WC CMA completed a total of one thousand eight
hundred seventy-seven (1,877) HCBS and non-HCBS referrals (see
OFFEROR'S RESPONSE 3 for referral type summary), in 2021 one thousand
seven hundred and fifty-seven (1,757) referrals were completed, and in
2020 one thousand seven hundred forty-nine (1,749) were completed.
The specific intake, screening, and referral service activities WC CMA has
provided to program applicants and existing Members for the past five (5)
years, include, but are not limited to: completing and documenting intake,
screening, and referral activities in the Department's information
management system (Section 8.393.2.B.1.a); the provision to information
and referral to other agencies as needed (Section 8.393.2.B.1.b); functional
eligibility assessment screens (Section 8.393.2.B.1.c); review of potential
pay sources (Section 8.393.2.B.1.d); and the prioritization of urgent
inquiries (Section 8.393.2.B.1.e).
WC CMA has an extensive referral network it has relied on for years to fill
gaps and meet the needs of people seeking help and assistance. If referrals
to other agencies and resources are deemed appropriate and useful to the
person seeking assistance, over the past five (5) years, WC CMA will refer
them to any number of possible departments and agencies, to include, but
not be limited to: Community Centered Boards (e.g., Envision); CHCBS case
management agencies (e.g., Access and Ability); Regional Accountable
Entities (e.g., Northeast Health Partners); North Range Behavioral Health;
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North Colorado Health Alliance; Connections for Independent Living; low-
income and senior housing providers; transportation providers; senior
centers; Colorado Legal Services; United Way; Catholic Charities; and the
numerous programs housed within the WCDHS, including but not limited to
those housed within the AAA (Adult Protective Services, Long Term Care
Financial, ADRC, Older American Act programs, Senior Nutrition Program
and Ombudsman Program); Child Protection and the Wraparound team;
Employment Services; Family Resource Division (Outreach, Prevention,
Emergency Rental Assistance and SSI/SSDI Specialists); and others.
For the past five (5) years, WC CMA has experience in receiving referrals
from a variety of sources, such as individuals in need of long-term services
and supports, their friends and families, numerous agencies and community
partners, hospitals, nursing facilities, other county departments and
divisions, other case management agencies, mental health agencies, PACE
sites, and others. WC CMA has years of experience receiving these referrals
by phone, in person, by fax, and secure email.
As an intake, screening, and referral process outcome, if an individual needs
services and supports through a publicly funded LTSS program such as an
HCBS waiver, WC CMA staff move the application forward by verifying
individual demographic information collected at intake (Section
8.393.2.B.2.a), coordinating the completion of the financial eligibility process
(Section 8.393.2.B.2.b) by verifying current financial status (Section
8.393.2.B.2.b.i), referring individuals to the county department of social
services (Section 8.393.2.B.2.b.ii), providing financial application forms
(Section 8.393.2.B.2.b.iii), and documenting follow-up activities to complete
the functional eligibility determination and the completion of the financial
eligibility determination (Section 8.393.2.B.2.b.iv). At the conclusion of the
process, WC CMA staff provides recipient appeal rights in accordance with
Sections 8.393.2.B.2.d and 8.057 et. seq.
Regardless of age, disability, income level, and location within the county,
anyone can enter through the front doors of WC CMA to receive the above
intake, screening, and referral services. While there are many ways WC CMA
works with people, for the past (5) years, WC CMA has primarily interfaced
with people through LTSS waivers and non -waiver programs.
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For children aged birth through eighteen (18), WC CMA has provided intake,
screening, and referral services for the HCBS Waiver for Children with a Life -
Limiting Illness and the Home Care Allowance program, and for ages sixteen
(16) to eighteen (18) years of age, the HCBS Waiver for Persons with a
Brain Injury. For adults aged eighteen (18) and older, for the past five (5)
years WC CMA has provided intake, screening, and referral services through
the HCBS Waiver for Persons who are Elderly, Blind, and Disabled, the HCBS
Waiver for Complimentary and Integrative Health (e.g., spinal cord injuries,
multiple sclerosis), the HCBS Community Mental Health Supports Waiver and
HCBS for Persons with a Brain Injury Waiver. Additionally, WC CMA
completes intake, screening, and referral services for individuals in need of
Long -Term Home Health services (RN, CNA), Hospital Backup admissions,
elderly persons in need of the Program for All -Inclusive Care for the Elderly
(PACE), for all individuals, regardless of disability and income status, and for
nursing facility admissions under Medicaid.
OFFEROR'S RESPONSE 2.a.ii.: Level of Care Screen and Needs
Assessments for LTSS programs.
Over the past five (5) years, WC CMA has conducted all Level of Care Screen
Assessments (RFP Section 3.17.2) and Needs Assessments (defined below)
in accordance with the current level of care screening guidelines at 10 CCR
2505-10-8.401 et. seq, the initial assessment requirements at 10 CCR 2505-
10-8.393.2.C et. seq., the assessment, reassessment, and informal
assessment requirements at 10 CCR 2505-10-8.393.2 et seq., the
comprehensive assessment, periodic reassessment, the identification of
client needs and service plan development requirements at 10 CCR 2505-10-
8.519.11.B et. seq., the SEP Contract, and Department Operational Memos.
In 2022, WC CMA case managers completed one thousand two hundred
forty-two (1,242) Initial Level of Care Screen Assessments for all SEP
managed LTSS programs (HCBS, Nursing Home, PACE, LTHH, HBU). Seven
hundred twenty-nine (729) of those Initial Assessments were for HCBS
waivers and therefore included a Needs Assessment. In 2022, WC CMA also
completed over one thousand three hundred (1,300) Level of Care Screen
and Needs Reassessments for Members receiving services from one (1) of
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five (5) HCBS waivers (HCBS-BI, HCBS-CIH, HCBS-CLLI, HCBS-CMHS,
HCBS-EBD).
Since 2003, WC CMA case managers have utilized the Department
prescribed Uniform Long -Term Care 100.2 Assessment (100.2) and its
supplemental assessment and needs tools to conduct all Level of Care
Screen and Needs Assessments. When the state implemented the ULTC
100.2 in 2003, in addition to conducting assessments, case managers were
newly assigned the regulatory responsibility of being the Utilization Review
Contractor (URC). This role meant that case managers had to determine if
an applicant was approved or denied for a program based on the information
contained within a complete assessment. No longer functioning as just
assessors, case managers have made level of care eligibility decisions, and
WC CMA has two (2) decades of completing level of care assessments that
include, but are not limited to the following components:
Conducting in -home and virtual assessments (Sections 8.393.2.C.4
and 8.393.1.M.c).
Gathering assessment information and client history from multiple
sources (e.g., Member, family, physician, medical records) for
Colorado's existing assessment tool in accordance with rules at
Section 8.393.2.C.5 et seq. and Section 8.519.11.B.1.b.
Obtaining diagnostic information from the individual's medical
provider (Section 8.393.2.C.5.a).
Determining specific program eligibility based on target population
criteria definitions at Section 8.400.16 and waiver specific criteria in
waiver specific rules, such as those at Section 8.515 for the HCBS-
BI waiver, and Section 8.517 for the HCBS-CIH waiver.
Determining functional capacity, functional capacity score, and the
functional need for a nursing facility level of care in accordance with
Sections 8.393.2.C.5.b and 8.401.15.A.
Assigning length of stays for individuals seeking nursing facility care
as required in 8.393.C.5.c, and according to guidelines in Section
8.402.15.
Completing initial assessments within the timeframes specified at
Section 8.393.2.C.1.a et. seq., RFP Section 3.17.2.3, the
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reassessment timeframes at Section 8.393.2.D.1 and in RFP
Section 3.17.3.1.
Utilizing the Department's information management systems (IMS)
to document assessment activities per Section 8.393.5.2 and the
record keeping and documentation requirements at Sections
8.519.12 and 8.393.1.1.
Issuing Notice of Actions for all program approvals and denials per
Sections 8.393.5.A, 8.393.3.A.2, and the recipient appeal rules in
Section 8.057; and preparing for and attending hearings related to
803s sent by WC CMA in accordance with Section 8.057.
With decades of experience conducting the above assessment activities, WC
CMA has the same amount of experience completing needs assessments for
HCBS waiver programs. Currently, the state prescribed level of care
assessment is the ULTC 100.2, and it addresses eight activities of daily living
(ADLs): bathing, dressing, toileting, mobility, transfers, eating, behaviors,
and memory/cognition. The ULTC 100.2 is the core of eligibility
determinations, and is the only assessment required for all programs. For all
HCBS waiver assessments, the needs assessments completed by WC CMA
have consisted of a combination of the ULTC 100.2, the individual's
Instrumental Activities of Daily Living (IADLs), and the completion of a
Service Plan.
In addition to ADLs, the IADL assessment considers a person's deficits and
needs in the areas of hygiene, medication management, transportation,
meal preparation, accessing resources, laundry, money management,
housework, and shopping. An assessment of the ADLs and IADLs creates a
more complete picture of an individual's deficits and the corresponding HCBS
service and non-HCBS service needs. The service plan represents the service
need response to all that was disclosed in the ADL and IADL assessment, to
include the individual's preferences, chosen services, and the opportunity to
further discuss and refine areas in need of support. WC CMA case managers
engage in the following needs assessment activities, and have done so for
twenty (20) years:
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The completion of the UTLC 100.2 assessment in accordance with
all relevant rules at Section 8.393 et. seq., Section 8.401 et seq.,
and Section 8.519 et seq.
The completion of the IADL assessment.
The identification of an individual's strengths, needs, and
preferences for services and supports as required in Section
8.393.2.G.1.a
Service plan development in accordance with Section 8.393.2.G.1.b
that addresses individual goals, assessed needs, and preferences.
Identifying client needs, health and safety concerns, and gathering
information from multiple sources, Section 8.519.11.b and
8.519.11.
Being sensitive to cultural considerations and communication needs
per Section 8.393.2.E.d.
Providing necessary information and support to ensure the
individual directs the assessment and service planning process as
defined in Section 8.393.2.E.4.
Documenting needs assessment activities in Department IMSs, to
include entering the ADL, IADLs, Service Plan, and an Inventory of
Member Needs.
In summary, WC CMA has extensive experience and a long history of
completing level -of -care screens and needs assessments for thousands of
people across a wide range of disabilities and income ranges, and the entire
age spectrum spanning from birth to older adults. Over the past twenty (20)
years, the sheer volume of assessments and member interactions has
resulted in the development of a refined and deep understanding of people,
disabilities, and the needs of our community. We have also learned how to
conduct effective and meaningful evaluations and understand the importance
of being empathetic and engaged while simultaneously meeting contractual,
federal, and state requirements
OFFEROR'S RESPONSE 2.a.iii. Administrative capacity to deliver case
management services in accordance with state and federal
requirements.
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Since 1993, the WC CMA has and continues to possess the administrative
capacity to deliver case management services in accordance with state and
federal requirements, our existing SEP contract with the Department, and
the potential contract associated with this solicitation. WC CMA is a part of
the necessary infrastructure, departments, divisions, and people to:
Successfully provide case management services to the community in
accordance with state, federal, and contractual requirements.
Establish and maintain referral networks and community partner
agreements and relationships.
Self -monitor for contract, financial, and program compliance.
Achieve contract objectives and performance standards.
In accordance with the Administration of a SEP requirements at 10 CCR
2505-10-8.393.1.A.1, WC CMA a) serves persons in LTSS programs as
defined in Section 8.390.3, b) has capacity to accept funding from multiple
sources, c) may utilize Subcontractors to complete SEP functions, d) may
receive funds from public or private foundations and corporations, and e)
publicly discloses all sources and amounts of revenue.
As a program within a county governmental system, WC CMA is nested
within a greater framework of departments and divisions that greatly
enhance the administrative capacity of the SEP effort. This nested
framework provides the WC CMA with a longstanding, stable structure to
support our business practices, programs, and the community we serve.
WCDHS is a large department, so in addition to the support WC CMA
receives from the overarching county structure, there are several divisions
within WCDHS that provide oversight and guidance. This ensures
consistency, quality, compliance, and effective communication, and helps
prevent duplication of services and efforts.
The Weld County administrative capacities that support county departments,
divisions, and programs (e.g., WC CMA) are as follows:
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Finance and Administration includes the offices of Human Resources,
Purchasing, Accounting, Budget, Information Technology, Geographical
Information System, Printing and Supply, Insurance, and Capital.
Human Resources (HR) assists Weld County departments in the hiring
process for new employees. In addition, HR oversees policies and rules
affecting employment, assists employees with any employment
questions, establishes job classifications, and compensation plans. HR
is also responsible for orientation of new employees and establishing
and implementing county -wide training programs.
Accounting and Payroll (Financel is responsible for receipt and disbursement
of Weld County's operating funds. The office accounts for all income of the
county, payments to vendors, cash balances, internal service charges, fixed
and depreciable assets, and insurance. One important task of Finance is the
processing of Weld County employees' payroll. The Finance office pays all
county employees and accounts for all taxes and other deductions associated
with the payroll.
Central Purchasing Office administers bid proposals and ensures
efficient, open, and competitive bidding on all purchases.
Information Technology (IT) aids with hardware, software, systems
access, cyber security, IT project management. IT ensures compliance
with information technology and information security standards and
practices in accordance with state and federal law and contracts that
include safeguarding electronic Protected Health Information (ePHI). IT
assists with the implementation and support of technology solutions
and is a common thread that enables the County business units and
offices to accomplish their respective missions. While IT is an
essential, foundational element for the County to provide certain
services and is also a catalyst for business innovation.
Public Information Office (Communications) serves residents by providing
timely and accurate information related to county government programs,
projects, news and policy items. The Public Information team publishes news
releases, newsletters, and multimedia projects as well as manages the
county's social media platforms, for all county departments. The Board of
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the Chief Public Information Officer is also responsible for media relations
and assisting the Weld County Attorney's Office with Colorado Open Records
Act (CORA) requests as needed.
County Attorney's Office serves as legal advisor for the Board of County
Commissioners (BOCC) and all departments and divisions of Weld County
government. When directed by the BOCC, the County Attorney represents
Weld County, county officers, county employees, and appointed boards and
commissions and their members in suits, actions, and other legal
proceedings.
Building Department helps to protect and enhance the quality of life for
County residents through the implementation of the adopted Comprehensive
Plan, Weld County Code, and Building Codes while providing professional,
friendly, and quality customer service to the community. The Weld County
Building Code, as adopted, addresses the design and installation of buildings
and structures through requirements which focus on safety, design control
and construction quality.
Facilities is responsible for the repair, maintenance, landscaping of the
grounds, nighttime security, and snow removal for 104 County
facilities/locations.
Weld County Board of County Commissioners (BOCCI is the statutory head
of Weld County's government. Weld County BOCC works to ensure continuity
amongst decisions and departments in the county, fiscal responsibility, and
that the voice of rural Colorado is heard and considered.
WCDHS administrative capacities that support department divisions and
programs are as follows:
Employee Support and Resources is WCDHS' internal Liaison with the Weld
County Human Resource Department.
Contract Management and Compliance is WCDHS' internal liaison with our
county Central Purchasing Office. They handle aspects of contract
management, ensuring effective communication and consistent processes
among all the various divisions within Human Services. This prevents
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duplication of services and allows for the sharing of information among
various divisions.
Fiscal is WCDHS' internal liaison with the County Finance Department. They
provide oversight and assistance to Human Services for all division related
fiscal matters which include individual division and program budgets.
Organizational and Integrity supports operational effectiveness for the
WCDHS divisions and staff. This is accomplished through facilitating
technology needs; conducting investigations of suspected public assistance
misuse; leading client appeals and administering local level hearings;
managing Civil Rights and Discrimination Complaints, managing incoming
and outgoing mail; partnering with IdentoGO for DHS and public
fingerprinting needs; issuing public assistance benefits and collecting client
payments; and coordinating the safety effort through security guard
administration and participation in the Safety Roundtables. They handle
system access requests, equipment purchase orders, and serve as WCDHS'
internal liaison with County IT.
Assistance Payments Division manages eligibility determinations for public
assistance benefits, including Health First Colorado (also known as
Medicaid), Supplemental Nutrition Assistance Program (SNAP), Temporary
Assistance for Needy Families (TANF, also known as Colorado Works) and
Adult Financial (including Old -Age Pension and Aid to the Needy and
Disabled).
Area Agency on Aging Division (Weld County AAA) assists individuals in
maintaining independence and dignity in their home and community. This
division oversees WC CMA and currently operates four (4) programs that
include:
• SEP
• Long -Term Care Eligibility
• Adult Protective Services, and
• Older Americans Act
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Having these programs in the same division allows for streamlined, effective
and efficient case management processes, particularly with applications,
eligibility determinations, assessments, and service provision.
In summary, the administrative capacity within and outside the WC CMA unit
is robust, extensive, exceedingly supportive, collaborative, and positioned to
deliver consistent and high -quality contract management and case
management services for the Department and the public.
OFFEROR'S RESPONSE 2.a.iv.: Experience developing and
participating in local community referral systems/networks,
referring individuals and Members to local government and
community entities for non HCBS program and services and
coordinating benefits and services across multiple entities.
WC CMA has years of experience developing and participating in local
community networks, referring members to other entities, an established
community referral system, linkages, and the ability to make community
referrals for services with other agencies.
In existence since 1993, WC CMA belongs to, and is an integral part of a
developed and long-time established network of entities that continuously
strives to provide support, resources, services, referrals, assistance, and
innovative responses to the needs of Weld County residents. Vast in scope
and depth, it consists of county government departments, divisions, and
programs closely linked to the SEP, and non -government agencies such as
providers, CMAs (SEPs and CCBs), and other entities that are outside of
Weld County government yet linked internally by shared community goals
and commitments.
Referral networks inside Weld County government are systems of
relationships and supports that are all joined by a shared network of
infrastructure, technology, departments, and divisions. WC CMA is situated
within the WCDHS, and as such, the divisions and subdivisions that comprise
this department are those most closely linked to the SEP effort. Within the
network of WCDHS, WC CMA has referral and resource access to several
divisions, such as the AAA, the Child Care Assistance Program, Employment
Services, Child Welfare, the Family Resource Division, and the Financial,
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Food, and Medical Services Division that among other functions, assists with
elderly, disabled, adult, and children's financial and medical programs. WC
CMA staff routinely coordinate program eligibility activities with long term
eligibility technicians in the Financial, Food, and Medical Services Division,
such as sending and receiving LTSS program referrals and communications
to support the applicant's journey to programs and services.
Under the umbrella of the AAA division, WC CMA is connected to several in-
house referral sources and resources, such as the Adult Protection Unit, the
Dental, Vision, and Hearing Program, the Family Care Support Program, the
In -Home Services Program, the ADRC, the Long -Term Care Ombudsman
Program, and the Aging Well Program. The connection between the AAA and
the SEP is further enhanced by the management structure of the AAA, which
has a Division Director that is also the administrator for the SEP contract and
program.
The non -governmental network outside of the WC CMA is extensive.
Consisting of a bi-directional information, assistance, and referral network
that is collaborative, coordinated, and adaptive. WC CMA sends and receives
referrals from several agencies, such as Community Centered Boards (e.g.,
Envision), CHCBS case management agencies (e.g., Access and Ability),
neighboring SEPs (e.g., Larimer OLTC, ACMI), Regional Accountable Entities
(e.g., Northeast Health Partners), North Range Behavioral Health, North
Colorado Health Alliance, Connections for Independent Living, low-income
and senior housing providers, transportation providers, senior centers,
Colorado Legal Services, United Way, Catholic Charities, HCBS providers of
all types (e.g., personal care, adult day centers, electronic monitoring),
home health agencies, hospice agencies, Meals on Wheels, hospitals (e.g.,
Northern Colorado Medical Center), PACE (e.g., Innovage), skilled nursing
facilities (e.g., Pelican Point and West Lake), and many others.
If a program applicant does not qualify for a HCBS waiver, WC CMA Case
Managers direct them to other internal programs such as the ADRC or Older
Americans Act program. Additionally, they may refer them to other DHS
programs like Prevention or Adult Protection and may suggest they contact
organizations such as, Connections for Independent Living, Catholic
Charities, Legal Services, Northern Colorado Health Alliance, 211, Lions
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Club, Seniors Helping Seniors, North Range Behavioral Health, Weld County
Food Bank, 60 Plus Rides, IntelliRide, and Meals on Wheels.
WC CMA maintains an internal fifty-one (51) page list of various community
resources and provider agencies, including those in neighboring counties. To
ensure that the information remains current, WC CMA collaborates with
other SEPs to maintain an up-to-date provider list for the area. Additionally,
WC CMA has a comprehensive resource guide called AAA Help Source,
available in both English and Spanish, in hard -copy or electronically. This
guide lists Medicaid and non -Medicaid service providers in Weld County. The
guide is updated twice a year for accuracy and published annually.
WCDHS has an established list of what is referred to as "Key Partnerships,"
which is defined as:
A working relationship, either formal or informal, that the WCDHS
forms with another agency, service provider or organization who
forwards the WC CMA mission, vision, and values to support the
citizens of Weld County. Key Community Partners work together to
share information, services or provide other types of support.
There are over one hundred forty-eight (148) partners and partner types on
the Key Community Partnership list, which represents the sheer scope and
depth of the referral networks and relationships that WC CMA has access to
and participates in.
OFFEROR'S RESPONSE 2.a.v: Administrative capacity to administer
State General Fund programs to include: Family Support Services
Program (FSSP), State Supported Living Services (State-SLS)
program, and the Omnibus Reconciliation Act of 1987 Specialized
Services (OBRA-SS) program in accordance with state regulations
and this solicitation.
WC CMA has the necessary administrative capacity to effectively administer
state general fund programs, including the Family Support Services Program
(FSSP), State Supported Living Services (State-SLS), and the Omnibus
Reconciliation Act of 1987 Specialized Services (OBRA-SS). This capacity is
supported by the infrastructure and resources provided by the WCDHS and
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its various divisions, as well as the Weld County Board of County
Commissioners.
WC CMA is part of a larger system within the WCDHS that provides the.
necessary infrastructure, departments, divisions, and personnel to deliver
high -quality case management services in accordance with state, federal,
and contractual requirements. The organization has established referral
networks and community partnerships, and it is equipped with the necessary
resources and processes to monitor contract, financial, and program
compliance. In accordance with the Administration of a SEP requirements at
10 CCR 2505-10-8.393.1.A.1, WC CMA serves persons in Long -Term
Services and Supports programs and has the capacity to accept funding from
multiple sources. Additionally, WC CMA is transparent in its reporting of all
sources of revenue, publicly disclosing all sources and amounts of revenue in
accordance with the regulations.
Weld County and WCDHS have various administrative capacities offered by
its divisions and programs, including Contract Management and Compliance,
Accounting and Payroll, Finance and Administration, Information Technology,
Employee Support and Resources, and Fiscal. The Assistance Payments
Division is responsible for determining eligibility for public assistance
benefits, while the AAA Division oversees several programs aimed at helping
individuals maintain their independence and dignity in their homes and
communities. This division also oversees the SEP program, Long -Term Care
Eligibility, Adult Protective Services, the Older Americans Act, allowing for
streamlined, effective and efficient case management processes.
To effectively administer state general fund programs, WC CMA has plans in
place to create a specialized unit within the organization that will be
dedicated to the management of these programs. The unit will be staffed
with dedicated personnel, including a CMA Supervisor, Lead Specialist, Case
Managers, and Case Aides, to ensure that all work required is conducted in
accordance with state regulations and contract requirements. The CMA
Supervisor, Lead Specialist, and Case Managers will be responsible for
ensuring that services are supported with required documentation, as
outlined in 10 C.C.R. 2505-10 Section 8.613.J.2 and 10 C.C.R. 2505-10
Section 8.501.3. This includes but is not limited to determining eligibility and
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enrollment, conducting assessments and re-evaluations, creating Individual
Support Plans (ISP) or an individualized Family Support Plan, providing on-
going case management, maintaining records, and utilizing appropriated
funds to provide or subcontract with providers for allowable services and
supports.
Additionally, an Administrative Clerk will be responsible for overseeing the
fiscal details of the programs, ensuring accurate payments and
documentation, and maintaining utilization and service expenditure records.
The CMA business plan also includes provisions for compliance with best
practices, managing caseload averages, and potential vacancies, with the
goal of continuously providing quality services to its members and their
families. The CMA will also have an Administrator to provide oversight and
support and several cross -trained staff in various positions to assist if
needed.
Overall, the administrative capacity within and outside the WC CMA unit is
robust, extensive, supportive, adaptive, collaborative, and positioned to
deliver consistent and quality contract management for the Department and
our community. For a more in-depth description of WC CMA's overall
administration capacity, see OFFEROR'S RESPONSE 1.c or 2.a.iii.
OFFEROR'S RESPONSE 2.b: Physical Office and Staffing Coverage
Offeror must provide a detailed plan outlining plans for a physical
and publicly accessible office and staffing coverage within each
Defined Service Area for which a response is submitted. This plan
must include but shall not be limited to:
i Adequate staffing through virtual and in -person services
throughout the Defined Service Area in addition to the physical
office space;
ii Providing access to its office for staff, individuals and Members,
service providers, families and others;
iii The ability for case managers to travel, regional coverage and
provide all required Case Management activities for the Defined
Service Area(s).
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As an existing CMA for RFP Defined Service Area 9, WC CMA's physical
presence in the form of an Americans with Disabilities Act (ADA) compliant
and publicly accessible building is established and ready for continued use if
WC CMA is awarded the contract associated with this solicitation. Located at
315 N. 11th Avenue., Building C, in Greeley Colorado, the third (3rd) floor of
this building has offices for employees of the SEP, Adult Protection Unit, and
the Older Americans Act Program. WCDHS has access to three (3) buildings
on the main campus in Greeley, two (2) buildings in downtown Greeley, one
(1) in Fort Lupton, and one (1) in Del Camino. Within the network of county
buildings, there currently exists an abundance of accessible space and
infrastructure for the SEP to grow by as much as one hundred fifty (150)
percent in its transition to a fully integrated Case Management Agency that
serves all programs contained in this solicitation.
For Example, If awarded the contract associated with this solicitation, WC
CMA will keep all Case Management Agency staff together at the main DHS
campus, Building C. To make space for the estimated forty (40) additional
employees necessary to staff the CMA, we may move Adult Protection and
Older Americans Act staff to the Chase Building in downtown Greeley. This
would happen prior to operational start date, and it would allow the entire
case management agency to reside in one centralized space. Due to the
availability of space in multiple locations owned by Weld County, WC CMA
has a high degree of flexibility to accommodate growth and new staff.
In accordance with regulations at 10 CCR 2505-10-8.519.2.A.1, WCDHS,
Building C, is a publicly accessible and ADA compliant physical office in Weld
County. It is open during regular business hours, Monday through Friday. In
addition to existing staff, all new WC CMA staff will have full time dedicated
office spaces on the third (3rd) floor, laptops, phones, monitors, and other
required office equipment necessary to effectively complete the work in this
solicitation. Staff will be in the office, Monday through Friday, during regular
business hours, to complete the work and to conduct in -person meetings
with Members, families, service providers, and other visitors. All visitors
have dedicated parking spaces to ensure ease of access to the building, and
first floor receptionists greet and assist everyone that comes through the
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doors. As needed, first (1St) floor meeting spaces are available for in -person
meetings.
WC CMA is fully staffed to address the case management needs and contact
preferences of LTSS program applicants and Members in all areas of Weld
County. All existing WC CMA staff, and all staff that are hired to fulfill the
contractual obligations associated with this solicitation will have:
A dedicated phone line for making and receiving calls.
A dedicated Outlook email account with secure and encrypted email
capabilities.
A Microsoft Teams account for conducting virtual meetings and
other contacts with Members, family members, providers, etc.
An assigned secure business laptop that supports working in the
office, from home, the residences of Members, and other locations
as required.
All WC CMA staff can provide case management services in -person and
virtually, and this will remain true for all staff hired prior to, during, and
after the operational start date of the contract associated with this
solicitation.
Since 1993, WC CMA has demonstrated its ability and capacity to provide in -
person and virtual case management services to all LTSS Members in Weld
County. Case Managers can travel to provide all required case management
activities throughout Weld County. As part of the hiring process, all
employees must a) be willing to drive, as needed, throughout Weld County
to fulfil contract contact requirements and Member contact preferences, b)
have a Valid Colorado Driver's License, c) liability insurance, d), and provide
their own transportation. WC CMA reimburses employees for all work -related
travel.
Since WC CMA's bid for this contract is limited to our existing service area,
and since WC CMA is a part of, and has access to Weld County resources, we
will have the necessary building space, department, divisions, policies,
procedures, and experience to grow and expand our case management
agency into a fully integrated CMA as defined in this solicitation.
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OFFEROR'S RESPONSE 2.c: Local and Regional Knowledge
Provide details that demonstrate how the Offeror will maintain local
and regional knowledge and expertise throughout the duration of
the contract period if awarded the Contract resulting from this
solicitation.
WC CMA is dedicated to integrating local and regional knowledge into its
daily operations. The agency operates as a separate entity, yet it is a part of
the Weld County AAA division, which is in turn a part of WCDHS. The
tripartite structure (department, divisions, programs) of WCDHS allows for
an approach to maintaining local and regional knowledge that is
multidivisional, comprehensive, collaborative, mutually sustaining and
contributory. This comprehensive approach involves internal and external
activities, meetings, and initiatives.
Maintaining and Facilitating Local Knowledge
To ensure that all key personnel, including Division Heads, Supervisors,
Managers, and Directors, are well-informed and up to date on the latest local
developments, WCDHS will continue to hold internal meetings such as the
DHS Leadership Meeting, DHS Quarterly Management Meeting, and the
Assistance Payments Operational Leadership Meeting.
WCDHS places a strong emphasis on local knowledge and participation
county -wide, and to achieve this, the agency requires all staff members to
participate in professional development by completing a minimum of twenty
(20) hours of training each year. WCDHS also provides a variety of local
networking and training opportunities to keep staff knowledgeable and up to
date.
WCDHS leverages the Community Assessment Survey for Older Adults
(CASOA) to obtain valuable data insights and benchmark comparisons to
understand the needs of older adults in our area.
WC CMA is committed to enhancing its local knowledge base by participating
in resource development efforts, attending meetings with multiple
community agencies, and collaborating with other LTSS agencies serving
Weld County. To further expand local knowledge, the agency will establish a
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Family Support Council and a Human Rights Committee, which will bring
together a diverse group of individuals from the community.
WC CMA is committed to strengthening its relationships with the local CCB,
Envision, and the Regional Accountable Entity (RAE) for the area, Northeast
Health Partners. This will be achieved through the exchange of program and
resource trainings, collaboration to identify areas of potential service
duplication and agency overlap and finding ways to support one another. WC
CMA staff will remain active members of the RAE's Program Improvement
Advisory Committee (PIAC).
The continuous engagement with referral networks both within and outside
of WC CMA contributes to maintaining local knowledge and expertise. As a
division of Weld County AAA, WC CMA is connected to several in-house
referral sources and resources, such as the Adult Protection Unit, Dental,
Vision, and Hearing Program, Family Care Support Program, In -Home
Services Program, ADRC, Long -Term Care Ombudsman Program, and the
Aging Well Program. The management structure of the AAA division, which
has a Division Director serving as the administrator for the SEP contract and
program, further strengthens the connection between the Weld County AAA
and the SEP.
WC CMA is part of an extensive non -governmental network that operates as
a collaborative and adaptive bi-directional information, assistance, and
referral network. The agency sends and receives referrals from a variety of
organizations, including CCBs (such as Envision), CHCBS Case Management
Agencies (such as Access and Ability), neighboring Single Entry Points (such
as Larimer OLTC and ACMI), Regional Accountable Entities (such as
Northeast Health Partners), North Range Behavioral Health, North Colorado
Health Alliance, Connections for Independent Living, low-income and senior
housing providers, transportation providers, senior centers, Colorado Legal
Services, United Way, Catholic Charities, HCBS providers of all types (such
as personal care, adult day centers, and electronic monitoring), home health
agencies, hospice agencies, Meals on Wheels, hospitals (such as UC Health
Greeley), PACE (such as True PACE), skilled nursing facilities (such as Fair
Acres Manor and Life Care Center), and many others.
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WC CMA maintains an internal fifty-one (51) page list of various community
resources and provider agencies, including those in neighboring counties. To
ensure that the information remains current, WC CMA collaborates with
other SEPs to maintain an up-to-date provider list for the area. Additionally,
WC CMA has a comprehensive resource guide called AAA Help Source,
available in English and Spanish. This guide lists Medicaid and non -Medicaid
service providers in Weld County. The guide is updated twice a year for
accuracy and published annually.
Maintaining and Facilitating Regional Knowledge
WC CMA remains committed to participating in regional and state meetings,
including the Aging and Adult SubPAC, CHSDA, and the Case Management
Quarterly Meetings, to network with other organizations and stay informed
of best practices and emerging trends in the field. The agency will continue
to attend professional conferences, such as the National Home and
Community -Based Services Conference, and American Society on Aging
National Conference, and the Annual USAging Conference, to maintain its
presence in the industry.
WCDHS subscribes to various national newsletters and distribution lists, such
as the Administration for Community Living, National Center on Law and
Elder Rights, and the American Society on Aging, to stay informed of the
latest developments in the field. Additionally, WC CMA leadership is actively
involved in the legislative process, offering testimony, and participating in
regularly scheduled Legislative Update meetings to ensure the agency
remains engaged in shaping the future of the field.
WC CMA staff will continue to participate in various local and regional
initiatives to enhance their knowledge and expertise, such as the Adult
Protection Community Team, Weld Senior Networking, Carbon Valley
Networking, Community Action Collaborative, Northern Colorado Quarterly
Community Consultation, Older Americans Act Advisory Board, SEP Advisory
and Resource Development Committee, Program Improvement Advisory
Committee (PIAC) Member, Home Delivered Meals Subcommittee,
Community of Practice Committee, and RAE Program Improvement Advisory
Committee. These efforts aim to foster interagency cooperation, educate the
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community, provide networking opportunities, and increase awareness of
available services.
In conclusion, WC CMA is dedicated to maintaining and enhancing its local
and regional knowledge and expertise. The agency operates within a
comprehensive, collaborative, and mutually sustaining structure that allows
for the integration of local and regional knowledge into its daily operations.
WC CMA is committed to participating in internal and external activities,
meetings, and initiatives to stay informed and engaged. WC CMA is steadfast
in staying informed of the latest developments in the field through its
participation in regional and state meetings, attendance at professional
conferences, and subscription to national newsletters and distribution lists.
With these and other efforts in place, WC CMA is well-equipped to maintain
its local and regional knowledge and expertise throughout the duration of
the contract period associated with this solicitation.
OFFEROR'S RESPONSE 2.d: Experience with Similar Projects
Experience managing projects of similar size and scope to the program
described in this solicitation.
As the SEP for Weld County since 1993, WC CMA has approximately thirty
(30) years of experience managing HCBS and non-HCBS programs that are
also a part of the contract associated with this. solicitation. The SEP contract
with the Department represents the primary project for WC CMA, described
in detail in the next section, Offer's Response 3, and addressed in
OFFEROR'S RESPONSE 1 and sections of Offer's Response 2. For CO LTSS
programs, in 2022, WC CMA completed one thousand eight hundred
seventy-seven (1,877) referrals, one thousand two hundred forty-two
(1,242) intake assessments, had one thousand six hundred forty-nine
(1,649) Members open to LTSS programs and services. Providing non-IDD
case management as described in this solicitation, the existing contract with
the Department, and the draft contract, is the primary source of experience
for WCDHS. This includes intake, screening, referral services, initial
assessments and annual reassessments, support planning, service
monitoring, and other case management activities described in 10 CCR
2505-10-8.393 et seq.
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The administrator of the SEP is also the Division Director of the Weld County
AAA. She has over eighteen (18) years' experience in CO waiver and non -
waiver program case management, ten (10) years of waiver program case
management and supervisor in Arizona, and years of experience managing
multiple programs (e.g., SEP, AAA), administrating multiple contracts,
developing programs, and developing and managing budgets. The WC CMA,
with the support for WCDHS and Weld County AAA, has the experience and
administrative capacity necessary to absorb the additional Member's and
staff required to provide services to all the programs covered in this
solicitation.
OFFEROR'S RESPONSE 3: LTSS Experience
Provide a detailed description of the Offeror's experience within the
last five (5) years providing, arranging for, or otherwise being
responsible for the delivery and coordination of LTSS programs
and/or HCBS waiver or non -waiver programs.
As the existing and historical Department contracted and certified SEP for
Weld County, in accordance with 10 CCR 2505-10-8.393 et seq., the SEP
Contract, Department operational memos, and Department trainings, over
the past five (5) years WC CMA has provided intake, screening and referral,
initial assessment, support planning, monitoring, and ongoing case
management services to people of all ages, disabilities, and income levels on
or applying for CO HCBS waiver and non -waiver programs. The SEP contract
with the Department and the HCA contract with CDHS and their
corresponding LTSS programs is the LTSS project managed by WC CMA, and
it is the project from which our current and historical experience delivering
and coordinating LTSS programs to the public is derived.
OFFEROR'S RESPONSE 3.a: Name and Location of Project
Project Name: Single Entry Point Agency for Weld County
Duration of Project: Since 1993
Contractor: Weld County Department of Human Services
Current Contract A: CDHCP 21-160398
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Current Contract B: CDHS (HCA) IHGAm202300001078
State Agency A: CO Department of Health Care Policy and Financing
State Agency B: CO Department of Human Services (CDHS)
Location: Weld County, Colorado
Main Office: 315 N. 11th Avenue, Building C
Greeley, Colorado 80632
Contract Purpose: The purpose of this Contract is for the Contractor to
serve as a SEP Agency within a local area where a
current or potential long-term care client can obtain
long-term care information, screening, assessment
of need, and referral to appropriate long-term care
program and case management services for all
Coloradoans within their designated Region/District.
OFFEROR'S RESPONSE 3.b: Populations Served
Age Range: All ages; birth to older adults
County Designation: Urban
Income Range:
Medicaid Status:
Less than three times the Supplemental Security
Income allowance per month ($2,742.00 for 2023)
and countable resources less than $2,000.00 for a
single person or $3,000.00 for a couple.
Individuals currently on or applying for Medicaid.
In 2022, WC CMA provided ongoing case management services as defined in
10 CCR 2505-10, Section 8.393 et seq. to one thousand six hundred forty-
nine (1649) LTSS Members on five (5) HCBS waivers (HCBS-BI, HCBS-CIH,
HCBS-CMHS, HCBS-CLLI, HCBS-EBD) and two (2) non -waiver programs
(Home Care Allowance, Long -Term Home Health). Twelve (12) of the one
thousand six hundred forty-nine (1,649) Members were one (1) to eighteen
(18) years of age, eight hundred thirty-one (831) were nineteen (19) to
sixty-four (64) years of age, and eight hundred six (806) were sixty-five
(65) years of age or older. For these same programs, in 2021 WC CMA
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served a total of one thousand five hundred forty-seven (1,547) Members,
one thousand four hundred seventy-seven (1,477) Members in 2020, one
thousand three hundred ninety-eight (1,398) Members in 2019, and one
thousand five hundred seven (1,507) Members in 2018. For simplicity, these
numbers are represented in the following two tables: 2022 Ongoing Counts
by Program and Age and Five (5) Years of Ongoing Counts by Program.
WC CMA 2022 Ongoing Members Served by Program and Age
Program
0 to 18 years
19 to 64 years
65+ years
TOTAL
HCBS BI
0
38
3
41
HCBS CIH
0
3
0
3
HCBS CMHS
0
138
32
170
HCBS CLLI
7
0
0
7
HCBS EBD
3
607
757
1,367
HCA
2
20
9
31
LTHH
0
25
5
30
TOTAL
12
831
806
1,649
WC CMA 5 Year Report of Ongoing Members Served by Program
Program
2022
2021
2020
2019
2018
HCBS BI
41
35
32
29
32
HCBS CIH
3
0
0
0
0
HCBS CMHS
170
143
134
138
128
HCBS CLLI
7
10
7
6
4
HCBS EBD
1,367
1,257
1,203
1,139
1,247
HCA
31
67
71
71
71
LTHH
30
35
30
15
26
TOTAL
1,649
1,547
1,477
1,398
1,507
In the fulfillment of SEP intake, screening and referral functions defined in
10 CCR 2505-10, Section 8.393 et seq, in 2022, WC CMA completed one
thousand eight hundred seventy-seven (1,877) LTSS program referrals. One
thousand three hundred ten (1,310) of those referrals were for HCBS
waivers, three (3) referrals were for HCA, forty-nine (49) were for LTHH,
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four hundred seventeen (417) were for nursing facility placements, and
ninety-eight (98) were for PACE program. In 2021 WC CMA completed a
total of one thousand seven hundred and fifty-seven (1,757) referrals for all
programs under this project / contract, and one thousand seven hundred
forty-nine (1,749) in 2020. The following table is a visual representation of
WC CMA's 2022 referral numbers.
WC CMA 2022 Intake Referral Counts by Program
HCBS
HCA
LTHH
Nursing Home
PACE
2022 Total
1310
3
49
417
98
1,877
The Department's contract associated with this project also includes LTSS
intake assessment functions and requirements as defined in 10 CCR 2505-
10, Section 8.393 et seq. In 2022, WC CMA completed a total of one
thousand eight hundred seventy-seven (1,877) intake assessments, seven
hundred twenty-nine (729) were for HCBS waivers, forty-six (46) were for
LTHH assessments, three hundred seventy-five (375) were nursing facility
assessments, and ninety-two (92) for the PACE program. The following table
is visual representation of these 2022 intake assessments numbers.
WC CMA 2022 Intake Assessment Counts by Program
HCBS
HCA
LTHH
Nursing Home
PACE
2022 Total
729
0
46
375
92
1,242
Individuals accessing HCBS and non-HCBS programs and services managed
by WC CMA present with a wide array of disabilities and functional
impairments. The populations primarily served through WC CMA managed
LTSS programs include, but are not limited to:
o Individuals with brain injuries
o Individuals with major mental illness
o Persons 65 years and older with a functional impairment
o Individuals who are blind
o Physically disabled persons
o Individuals with spinal cord injuries
o Individuals with multiple sclerosis
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o Individuals with spina bifida
o Individuals with muscular dystrophy
o Children with a life -limiting illness
o Individuals with memory and cognitive impairments
OFFEROR'S RESPONSE 3.c: Population Served was Medicaid, Non -
Medicaid, or Both
The HCBS waiver and non -waiver programs served by WC CMA are Medicaid
programs. Individuals without Medicaid are typically limited to new program
applicants, and as such, they can be assessed for any of the above programs
but are required to apply, and eventually be approved for Medicaid. All
existing Members, reflected in the section, Ongoing Members Served by
Program, are Medicaid approved. Some, but not all Members will have
Medicaid and Medicare.
OFFEROR'S RESPONSE 3.d: Primary Services Included in this Project.
In accordance with 10 CCR 2505-10, Section 8.393 et seq, the SEP Contract
for Weld County, Department operational memos and trainings, and other
relevant HCBS waiver and non -waiver program rules, since 1993, and over
the past (5) years, WC CMA has provided the following services, to include
but not be limited to: intake, screening and referral, assessment and
reassessment, support plan development, person -centered planning, service
monitoring, critical incident reporting, ongoing case management, intake
case management, monitoring of individuals' health and welfare,
documentation of contacts and case management activities in the
Department -prescribed IMS, resource development, and case closure.
OFFEROR'S RESPONSE 3.e: Activities in Rural and Frontier Areas, if
Appropriate
Weld County (Service Area 9) has a county designation of "urban" in
reference to this RFP (see RFP Section 1.1.2), and therefore, there are no
unique rural or frontier area activities to report under this project. As the
third (3rd) largest county in Colorado, spanning four thousand (4,000)
square miles in size with towns and cities geographically dispersed across
the area, WC CMA provides the same level of LTSS case management
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services to all residents in Weld County, regardless of location and distance
from our main office. Although not classified as rural, WC CMA does have
over five (5) years' experience a) managing the challenges associated with
finding and setting up HCBS services for Members far removed from more
populated areas, b) working with providers and other community partners
(e.g. RAE, ADRC, AAA) to enhance and support service access in more
remote areas, c) driving long distances to complete home visits, and d)
working with our county communications department to disseminate
information to reach all areas of the county.
OFFEROR'S RESPONSE 3.f: Experience serving people with
disabilities, marginalized populations, low-income individuals and
strategies for increasing access to historically underserved
populations.
Since 1993, WC CMA has provided case management services to all Weld
County residents in need of such services, to include, individuals of all ages,
abilities, marginalized and unmarginalized populations, and low-income
levels who are receiving or applying for HCBS waiver and non -waiver
programs. These services include but are not limited to intake, screening,
referral, initial assessment, support planning, person -centered planning,
service brokering, monitoring, and ongoing case management activities.
WC CMA serves individuals with a wide range of disabilities and functional
challenges, including brain injuries, major mental illness, elderly with
functional impairments, blindness, physical disabilities, spinal cord injuries,
multiple sclerosis, spina bifida, muscular dystrophy, life -limiting illnesses in
children, memory and cognitive impairments, and developmental disabilities.
Over the decades, WCDHS and WC CMA have engaged in a conscious and
sustained effort to increase and promote program and service access to all
populations in Weld County. These efforts have included participation in
resource fairs, disseminating marketing information, using social media and
our website, resource guides, brochures, resource development, and
working with HCBS providers.
The Weld County AAA, a division under the WCDHS that includes the SEP
program/contract, participates in local resource fairs, such as the Project
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Connect and the Weld Senior Symposium. The fairs allow opportunities to
network with other providers and meet individuals in the community who are
seeking information and resources about services. For many, these resource
fairs are doorways to LTSS programs by way of the on -the -spot referrals.
Weld County AAA creates and distributes external marketing materials and
uses its website and social media platforms (such as Facebook, Instagram,
and Twitter) to communicate with the community. In order to provide
information on both our internal programs and external resources for older
adults with disabilities, family caregivers, and community members, Weld
AAA has established a guide called the HelpSource. This guide is available
online and in hard copy, in both English and Spanish. Additionally, there are
informational brochures for programs which include a guide to long-term
care services in English and Spanish. Through the relationship with the local
newspaper, Weld County AAA contributes to its "Beyond 60 Active Living"
section. Additionally, twenty-three (23) meal sites operating across the
county, many in rural/low-income areas, serve meals while providing
programming to inform participants of services offered through WCDHS.
Weld County AAA recognizes the importance of ensuring that marginalized
communities and those residing in remote areas have access to essential
social services and support systems. To this end, partnerships have been
formed with Catholic Charities and North Range Behavioral Health to conduct
community outreach and provide Peer Counseling services, including
bilingual services.
Weld County AAA is closely aligned with Sunrise Community Health, a
dedicated healthcare organization committed to promoting health equity and
serving marginalized populations. Our location across the street from the
Adelante Clinic allows us to easily connect our members to the high -quality
medical, dental, and mental health services they need. Additionally, our
collaboration with Lutheran Family Services Rocky Mountains, a non-profit
human services agency, enhances our ability to provide a wide range of
support, including adoption, foster care, older adult caregiver, and refugee
services.
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Weld County AAA is equipped to serve a diverse community, including those
who do not speak English as their primary language. Our multilingual
capacity and commitment to accommodating communication challenges
allow us to effectively assess individual needs and connect members to the
appropriate resources. Although our programs are available to all members
who qualify, we strive to meet the unique needs of our community. For
example, in response to feedback from our Spanish-speaking residents, we
now offer Spanish -language resources and events, such as a wellness class
(Tomando Control de su Salud) and a senior nutrition meal site at the
Rodarte Community Center. We host community feedback sessions, and we
aim to ensure thorough representation by holding them throughout the
county, virtually and in Spanish.
Weld County AAA is dedicated to promoting equity in the provision of
services and continuously seeking innovative ways to serve and reach
populations of all types, to include the marginalized and underserved. Our
commitment to this goal drives us forward as we strive to make a positive
impact in our community.
Additional efforts to increase access include WC CMA's bi-annual resource
development meetings with partnering agencies in the community to identify
service barriers, gaps, and solutions. The WC CMA team regularly conducts
HCBS program and service training sessions for healthcare facilities
(hospitals, nursing facilities), community providers, other county
departments and divisions, and other organizations. The WC CMA team also
invites HCBS service providers to attend monthly staff meetings to discuss
their services, the referral process, and answer any questions from case
managers.
Lastly, Weld County has offices in multiple areas throughout the county that
allow for easy access to information and services offered by WCDHS, Weld
AAA, and WC CMA.
OFFEROR'S RESPONSE 3.g.: Any Corrective Action Plans/plan of
correction relating to contract non-compliance and/or deficient
contract performance to include but not limited to:
I Breach of Contract
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In the past five (5) years, WC CMA has had no instances of breaching any
contract(s), to include the County Department of Human Services (CDHS)
contract for HCA and the Department SEP contract. In accordance with SEP
Certification requirements at 10 CCR 2505-10, Section 8.392.4, WC CMA has
been recertified annually by the Department to provide LTSS case
management services in Weld County for thirty (30) years.
ii. Timely follow-up of Critical Incident Reporting (CIR)
The Department contract standard for critical incident timely follow-up
compliance is ninety (90) percent. Since Fiscal Year (FY) 2019, WC CMA has
had five (5) years of meeting the performance standard for CIRS entered on
time, and a corresponding four (4) years of underperformance in most
quarters for not completing CIR Follow Up activities on time. From FY19 to
FY23, there was a fifty-two (52) percent increase in compliance with follow
up activities. In the second (2nd) quarter of FY23, ninety-seven (97) percent
of cases' follow up activities were completed on time. Since the advent of a
CIRS quarterly paid for performance system, WC CMA has missed the
performance threshold two (2) times, and therefore was denied payment
associated with sufficient performance in CIR timely activities.
In response to underperformance issues in CIR follow-up activities, CIRS
training and retraining occur at least once per year, and all CIRS are
reviewed by the supervisory team. Follow-up activities are monitored, and if
needed, reminders are sent to case managers. These efforts account for the
increase in performance from FY19 to FY23. In FY22, based on a Department
review of one hundred forty (140) Critical Incidents in the fourth (4th)
quarter, WC CMA scored ninety-eight (98) percent compliance with on time
notification entry, and one hundred (100) percent in on time follow up
responses.
CIRS Enter and Follow Up Performance Review Results by FY
Description
FY19
FY20
FY21
FY22
FY23
Number of CIRS Reviewed
150
350
340
562
121
CIR Notification Entered On Time
90%
90%
93%
98%
94%
CIR Follow Up Activities On Time
42%
38%
43%
88%
94%
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iii. Program and Quality Review (PQR) findings;
In the past five (5) years, WCDHS has not been subject to any Program and
Quality Reviews as defined by the Department.
iv. Financial Compliance Reviews (FCR) findings;
An FY18, Financial Compliance Review conducted by the Department
contracted account firm, Colorado Independent Consultants Network, LLC,
had one finding:
Issue: The Agency's Schedule of Expenditures of Federal Awards
(SEFA) is overstated by $670.00. The amount of Federal
expenditures totaled $849,323.00, while the SEFA reported
$849,993.00. Total expenditures of federal awards (up to the
amount of the Federal award received) are required to be reported
on the SEFA as part of the organization's audited financial
statements.
Management Response: "We agree. I inadvertently pulled data too
early from one source prior to it being finalized. I hadn't noticed the
amount changed in time to correct it before publication. I will
compare each of the potential sources of information in order to
ensure that they agree or, at least, are reconciled to one another,
before completing the schedule."
v. Financial Post Payment Reviews (PPR);
In the past five (5) years, WC CMA has no findings related to PPRs.
vi. Management Decision Letters (MDL);
In the past five (5) years, WC CMA has had no instances of receiving
Management Decision Letters (MDLs), to include MDLS related to the County
Department of Human Services (CDHS) contract for HCA and the
Department SEP contract. In accordance with SEP Certification requirements
at 10 CCR 2505-10, Section 8.392.4, WC CMA has been recertified annually
by the Department to provide LTSS case management services in Weld
County for over twenty (20) years.
vii. Single Audit findings;
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In the past five (5) years, WC CMA did not have any Single Audit findings.
viii. Other applicable finding of non-compliance from other
state and federal agencies
To ensure state and federal compliance with HCBS waiver performance
measures the Department conducts annual Quality Improvement Strategy
(QIS) reviews. Results for each year consist of a published report of
deficiencies and the SEP's corrective actions measures.
See Attachment C FY18 - FY22 HCPF QIS Results and Corrective Actions for
Weld County SEP for FY18, FY19, FY20, FY21, and FY22 QIS findings and the
corresponding corrective actions. For a snapshot view see the table below.
QIS Deficiencies Numbers by Fiscal Year
FY18
FY19
FY20
FY21
FY22
10
9
10
9
2
OFFEROR'S RESPONSE 3.h.: Adverse contract actions and/or project -
associated litigation (including terminations and/or cancellations) in
which the Offeror was (or is) involved;
In the past five (5) years, WC CMA has not been involved in any adverse
contract actions and/or project -associated litigation (including terminations
and/or cancellations).
OFFEROR'S RESPONSE 3.i.: A Project Contract Manager name with
contact information
Project Contact Manager:
Contact Information:
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Kelly Morrison, Director
Area Agency on Aging
Weld County Department of Human Services
315 N 11th Avenue, Building C
Greeley, Colorado 80631
Phone: 970-400-6786
Fax: 970-400-6951
Email: kmorrison(alweldgov.com
OFFEROR'S RESPONSE 3.j.: A Transition Coordinator name with
contact information
Transition Coordinator: Kelly Morrison, Director
Area Agency on Aging
Contact Information:
Weld County Department of Human Services
315 N 11th Avenue, Building C
Greeley, Colorado 80631
Phone: 970-400-6786
Fax: 970-400-6951
Email: kmorrison(alweldgov.com
OFFEROR'S RESPONSE 4: Sufficient Personnel
Provide a detailed explanation of how the Offeror will provide
sufficient personnel to perform the Work, including all of the
following:
OFFEROR'S RESPONSE 4.a: Internal Organization Structure
Description of the internal organizational structure, including a
delineated management structure to include but not limited to:
i. Clearly define lines of responsibility, authority,
communication, and coordination within and between
various components and Departments of the organization.
The proposed organizational structure of WC CMA includes several positions
with defined lines of responsibility, authority, communication, and
coordination within and between various components and departments of
the organization. The structure is designed to facilitate efficient and effective
communication, relationships building, opportunities for innovation through
collaboration and team interaction, manageable workloads, and a decrease
in task complexity by way of partitioning functions and tasks into a variety of
positions.
At the top of the structure is the Human Services Director, who reports to
the County of Weld's Board of County Commissioners and provides
leadership, guidance, and support to the Area Agency on Aging Division,
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including the CMA. The Human Services Deputy Director reports to the
Human Services Director and provides support to the Area Agency on Aging
Division and CMA, including communication with the Board of County
Commissioners and collaboration with other county departments.
The CMA Administrator is a key personnel position and reports to the
Department of Human Services Deputy Director. They directly supervise the
CMA along with other Area Agency on Aging division programs, serve as the
CMA Administrator, Contract Lead, Finance Director, and IT Liaison, and
communicate with several personnel, including the Human Services Director
and CMA Case Management Director.
The Case Management Director reports to the CMA Administrator and
directly supervises the HCBS-DD, HCBS-SLS, OBRA-SS, State- SLS, and
FSSP waiver programs within the Case Management Agency (CMA). They
provide leadership, guidance, and support to staff ensuring a high level of
performance and compliance with County, State, and Federal rules and
regulations.
The CMA Agency Manager reports to the CMA Director and directly
supervises the CMA unit supervisors, providing oversight, monitoring, and
direct support of work being completed by staff in the CMA Waiver and SFG
Programs to ensure a high level of employee performance and compliance
with County, State, and Federal rules and regulations.
The Case Management Supervisor is a key personnel position and reports to
the CMA Manager, CMA Administrator, and CMA Director. They directly
supervise the CMA unit staff, provide leadership, guidance, and support to
staff ensuring a high level of performance and compliance with County,
State, and Federal rules and regulations, and address employee concerns.
Other positions in the organizational structure include the Program
Specialist, Case Manager, Utilization Review Nurse, Case Aide, and
Administrative Fiscal Assistant. These positions report to different direct
reports and communicate with other personnel as required by their
responsibilities.
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There are also several Weld County DHS divisions that have a supportive
relationship with CMA. These divisions include Contract Management and
Compliance, Fiscal, and Human Resources, with each providing assistance,
oversight, and recommendations to the department for all division -related
fiscal matters, including individual division and program budgets, hiring,
disciplinary, or termination of employment practices, and contract
management, review, and approval with the Board of County
Commissioners.
Overall, the organizational structure of WC CMA is designed to ensure
effective communication, collaboration, and compliance with local, state, and
federal regulations. Each position has defined lines of responsibility and
authority, and communication and coordination among different components
and departments that are essential to ensure the smooth functioning of the
organization.
CMA Organization Structure: Details and Visual Aid
Position Title
CMA Position - Primary
CMA Position - Secondary
CMA Personnel Classification
Number of Positions
Reports To
CMA Direct Reports
Non-CMA Direct Reports
Time Dedicated to CMA
Communicates With
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Human Services Director
Not Applicable
Not Applicable
Non -Applicable
One (1)
County of Weld, Board of County
Commissioners
None
DHS Deputy Director, Assistance
Payments Division Director, Child Support
Division Director, Child Welfare Division
Director, Family Resource Division
Director, Senior Fiscal Advisor
Three (3) Percent
Board of County Commissioners, Human
Services Deputy Director, County
Department Heads, CMA Administrator,
Case Management Director, DHS Division
Director(s)/Deputies, and other non-CMA
personnel.
CMA Responsibilities
Provide leadership, guidance, and support to Area Agency on Aging Division,
including the CMA, to ensure overall performance and compliance across
local, state, and federal regulations. Facilitate communication with the Board
of County Commissioners. Ensure collaboration and communication with
other county departments, including Legal, IT and Human Resources and our
internal divisions (such as Fiscal and Contracts).
Position Title Human Services Deputy Director
CMA Position - Primary Not Applicable
CMA Position - Secondary Not Applicable
CMA Personnel Classification Non -Applicable
Number of Positions One (1)
Reports To Human Services Director
CMA Direct Reports Area Agency on Aging Division Director /
CMA Administrator
Non-CMA Direct Reports
Employment Services Division Director,
Fiscal Division Director, Organizational
Integrity Division Director, Administration
and Support Division Manager, Strategic
Plan Division Coordinator
Time Dedicated to CMA Five (5) percent.
Communicates With
Human Services Director, BOCC, County
Department Heads, CMA Administrator,
Case Management Director, DHS Division
Director(s)/Deputies, and other non-CMA
personnel.
CMA Responsibilities
Provide leadership, guidance and support to Area Agency on Aging Division,
including the CMA, to ensure overall performance and compliance across
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local, state, and federal regulations. Facilitate communication with the Board
of County Commissioners. Ensure collaboration and communication with
other county departments, including Legal, IT and Human Resources and our
internal divisions (such as Fiscal and Contracts).
Position Title Area Agency on Aging Division Director
CMA Assignment - Primary Administrator
CMA Assignment — Secondary Contract Lead
Finance Director
CMA Personnel Classification
Number of Positions
Reports To
Information Technology Liaison
Key Personnel
One (1)
Department of Human Services Deputy
Director
CMA Direct Reports Deputy Division Director / CMA Case
Management Director
Non-CMA Direct Reports
Time Dedicated to CMA
Communicates With
CMA Responsibilities
Four (4) Waiver Supervisors
Administrative Fiscal Assistant
Older Americans Act Manager
Senior Nutrition Program Supervisor
Regional Ombudsman
Forty (40) Percent
Human Services Director/Deputy, Deputy
Division Director/CMA Case Management
Director, CMA Supervisors, CMA Manager,
Utilization Review Nurse, CMA Case
Managers, CMA Case Aides, CMA
Administrative Fiscal Clerk, Department
and Division Leadership, other non-CMA
personnel.
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Directly supervise the Case Management Agency (CMA) along with other
Area Agency on Aging (AAA) division programs. Serve as the CMA
Administrator, Contract Lead, Finance Director, and IT Liaison. Provide
leadership, guidance, and support to staff ensuring a high level of
performance and compliance with County, State, and Federal rules and
regulations. Responsible for serving as the Contractor's primary point of
contact for deliverables and contract -related questions or issues for the
Department. Back-up for the Case Management Director and AAA Deputy
Division Director. Available to the Department outside of normal business
hours with prior notice from the Department. Attend regularly scheduled
meetings with the Department and external stakeholders. Authority to
represent CMA regarding work planning, problem resolution, and program
development. Ensure the completion of all work, including Deliverables in
accordance with the Contract's requirements, ensuring the accuracy,
timeliness, and completeness of the work. Address employee concerns and
resolve problems in collaboration with Department Administration and
County Human Resources. Assist in developing educational and professional
development opportunities for staff. Monitor and evaluate workflow within
the Division using knowledge of business functions, and program
requirements. Establish and enforce standards for the quality and quantity of
work for staff in the AAA Division, to include the CMA. Monitor community
input, complaints, and any escalations to ensure responsiveness and
implement corrective measures if warranted. Perform regular reviews to
determine division accuracy and compliance with established standards.
Monitor and evaluate units for effectiveness, determining problems and the
appropriate corrective action(s) to maximize the efficiency of staff and
systems and ensure compliance with County and Department policies.
Collaborate with partner agencies such as the Community Centered Board
(CCB) and the Regional Accountable Entity (RAE).
Position Title Area Agency on Aging Deputy Division
Director
CMA Assignment - Primary Case Management Director
CMA Assignment - Secondary None
CMA Personnel Classification Key Personnel
Number of Positions One (1)
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Reports To
CMA Direct Reports
Non-CMA Direct Reports
Time Dedicated to CMA
Communicates With
Area Agency on Aging Division Director /
CMA Administrator
One (1) Waiver Manager
Two (2) Waiver Supervisors
Adult Protection Supervisor
Long Term Care Eligibility Supervisor
Twenty-five (25) percent.
CMA Administrator, AAA Division Director,
Human Services Director/Deputy, Deputy
Division Director/CMA Case Management
Director, CMA Supervisors, CMA Manager,
CMA Case Managers, Utilization Review
Nurse, CMA Case Aides, CMA
Administrative Fiscal Clerk, Department
and Division Leadership, other non-CMA
personnel.
CMA Responsibilities
Directly supervise the HCBS-DD, HCBS-SLS, OBRA-SS, State-SLS, and FSSP
programs within the Case Management Agency (CMA) along with other Area
Agency on Aging (AAA) division programs. Serve as the Case Manager
Director for the CMA. Provide leadership, guidance, and support to staff
ensuring a high level of performance and compliance with County, State, and
Federal rules and regulations. Responsible for serving as a secondary point
of contact for deliverables and contract -related questions or issues for the
Department. Assist with ensuring the completion of all work, including
Deliverables in accordance with the Contract's requirements, ensuring the
accuracy, timeliness, and completeness of the work. Back-up for the Case
Management Agency Administrator, Contract Lead, Finance Director, and AAA
Division Director. Available to the Department outside of normal business
hours with prior notice from the Department. Attend regularly scheduled
meetings with the Department and external stakeholders. Collaborate with
partner agencies such as the Community Centered Board (CCB) and the
Regional Accountable Entity (RAE). Authority to represent CMA regarding
work planning, problem resolution, and program development. Coordinate
and oversee community meetings and boards, including the Human Rights
Committee (HRC) and Family Support Council (FSC). Review preliminary
investigation results to ensure accurate and thorough investigations were
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completed, preventative strategies were implemented, request follow-up
action, and ensure completed investigations are ready to be reviewed by the
HRC. Monitor community input, complaints, and any escalations to ensure
responsiveness and implement corrective measures if warranted. Serve as
the Medical Assistance (MA) Site Eligibility Liaison to ensure collaboration
and coordination between LTC Financial unit and CMA Case Managers.
Address employee concerns and resolve problems in collaboration with
Department Administration and County Human Resources. Assist in
developing educational and professional development opportunities for staff.
Monitor and evaluate workflow within the Division using knowledge of
business functions, and program requirements.
Position Title
CMA Assignment - Primary
CMA Assignment - Secondary
CMA Personnel Classification
Number of Positions
Reports To
CMA Direct Reports
Non-CMA Direct Reports
Time Dedicated to CMA
Communicates With
Case Management Agency Manager
Case Management Agency Manager
None
Other Personnel
One (1)
Area Agency on Aging Deputy Division
Director / CMA Director
CMA Supervisors
None
One Hundred (100) Percent
CMA Administrator/AAA Division Director,
Deputy Division Director/CMA Case
Management Director, CMA Supervisors,
CMA Case Managers, Utilization Review
Nurse, CMA Case Aides, CMA
Administrative Fiscal Clerk, and other
non-CMA personnel.
CMA Responsibilities
Directly supervise the CMA unit supervisors. Provide oversight, monitoring,
and direct support of Work being completed by staff in the CMA Waiver and
SFG Programs to ensure a high level of employee performance and
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compliance with County, State, and Federal rules and regulations.
Participates in development and maintenance of department policies and
procedures. Collect and track qualitative and quantitative data to ensure
internal and community initiatives meet intended outcomes. Assists with
creation of CMA reports, presentations, and other communications. Take part
in community meetings, Outreach events and boards. Support the AAA
Director and Deputy Director in meeting contractual requirements for CMA
contract. Work closely with the CMA Leadership team on initiatives directly
related to program efficiency and administration. Provide technical expertise
to staff, leadership, and community partners. Provide education and training
to community partners, Department and County partners and other
stakeholders on CMA programs and resources. Maintain all standards related
to member confidentiality and HIPAA regulations.
Position Title
CMA Assignment - Primary
CMA Assignment - Secondary
CMA Personnel Classification
Number of Positions
Reports To
CMA Direct Reports
Non-CMA Direct Reports
Time Dedicated to CMA
Communicates With
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Case Management Supervisor
Case Management Supervisor
Continuous Quality Improvement (CQI)
Temporary Lead
Regional Accountable Entity (RAE)
Temporary Liaison
MA Site / County Eligibility Liaison
Member and Family Liaison
Key Personnel (due to Secondary
Assignments)
Six (6)
CMA Manager, CMA Administrator, CMA
Director
Case Managers, Program Specialist, Case
Aides, Utilization Review Nurse
None
One Hundred (100) Percent
CMA Administrator/AAA Division Director,
Deputy Division Director/CMA Case
Management Director, CMA Manager,
CMA Program Specialist, CMA Case
Managers, Utilization Review Nurse
CMA Case Aides, CMA Administrative
Fiscal Clerk, other non-CMA personnel
CMA Responsibilities
Directly supervises the CMA unit staff. Provide leadership, guidance and
support to staff ensuring a high level of performance and compliance with
County, State and Federal rules and regulations. Address employee concerns
and resolve problems in collaboration with Department Personnel and County
Human Resources. Assist in developing educational and professional
development opportunities for staff. Monitor and evaluate workflow using
knowledge of business functions, program requirements and economic
conditions to establish unit goals and timetables. Assign and schedule work
within the unit using assigned employee's performance and level of skill to
assure coverage and efficiency in caseload handling while accomplishing
program goals accurately and timely. Use tracking data to identify trends in
member volume and the need for making changes in work assignments to
adjust accordingly. Conduct individual and group conferences to set and
monitor deadlines. Establish and enforce standards for quality and quantity
of work performed by workers in the CMA unit using professional standards
set primarily through state rules, statutes, and manual regulation. Remain
knowledgeable of waiver requirements and train staff as needed. Authorize
services over cost containment within defined limits. Develop systematic
methods to monitor work to ensure compliance. Maintain quality assurance
levels for all CMA Programs through case audits, member satisfaction
surveys and case consultations to ensure all program and contract
requirements are met. Manage all the components of the Home and
Community Based Services Waiver Programs, the Nursing Facility placement
process, the State only long-term care programs, State General Fund
programs and the Private Case Management functions of the CMA. This
includes referring cases to certified investigators or Human Rights
Committee, approving consumer moves for individuals receiving HCBS-DD
Services, approving respite unit increase documentation for individuals
receiving SLS/CES services. Review incident reports and complaints and
work to resolve. Communicate effectively and work in conjunction with local,
state, and federal entities to ensure member access to services. Collaborate
with Program Approved Service Agencies through regularly scheduled
meetings. Serve as an advocate for members, families, and/or providers
during conflict situations and assist with problem solving the best solutions
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to meet members' needs. Assist with the coordination of the Community
Advisory Committee, Human Rights Committee, Family Support Council and
conducts regular meetings as required. Participate in the budgeting process,
demonstrating a clear understanding of the funding mechanisms of the CMA.
Act as the lead for Continuous Quality Improvement (CQI) and liaison for the
RAE and IT departments. Maintain an accurate member reporting system
and submit timely reports as required by contract and regulations and
internal monitoring requirements. Maintain all standards related to member
confidentiality and HIPAA regulations.
Position Title
CMA Assignment - Primary
CMA Assignment - Secondary
CMA Personnel Classification
Number of Positions
Reports To
CMA Direct Reports
Non-CMA Direct Reports
Time Dedicated to CMA
Communicates with
Program Specialist (Lead)
Program Specialist (Lead)
None
Other Personnel
Four (4)
Case Manager Supervisors
None
None
One Hundred (100) Percent
CMA Manager, CMA Supervisors, CMA
Case Managers, CMA Case Aides,
Utilization Review Nurse, CMA
Administrative Fiscal Clerk, and other
non-CMA personnel.
CMA Responsibilities
Acts as a resource or expert in CMA program areas providing technical
assistance, clarification, and support to other employees in the unit on
program policies and procedures. Troubleshoot with staff and provide
direction on resolution for complicated cases. Assist case managers when
intake referrals are high or there are uncovered caseloads. May carry a
caseload of complex, confidential and/or sensitive cases as assigned.
Coordinate training program for new employees working in conjunction with
the other Program Specialists. Maintain and update all training tools,
manuals, and presentations as needed as CMA rules and guidelines are
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added, changed, or updated by the Department. Work with supervisors to
develop internal policies and procedures for the CMA team. Develop
refresher training materials for existing staff members within the CMA based
upon identified needs. Facilitate the training program for new employees in
conjunction with the other Specialists. Conduct training to optimize
employee learning and development using the most effective instructional
methods. Document training outcomes on new employees and provide
feedback to the supervisor identifying areas for improvement and tracking
trends resulting in additional training needs. Provide and document ongoing,
refresher trainings to staff. Assist supervisors with coordinating and tracking
attendance at required Department trainings. Provide training to other
divisions and with community partners as needed. Complete case reviews of
new case managers to ensure program compliance. Complete routine in-
depth case reviews of ongoing cases to ensure program compliance by
reviewing content and system data entry to determine if accurate, timely
case processing occurred based on program regulation and requirements.
Document case review findings for review by supervisors and provide timely
and accurate case review feedback to the appropriate staff. Maintain the
provider resource lists utilized by case managers and provided to members.
Maintain all standards related to member confidentiality and HIPAA
regulations.
Position Title
CMA Assignment - Primary
CMA Assignment - Secondary
CMA Personnel Classification
Number of Positions
Reports To
CMA Direct Reports
Non-CMA Direct Reports
Time Dedicated to CMA
Communicates with
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Case Manager
Case Manager
None
Other Personnel
Forty -Seven (47)
Case Manager Supervisors
None
None
One Hundred (100) Percent
CMA Manager, CMA Supervisors, CMA
Case Managers, Utilization Review Nurse,
CMA Case Aides, CMA Administrative
Fiscal Clerk, other non-CMA personnel
CMA Responsibilities
Manage and understand all the components of the Home and Community
Based Services Waiver Programs (HCBS), Programs of All -Inclusive Care for
the Elderly (PACE), the Nursing Facility placement process and State General
Fund programs administered by the CMA. Complete initial level of care
screening, Intellectual and Developmental Disabilities (IDD) and Delay
determination of referred members to determine potential eligibility for CMA
programs and/or referral to appropriate community services. Complete
comprehensive functional needs assessments according to program
regulations and mandatory time frames to determine eligibility for CMA
programs. Participate in the appeal hearing process for denials of eligibility
or services. Develop and implement a written person -centered plan of care
which identifies specific services to meet each member's care needs as well
as individual goals for those services and adjust as needed. Authorize all
long-term home health services as well as non -skilled waiver program
services ensuring appropriateness and necessity of services according to
program regulations while conforming to State cost containment guidelines.
Apply case management principles to manage a diverse caseload of eligible
members as required by regulations. Maintain ongoing contact with
members, via home visits and phone calls. Maintain communication with
service providers as required by regulations to provide support and ensure
services are implemented as planned and remain appropriate and necessary.
Adjust services as necessary to continue to meet member needs. Provide
support and advocacy to members, families and providers during conflict
situations and assist with problem solving to identify the best solutions to
meet members' long term care needs, including potential, future needs that
may arise. Accurately establish and maintain member physical and digital
files in accordance with CMA contract and program regulations including
maintaining all standards related to the case management prescribed
computer system. Maintain all standards related to member confidentiality
and HIPAA regulations.
Position Title Utilization Review Nurse
CMA Assignment - Primary Utilization Review Nurse
CMA Assignment - Secondary None
CMA Personnel Classification Other Personnel
Number of Positions One (1)
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Reports To Case Manager Supervisors
CMA Direct Reports None
Non-CMA Direct Reports None
Time Dedicated to CMA One Hundred (100) Percent
Communicates with: CMA Manager, CMA Supervisors, CMA
Case Managers, CMA Case Aides, and
other non-CMA personnel
CMA Responsibilities
Complete comprehensive face to face functional assessments with members
in their home as is mandated by need and regulations to determine eligibility
for long-term home health services. Review prior authorization requests
(PARS) and home health care plans submitted by home health agencies for
appropriateness of skilled care to be provided to Medicaid members. Consult
with home health agency staff, physicians, and other medical professionals,
and/or members and families to aid in determination of appropriateness of
services and medical necessity. Refer members to appropriate community
resources to assist in meeting member needs. Make all home health service
denials in cases where services do not meet the medical necessity and/or
level of care criteria under program requirements and participate in appeal
hearings. Assist case management staff in the determination of
appropriateness of long-term care services and medical necessity as needed.
Accurately establish and maintain member physical and digital files in
accordance with CMA contract and program regulations including maintaining
all standards related to the State prescribed computer system. Maintain all
standards related to member confidentiality and HIPAA regulations.
Position Title Case Aide
CMA Assignment - Primary Case Aide
CMA Assignment - Secondary None
CMA Personnel Classification Other Personnel
Number of Positions Five (5)
Reports To Case Manager Supervisors
CMA Direct Reports None
Non-CMA Direct Reports None
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Time Dedicated to CMA One Hundred (100) Percent
Communicates with
CMA Manager, CMA Supervisors, CMA
Case Managers, Utilization Review Nurse,
CMA Administrative Fiscal Clerk, other
non-CMA personnel.
CMA Responsibilities
Act as a member of the AAA phone team, answer incoming calls to the
division, and efficiently and accurately identify caller needs. Direct callers to
the proper department employee in a customer focused manner. Understand
CMA rules and regulations and provide information to customers requiring
information related to program qualification, documentation, and process
over the phone. Ask questions to discern all relevant facts and gather as
much information as possible to prepare customer file. Accept referrals of
potential customers by phone, in -person, or other forms of communication.
Create member files for all verified and certified customers. Use
computerized tracking system to follow-up with Medicaid technician if
financial information has not been received. Document all member contact,
information requests, and follow-up activity in appropriate database. Perform
a variety of basic clerical duties that include data entry, imaging, mail
distribution and copying. Assemble and distribute informational packets,
forms, and medical information requests. Document all activity and follow-up
to ensure receipt of information. Complete monthly verification of service for
all members. Track activity and verification and refer any nonuse to
appropriate Case Manager. Update provider lists with current information.
Act as a liaison between members, CMA, Aging and Disability Resources for
Colorado, Medicaid Eligibility, Adult Protective Services, and community
partners regarding Medicaid Long Term Care programs. Assist the CMA Case
Managers in resolving eligibility issues and using reports that may be helpful
in continuity of care across programs. Develop a comprehensive system that
tracks all members who are being assisted by this program for financial
eligibility. Maintain all standards related to member confidentiality and HIPAA
regulations.
Position Title Administrative Fiscal Assistant
CMA Assignment - Primary Administrative Fiscal Assistant
CMA Assignment - Secondary None
CMA Personnel Classification Other Personnel
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Number of Positions
Reports To
One (1)
Reports to AAA Division Director/CMA
Administrator
CMA Direct Reports None
Non-CMA Direct Reports None
Time Dedicated to CMA One Hundred (100) Percent
Communicates With CMA Administrator/AAA Division Director,
Deputy Division Director/CMA Case
Management Director, CMA Manager,
CMA Supervisors, CMA Program
Specialist, CMA Case Managers,
Utilization Review Nurse, CMA Case
Aides, CMA Administrative Fiscal Clerk,
other non-CMA personnel.
CMA Responsibilities
Facilitate and serve as unit liaison for members and providers requiring
assistance with receipts and invoice submissions. Maintain tracking logs for
all services and payments being authorized for Waiver and State General
Fund members. Receive invoices, perform quality checks, and prepare
documents to send to the Fiscal department for payment. Develop tracking
logs for members and families and provide training on program
requirements. Assist with tasks related to rates -based reimbursement and
targeted -case management and payment reconciliation. Assist with
coordination of all boards and committees required by the CMA contract such
as room reservations, prepare agendas, and distribute minutes. Participate
as a team member of the division establishing and maintaining a high
degree of cooperation with coworkers. Display a willingness to collaborate
and problem solve. Aid co-workers when needed. Maintain all standards
related to member confidentiality and HIPAA regulations.
WCDHS Division: Contract Management and Compliance
Relationship to CMA: Supportive
CMA Primary Contact: AAA Division Director/CMA Administrator
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CMA Secondary Contact: AAA Deputy Division Director/Case
Management Director
CMA Responsibilities
Assist with contract management. Ensure effective communication and
consistent processes among divisions. Coordinate contract review and
approval with our Board of County Commissioners. Foster communication
and information sharing among divisions. Prevent duplication of services.
Internal liaison with our county central purchasing office.
WCDHS Division: Fiscal
Relationship to CMA: Supportive
CMA Primary Contact: AAA Division Director/CMA Administrator
CMA Secondary Contact: AAA Deputy Division Director/Case
Management Director
CMA Responsibilities
Provide oversight, assistance, and recommendations to the department for
all division related fiscal matters, including individual division and program
budgets.
WC Department:
Relationship to CMA:
CMA Primary Contact:
CMA Secondary Contact:
Decisional Authority:
CMA Responsibilities
Assist Weld County departments, including the CMA, with all hiring,
disciplinary, or termination of employment practices. Oversee policies and
rules affecting employment, assist employees with any employment
questions, establish job classifications, and compensation plans. Responsible
for orientation of new employees and establishing and implementing county-
wide training programs.
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Human Resources
Supportive
AAA Division Director/CMA Administrator
AAA Deputy Division Director/Case
Management Director
Hire, Terminate, Disciplinary
OFFEROR's RESPONSE 4.a.ii: Describe how the organizational
structure facilitates creative thinking and innovative solutions.
WCDHS has a core set of department values that we strive to incorporate
into every facet of our work: Communication, Innovation, Integrity,
Accountability and Service. The Weld County AAA has operationalized these
values and they are a consistent standard among all our programs (e.g.,
Older Americans Act, CMA). We encourage the ongoing exchange of
information and ideas, ensuring effective collaboration to achieve optimal
outcomes. We support an environment of creative solutions with a
commitment to continuous improvement. It is our expectation that we all
demonstrate authentic, ethical actions in all circumstances. Every member of
our team is responsible for taking ownership of decisions and actions. And
our goal is to provide timely and dedicated assistance in a genuine and
effective manner.
Our organizational structure is set up to support our staff so that we can
serve our community in the most efficient and effective way. It is designed
to ensure we can address the needs of all the individuals within the
population we serve. We hire qualified staff, invest in staff development, and
provide the support needed so that our organization is successful in
achieving our goals and serving our members.
We have a team approach to the work we do and believe in leadership at all
levels. We encourage open and respectful communication and sharing of
ideas. Within our organization, staff meet regularly with their direct
supervisors, including upper -level management. We meet as smaller units
and as a larger team and as a division. We ensure our organization's
supervisors and administrators are accessible to all staff. We strive to hire
diverse staff with the proper education and experience to perform their
assigned job duties and then invest in their development. We cross train
staff so that we can increase knowledge of existing services and foster
understanding and appreciation for the duties and responsibilities of others.
We are committed to succession planning, so that we are preparing and
developing staff to grow within our programs. Our organizational structure
includes enough people to accomplish our goals and still affords us the
opportunity to be familiar with each other, allowing us to work together and
support each other. Our emphasis on collaboration and inclusivity
encourages creativity and out of the box thinking, working with internal and
external community partners, and involving the individuals we serve along
with any supports they wish to include.
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Critical Key Personnel in the CMA are staffed by the Weld AAA Division
Director and Deputy Division Director. This will foster a culture of innovation
and creativity in the agency, as these individuals bring their collective
expertise from multiple programs to every encounter. They will provide a
unique perspective to every situation, and their contributions will enrich each
program and enhance its potential for comprehensive and creative solutions.
Overall, this model is designed to foster a culture of innovation and
creativity by creating a dynamic, collaborative environment in which staff
can work together to develop new and effective approaches to case
management. This will ultimately result in increased benefits for members,
their families, and the wider community.
OFFEROR'S RESPONSE 4.a.iii: An organizational chart listing all
positions within the Offeror's organization that are responsible for
the performance of any activity related to the Contract resulting
from this solicitation, their hierarchy and reporting structure.
See Two (2) Organization Charts on Next Page
• Weld County Case Management Agency
• Weld County Case Management Agency Within WC AAA Structure
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*Supervision of
the following
programs:
HCBS-CMHS
HCBS-CIH
HCBS-EBD
HCBS-BI
HCBS-HBU
LTHH
PACE
NF
Manager
Department of Human Services Director: Jamie Ulrich
Area Agency on Aging - CMA Deputy Director: Tami Grant
February 2023
*Supervision of
the following
programs:
HCBS-CMHS
HCBS-CIH
HCBS-EBD
HCBS-BI
HCBS-HBU
LTH H
PACE
NF
AAA Deputy
Division Dir.
Department of Human Services Director: Jamie Ulrich
Area Agency on Aging Deputy Director: Tami Grant
HS Director
HS Deputy Director
I
AAA Division
elector/
CMA Administrator
TC Program APS Supervisor
Supervisor
1-PRS I 1-Screener
1-CSS ' , 1 -PT CA
7 -Technicians 7 -Caseworkers
Manager
Administrative
Assistant
February 2023
OFFEROR'S RESPONSE 4.b: Providing Qualified Key Personnel
How the Offeror will provide Key Personnel that meets or exceeds
the requirements contained in this solicitation and in Appendix B.
WC CMA currently has the required Key Personnel in place that meet or
exceed the requirements in this solicitation and Appendix B. Our plan is to
assign the following Key Personnel positions to existing personnel within the
organization: Administrator, Finance Director, Case Management Director,
Continuous Quality Improvement (CQI) Lead, Contract Lead, Information
Technology (IT) Liaison, RAE Liaison, Medicaid Assistance (MA) Site/County
Eligibility (CE) Liaison, and a Member and Family Liaison. Key Personnel
assignments will be held by a team of CMA administrators and supervisors
with decades of combined experience serving people through LTSS
programs. WC CMA's tentative Key Personnel position assignments for
forthcoming contact are:
CMA Administrator Kelly Morrison, Director, Weld AAA
Phone: 970-400-6786
Email: kmorrison@weld.gov
Finance Director Kelly Morrison, Director, Weld AAA
Phone: 970-400-6786
Email: kmorrison@weld.gov
Contract Lead Kelly Morrison, Director, Weld AAA
Phone: 970-400-6786
Email: kmorrison@weld.gov
Case Management Dir. Jill Colavolpe, Deputy Director, Weld AAA
Phone: 970-400-6109
Email: jcolavojx@weld.gov
IT Liaison Kelly Morrison, Director, Weld AAA
Phone: 970-400-6786
Email: kmorrison@weld.gov
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RAE Liaison
MA/CE Liaison
Meghan McWilliams Supervisors, Weld County
Phone: 970-400-6108
Email: mmcwilliamsPweld.gov
Jill Colavolpe, Deputy Director, Weld AAA
Phone: 970-400-6109
Email: jcolavojx@weld.gov
Member & Family Liaison Sandra Hasch
Phone: 970-400-6102
Email: shaschi8 weld.gov
Continuous QI Lead
Angela Korthaus, Supervisor, Weld County
Phone: 970-400-6838
Email: akorthausPweld.gov
If awarded the Contract for Service Area 9, WC CMA shall provide the
Department with a final list of individuals assigned to the Contract and
appropriate contact information for those individuals in accordance with
identified timelines identified in the Contract. Additionally, per RFP section
2.3.5, WC CMA shall not permit any individual proposed for assignment to
Key Personnel positions to perform any Work prior to the Department's
approval of that individual to be assigned as Key Personnel. The Contractor
shall notify the Department of any changes in writing throughout the terms
of the contract.
OFFEROR'S RESPONSE 4.c: Training all Other Personnel
How the Offeror will provide and train all Other Personnel so that
the Work is completed accurately and in a timely manner in
compliance with state and federal regulatory requirements and
Contract requirements.
i. Additionally, include a listing of the position titles for each
position required in the Contract, the general responsibilities of
that position, the number of individuals filling that position and
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the numbers of hours each week the position will be dedicated
to the Work.
Provide Other Personnel
WC CMA is proposing a total of sixty-five and one half (65.5) Other
Personnel positions to fulfill contract requirements and meet best practice
standards set by the Department in RFP Section 2.3.6.1. The positions
include one (1) Program Manager, six (6) Supervisors, forty-seven and a
half (47.5) Case Managers (including five and a half [5.5] Intake Case
Managers), four (4) Specialists (Lead Case Manager), one (1) Fiscal Clerk,
and six (6) Case Aides. The Case Managers are further divided into Non-IDD
Adult Waiver Case Managers (25.5), IDD Waiver and State General Fund
Program Case Managers (16), and Pediatric Program Case Managers (6).
The Specialists are divided into Non-IDD Adult Waiver Specialist (2) and IDD
Waiver and State General Fund Specialist (2). The Case Aides are divided
into Non-IDD Adult Waiver Case Aides (3), IDD Waiver and State General
Fund Program Case Aides (2), and Pediatric Programs Case Aides (1).
Detailed lists, charts, and descriptions of Key Personnel and Other Personnel
can be found in OFFEROR'S RESPONSEs 4.a.i, 4.a.iii., 4.b.i, and 4.f.
All Other Personnel hired to provide case management services shall meet or
exceed all the case management qualifications at 10 CCR 2505-10-8.519.5.A
and 8.519.5.B, supervisors and program managers positions will comply with
10 CCR 2505-10-8.519.2.5.H, and all staff shall comply with the conflict -of -
interest rules at 10 CCR 2505-10-8.519.5.C. As evidenced in Offer's
Response 1.c, all existing staff meet or exceed these qualifications, and WC
CMA has recruitment practices in place to ensure all staff meet contract
standards and standards set forth by WCDHS.
To achieve the staffing levels necessary to fulfill the Work associated with
this solicitation and contract, upon being notified of the contract award for
Weld County, we will implement a recruitment plan that includes meeting
with our local CCB, Envision, to evaluate current staffing levels and to assess
the interest of their qualified and trained employees in coming to the new
CMA. A recruitment plan specific to this effort will be fully developed, and
any position gaps will be addressed by distributing open positions internally,
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posting jobs online, and reaching out to community partners. For a detailed
explanation of our plans to recruit and retain positions, see Offer's Response
4.f.
Training Staff
WC CMA will conduct an operational readiness assessment three (3) to five
(5) months before the contract start date, and it will involve evaluating all
current staff for compliance with the updated training requirements outlined
in the new contract and any changes to 10 CCR 2505-10 8.519 et seq. This
evaluation will also identify any gaps in program knowledge, particularly
those related to CCB programs such as HCBS-CES, HCBS-SLS, and FSSP.
Any deficiencies found will be addressed at least one (1) month prior to the
start of the new contract, including training staff on new programs. As part
of the post -award preparatory process, WC CMA will request training
materials on HCBS and non-HCBS programs from Envision.
As part of the recruitment process with Envision, candidates who express
interest, who are interviewed and subsequently hired, will be evaluated for
their compliance with the new training requirements. WC CMA will request
Envision's training tracking deliverable as part of this evaluation process,
and WC CMA will work with Envision to help address identified gaps before
the new contract begins. All new hires, whether from Envision or other
sources, will be subject to WC CMA's new hire training plans and procedures.
WC CMA will use its existing training strategies, materials, and plans to
ensure that all case managers receive the required training in accordance
with contract requirements and regulations. Training materials and
processes will be adjusted as necessary to incorporate new programs and
services. The New Hire Training Plan consists of two (2) aspects: General
and Specific. General training includes topics that every employee must
know, while Specific training focuses on areas of need expertise and
application. For instance, all case managers will receive an overview of all
programs and their corresponding services and eligibility requirements, but
only those assigned to specific programs and teams (Non-IDD, IDD,
Pediatric) will receive in-depth trainings for programs they will be managing.
WC CMA does not expect every employee to know the details of the eighteen
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(18) programs associated with this Solicitation, and therefore our staff will
rely on each other, internal trainings, presentations, and meetings to stay
program informed.
Below is an example of a fifteen (15) -day training plan that includes the
training requirements and guidelines mandated by the contract. This plan is
specific to a non-IDD Adult program but can be adapted to fit the team and
programs to which the new hire is assigned.
Training Requirements, Guidelines, and Attestations
WC CMA shall ensure that all Other Personnel have sufficient training and
experience to complete all portions of the Work assigned to them. WC CMA
shall provide all necessary training to its Other Personnel, except for State -
provided training specifically described in this Contract. WC CMA shall ensure
that all staff assigned to perform the Work in this Contract pass
competency -based training requirements as defined by the Department,
including, but not limited to, disability/cultural competency, person-
centeredness, soft skills, as well as program -specific knowledge and skills.
WC CMA shall ensure that all case management staff receive training within
one -hundred twenty (120) calendar days after the staff member's hire date
and prior to being assigned independent case management duties. All other
case management staff must receive retraining as required by the
Department, a Department -approved vendor, or WC CMA.
Training modalities may include the Department's Learning Management
System (LMS), web -based training, virtual instructor -led training, in -person
training sessions, and training materials available on the Department
website. WC CMA shall utilize training materials provided by the Department
when available. Case management staff shall complete all training
requirements in the contract and at 10 CCR 2505-10 8.519.5.E et. seq., to
include but not be limited to:
• Applicable Federal and State laws and regulations for LTSS programs
• Critical Incident Reporting
• Determination of Developmental Disability or Delay
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• Disability and Cultural Competency
• Equity, Diversity, Inclusion, and Accessibility (EDIA)
• Intake and Referral
• Level of Care Screen and Needs Assessment
• Long Term Home Health (LTHH)
• Long Term Services and Supports Eligibility
• Mandatory Reporting
• Notices and Appeals
• Nursing Facility Admissions
• Participant Directed Training
• Person -Centered Support Planning and Person -Centered Support Plan
• Pre -Admission Screening and Resident Review (PASRR)
• State General Fund Program Requirements and Services
• State General Fund Program Ongoing Case Management
• System Documentation
• Waiver Requirements and Services
WC CMA shall ensure that Case Managers meet competency requirements
determined by the Department to perform case management tasks,
including the correct application of the Colorado Single Assessment and
Person -Centered Support Plan. WC CMA understands Case Managers must
pass assigned training competency requirements to independently perform
Case Management activities. Case Managers shall receive oversight reviews
of their performance, including their competency in completing the Level of
Care Screen. WC CMA shall shadow case management staff completing the
Level of Care Screen on an annual basis and prior to the end of each
Contract Fiscal year to establish case manager competency administering
the Level of Care Screen. Supervisors, lead workers, or a case manager with
at least three years of case management experience may perform this
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shadowing. WC CMA shall maintain documentation on case manager
performance and provide it to the Department upon request. WC CMA shall
provide the date all case management staff, including new and existing staff,
were hired and the dates of received training in the areas identified in
Section 1.2.3, using the reporting template provided by the Department for
review, approval, and payment.
New Hire Training Plan - First 15 Days
Preparation Prior to Start Date: Set up the new hire's desk and office
equipment. This includes ensuring that the new hire has all the necessary
office supplies, a computer, scanner, and phone.
Next, the training team will prepare training documents and desktop aids
that the new hire will use as references during their training period. The
documents include the 100.2 Certification Dates Chart, which provides
information on the certification requirements for Medicaid clients; the 803
Denial Reasons and Regulations, which outlines the regulations for Medicaid
denials; the County Holidays, which provides information on the county's
holiday schedule; the Staff List and Extensions, which provides a directory of
staff members and their contact information; the LTC Acronyms, which is a
glossary of acronyms commonly used in the long-term care industry; the
APS Flyer, which provides information on the Adult Protective Services
program; the Cisco Phone Quick Guide, which explains how to use the phone
system; and several other documents such as client file and OnBase
guidelines; waiver and non -waiver program charts; financial rate sheets;
email encryption; PAR codes; and more.
The new hires will be assigned a training team, which will include a
Supervisor and/or a Specialist who will oversee training. In addition, an
oversight team will be assigned to review one hundred (100) percent of the
new hire's work for six (6) months to ensure that they are meeting the
required standards and to provide feedback and support as needed.
Day 1: On the first day of training, the new case manager (NCM) will attend
a human resources orientation and receive a tour of the building and
department. They will be introduced to the staff and complete paperwork
related to the Care and Case Management System (CCMS) access. The NCM
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will have a one-to-one meeting with their team supervisor to discuss
expectations and answer any questions they may have. The day will also
include an introduction to the Area Agency on Aging & LTSS Program
PowerPoint, and they will cover the history of case management redesign,
lines of responsibility and authority, and WC CMA's three (3) case
management teams, including the Non-IDD Program Adult Team, IDD
Program Adult Team, and Pediatric Program Team. They will also receive an
overview of the various departmental summaries, including the SEP Map,
CCB Map, Non-IDD Programs Overview, IDD Programs Overview, and
Pediatric Programs Overview. By the end of this day, the NCM will have a
general understanding of the LTSS program and how WC CMA operates.
Day 2: The NCM will learn about financial eligibility and long-term care
Medicaid, including what Health First Colorado is, the application process for
LTSS programs, and financial requirements such as income limits, assets,
and income trusts. They will also learn about DHS financial assistance
programs and Medicare programs and services. The NCM will participate in
the HCBS Waivers & Services PowerPoint, which will cover waivers, program
eligibility criteria, HCBS services, HCBS provider agencies, program -
approved service providers (PASA), nursing facility care, PACE, LTHH, and
private case management. The NCM will also receive Waiver 101, CIH waiver
state PowerPoint, LTSS video, and LTSS glossary training.
Day 3: The NCM will participate in the intake and referral PowerPoint, which
will cover information and referral, developing care plans, intake and
screening, timeframes, ongoing case management processes, assessment
types, PASRR, tracking examples, and case closures. They will also
participate in the Alzheimer's and dementia training from the state training
site.
Day 4: The NCM will receive training on scoring the ULTC 100.2 PowerPoint,
which will cover ADL's; IADL's; scoring guidelines; pediatric and age -
appropriate scoring guidelines; behavior vs. memory scoring; documentation
guidelines; contingency plans and goals; narrative statements; and ULTC
100.2: determining level of care from the state training site.
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Day 5: The NCM will learn about Monitoring and will participate in monitoring
for HCBS Case Managers from the state training site. They will also receive
disability and cultural competency training, person -centered service plans
training, and will review tracking and organization.
Day 6: The NCM will participate in PMIP training, which will include
instructions, attestation forms, and the CLLI physician statement. They will
receive an introduction to CDASS, covering reasons for the program, initial
paperwork and process, task worksheets, and overspending process. They
will participate in CDASS/IHSS CDCO training from the CDCO site and will
review Skilled vs. Unskilled Health Maintenance guidelines.
Day 7: The NCM will receive training on the introduction to IHSS and will
participate in the IHSS overview from the state training site. They will also
receive training on Telligen, including the URUM user guide, review types,
and tip sheets. The NCM will participate in a Telligen overview from the state
training site.
Day 8: The NCM will participate in the Bridge, PARS & PETI training, which
will cover the introduction to Bridge navigation, decoding PARS, inventory of
needs, PETI, goals, and the CDASS worksheet. They will receive Bridge
training from the state training site, Bridge Proration training, and CDASS
DXC training from the state training site. The NCM will also receive ACF PETI
training from the state training site. This day will provide the NCM with an
in-depth understanding of the processes and tools used in the LTSS
program. The NCM will learn how to navigate the system and to work within
the program's guidelines to support members effectively.
Day 9: The NCM will receive Critical Incident Report (CIRS) training
PowerPoint - Section 16, as well as CIRS training from the state training
site. They will receive the CIRS Technical Guide, Critical Incident Type Desk
Aid, and Fatal Five training. The NCM will also receive training on home
modifications, which will cover initial paperwork, referral process and
checklist, and SEP home mod training from the state training site. This day
will provide the NCM with an understanding of the different types of critical
incidents that can occur and how to report them appropriately. They will also
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learn how to work with members who require home modifications to ensure
their safety and well-being.
Day 10: The NCM will receive training on over cost containment and rights
modifications. They will participate in the individual rights and rights
modification training from the state training site and will learn about notices
and appeals. The NCM will also learn about the HCBS final settings rule from
the state training site. By the end of this training, the NCM will understand
how to work within the program's regulations to contain costs and ensure
members receive appropriate and affordable services.
Day 11: The NCM will receive more in-depth training on LTSS Medicaid
Waivers, which will cover the various waivers available, HCBS agencies, and
Program Approved Service Providers (PASA). They will learn about program
eligibility criteria and HCBS services, including nursing facility, PACE, and
LTHH. The NCM will also receive Waiver 101 for Case Managers training from
the state training site. This day will provide the NCM with an in-depth
understanding of the LTSS Medicaid Waivers available and the services they
provide.
Day 12: The NCM will receive training on HIPAA and PHI, including an
overview and in-depth understanding of the policies and procedures related
to HIPAA and PHI. They will also receive training on Long Term Home
Health, which will cover the services available and the program's eligibility
criteria. By the end of this training, the NCM will have a comprehensive
understanding of the HIPAA and PHI policies and procedures and the Long
Term Home Health program.
Day 13: The NCM will receive training on transition services from the state
training site, which will cover the process for transitioning clients from one
program to another. They will also receive training on electronic visit
verification and remote supports to understand how to document services
provided to members. The NCM will also receive training on incident
management and prevention strategies to learn how to prevent incidents
and handle them appropriately if they occur.
Day 14: The NCM will receive training on PASRR, including an overview of
the PASRR program, nursing facility admission, and the client file and
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OnBase, which will cover the guidelines for client file documentation and
scanning. By the end of this training, the NCM will have a comprehensive
understanding of the PASRR program and the requirements for member file
documentation and scanning. By the end of this training, the NCM will have
a comprehensive understanding of the LTSS program's various aspects and
will be ready to start working with members under supervision.
Day 15 - Day 25
During this time, the NCM will meet with various DHS personnel and other
related professionals to learn more about their roles and how they fit into
the LTSS program. They will review and read LTSS program regulations to
gain a better understanding of the program requirements. The NCM will
shadow a case manager at their desk to learn more about how to navigate
the system and manage member needs. They will also shadow a case
manager on member visits to learn more about how to interact with
members and provide case management services. The NCM will complete
contacts under supervision, including quarterly calls, a six-month review,
reassessments, intake assessments, nursing home assessments, and PACE
assessments. The NCM will also receive training from DHS personnel,
including DHS orientation, the LTSS program director, the ombudsman, APS,
and long-term care technicians, to name a few. By the end of this training,
the NCM will have a comprehensive understanding of the LTSS program and
be ready to work independently with members. The supervisor training and
monitoring plan will ensure that the NCM receives the necessary support and
guidance during the early stages of their career.
Additionally, include a listing of the position titles for each
position required in the Contract, the general responsibilities of
that position, the number of individuals filling that position and
the numbers of hours each week the position will be dedicated
to the Work.
Administrator
Number of Individuals Assigned: One (1)
Position Classification: Key
Page 195
RFP Section: 2.3.2.1
Number of Hours Per Week: Eleven (11)
General Work/Responsibilities/Duties:
This role directly supervises the Case Management Agency, providing
leadership, guidance, and support to ensure high performance and
compliance with rules and regulations. Main point of contact for contract -
related questions and issues. Addresses employee concerns, develops
educational opportunities, and monitors and evaluates workflow and
compliance with established standards. Collaborates with partner agencies to
maximize efficiency and compliance with policies.
Finance Director
Number of Individuals Assigned: One (1)
Position Classification: Key
RFP Section: 2.3.2.2
Number of Hours Per Week: One (1)
General Work/Responsibilities/Duties:
Budgeting and forecasting, financial analysis, reporting, contract
negotiations, compliance, risk management, strategic planning
Case Management Director
Number of Individuals Assigned: One (1)
Position Classification: Key
RFP Section: 2.3.2.3
Number of Hours Per Week: Twelve (12)
General Work/Responsibilities/Duties
Primary backup for the Administrator and Contract Lead. Provides oversight
and support for the Manager of programs and services that serve individuals
with intellectual and/or developmental disabilities. Provides oversight and
ensures compliance for all investigative activities.
Page 196
Continuous Quality Improvement Lead
Number of Individuals Assigned: One (1)
Position Classification: Key
RFP Section: 2.3.2.4
Number of Hours Per Week: Three (3)
General Work/Responsibilities/Duties:
Assist in the development and implementation of quality improvement
initiatives. Assist with the development and implementation of the
Continuous Quality Improvement Plan. Develops corrective actions plans for
Department QIS findings.
Contract Lead
Number of Individuals Assigned: One (1)
Position Classification: Key
RFP Section: 2.3.2.5
Number of Hours Per Week: Three (3)
General Work/Responsibilities/Duties
Primary point of contact for the Department. Primary point of contact for
contract deliverables and other contract -related questions or issues for the
Department. Ensures the completion of all Work in accordance with the
Contract's requirements. Ensures the timely submission and accuracy of all
Deliverables submitted to the Department.
Information Technology Liaison
Number of Individuals Assigned: One (1)
Position Classification: Key
RFP Section: 2.3.2.6
Number of Hours Per Week: One half (.5)
General Work/Responsibilities/Duties
Page 197
Serve as a point of contact between IT and WC CMA, and between WC CMA
and The Department. Collaborate with other departments to identify
opportunities for technological solutions to improve workflow or solve
problems.
Regional Accountable Entity Liaison
Number of Individuals Assigned: One (1)
Position Classification: Key
RFP Section: 2.3.2.7
Number of Hours Per Week: Two (2)
General Work/Responsibilities/Duties
Ensure collaboration with RAEs in accordance with contract requirements.
Serve as the point of contact for RAE related matters between WC CMA and
RAEs, the Department, and other entities. Help create a complex and
creative solutions process and establish and participate in joint coordination
meetings
Medical Assistance (MA) and County Eligibility Liaison
Number of Individuals Assigned: One (1)
Position Classification: Key
RFP Section: 2.3.2.8
Number of Hours Per Week: One (1)
General Work/Responsibilities/Duties
Serve as the point of contact between WC CMA and MA Sites and County
Eligibility. Collaborate with MA Sites and County Eligibility departments to
streamline processes and communications. Point of contact for complaints
about WC CMA, from MA Sites and County Eligibility departments.
Member and Family Liaison
Number of Individuals Assigned: One (1)
Position Classification: Key
Page 198
RFP Section: 2.3.2.9
Number of Hours Per Week: Two (2)
General Work/Responsibilities/Duties
Serve as a point of contact and advocate for members and their families,
ensuring that their concerns are heard and addressed. Act as a resource to
members and their families, providing information on available resources
and services, and supporting them in accessing those services. Conduct
outreach and education to the community to ensure that members and
families are aware of available services and resources.
Manager
Number of Individuals Assigned: One (1)
Position Classification: Other Personnel
RFP Section: 2.3.6.1
Number of Hours Per Week: Forty (40)
General Work/Responsibilities/Duties
Directly supervise the CMA unit supervisors. Provide oversight and
monitoring of work completed by staff in the CMA Waiver and SFG programs
to ensure high performance and compliance with rules and regulations.
Participate in the development and maintenance of department policies and
procedures. Collect and track qualitative and quantitative data to ensure that
initiatives meet intended outcomes. Provide technical expertise, education,
and training to community partners, department and county partners, and
other stakeholders on CMA programs and resources while maintaining
member confidentiality and HIPAA regulations.
Supervisor
Number of Individuals Assigned: (6)
Position Classification: Other Personnel
RFP Section: 2.3.6.1
Page 199
Number of Hours Per Week: Thirty-nine (39)
General Work/Responsibilities/Duties
Directly supervise all case management staff. Provide leadership, guidance,
and support to staff to ensure high performance and compliance with rules
and regulations. As needed, provide case coverage, and complete all case
management functions and activities. Monitor and evaluate workflow to
establish unit goals and timetables, assign and schedule work, and use
tracking data to identify trends in member volume. Establish and enforce
standards for quality and quantity of work performed by workers in the CMA
unit. Remain knowledgeable on waiver and non -waiver program
requirements and train staff as needed. Maintain quality assurance levels for
all programs through case audits, member satisfaction surveys, and case
consultations. Manage all components of the Home and Community Based
Services Waiver Programs, the Nursing Facility placement process, the State
only long-term care programs, State General Fund programs, and the
Private Case Management functions of the CMA. Serve as an advocate for
members, families, and/or providers during conflict situations and assist with
problem -solving the best solutions to meet members' needs. Maintain an
accurate member reporting system and submit timely reports as required by
contract and regulations and internal monitoring requirements. Maintain all
standards related to member confidentiality and HIPAA regulations.
Specialist
Number of Individuals Assigned: Four (4)
Position Classification: Other Personnel
RFP Section: 2.3.6.1
Number of Hours Per Week: Forty (40)
General Work/Responsibilities/Duties
Provide technical assistance and support to other employees on CMA
program policies and procedures. Troubleshoot complicated cases and
provide direction on resolution. Assist case managers during high intake
referrals or uncovered caseloads and carry a caseload of complex cases.
Page 1100
Develop and facilitate training programs for new and existing employees,
document training outcomes, and provide ongoing refresher training.
Conduct case reviews to ensure program compliance, document findings for
supervisor review, and maintain provider resource lists while ensuring
member confidentiality and HIPAA compliance.
Case Manager
Number of Individuals Assigned: Forty-seven and one half (47.5)
Position Classification: Other Personnel
RFP Section: 2.3.6.1
Number of Hours Per Week: Thirty-nine and three quarters (39.75)
General Work/Responsibilities/Duties
Perform all case management functions and activities as required under
Colorado rules and regulations, to include intake and ongoing case
management. Manage HCBS Waiver Programs, PACE, Nursing Facility
placement process, and State General Fund programs. Conduct level of care
screenings and functional needs assessments to determine eligibility and
develop person -centered care plans. Authorize long-term home health and
non -skilled waiver program services, apply case management principles to
manage caseload, and maintain ongoing contact with members and service
providers. Provide support and advocacy for members, families, and
providers during conflict situations and problem -solving to meet members'
long-term care needs. Maintain accurate member physical and digital files
while ensuring member confidentiality and HIPAA compliance.
Case Aide / Receptionist
Number of Individuals Assigned: Five (5)
Position Classification: Other Personnel
RFP Section: 2.3.6.1
Number of Hours Per Week: Thirty-nine and three quarters (39.75)
General Work/Responsibilities/Duties
Page 1101
Answer incoming calls and direct customers to the appropriate department
employee while providing accurate and timely information related to CMA
rules and regulations. Accept referrals and create member files, following up
on financial information and documenting all member contact and follow-up
activity. Perform basic clerical duties such as data entry, imaging, and mail
distribution, as well as monthly verification of service for all members. Act as
a liaison between the member, CMA, and community partners regarding
Medicaid Long Term Care programs and assist in resolving eligibility issues.
Develop a comprehensive tracking system for all members assisted by the
program for financial eligibility and update provider lists with current
information.
Administrative Assistant
Number of Individuals Assigned: One (1)
Position Classification: Other Personnel
RFP Section: 2.3.6.1
Number of Hours Per Week: Forty (40)
General Work/Responsibilities/Duties
Serve as a liaison for members and providers to assist with receipts and
invoice submissions, maintaining tracking logs for services and payments
authorized for Waiver and State General Fund members. Receive invoices,
perform quality checks, and prepare documents for payment processing by
the Fiscal department. Develop tracking logs and provide training on
program requirements for members and families. Assist with rates -based
reimbursement, targeted -case management, and payment reconciliation
tasks. Coordinate boards and committees required by the CMA contract,
participate as a team member of the division, maintain member
confidentiality and HIPAA compliance, and collaborate with coworkers to
problem -solve and provide support as needed.
Utilization Review Nurse
Number of Individuals Assigned: One (1)
Position Classification: Other Personnel
Page 1102
RFP Section: 2.3.6.1
Number of Hours Per Week: Ten (10)
General Work/Responsibilities/Duties
Complete face-to-face functional assessments with members in their homes
to determine eligibility for long-term home health services as mandated by
regulations. Review prior authorization requests and home health care plans
submitted by agencies for appropriateness of skilled care, consulting with
medical professionals and referring members to community resources as
needed. Make home health service denials when services do not meet
medical necessity and participate in appeal hearings. Assist case
management staff in determining appropriateness of long-term care services
and medical necessity. Accurately establish and maintain member physical
and digital files, ensuring compliance with CMA contract and program
regulations, as well as maintaining member confidentiality and HIPAA
compliance.
OFFEROR'S RESPONSE 4.d: Replacing Key Personnel
A plan for how the Offeror will replace all Key Personnel and Other
Personnel so that the transition between personnel does not impact
the ability of the Contractor to complete the Work.
At present, WC CMA has all Key Personnel positions assigned and filled by
existing CMA staff, and we have over sixty (60) percent of the Other
Personnel required to complete the work.
Upon being awarded the contract, WC CMA will immediately schedule a
meeting with our local CCB, Envision, to discuss the transition process,
including employment opportunities at the WCDHS. WC CMA will strive to
obtain as many qualified candidates as possible to fill forthcoming open
positions.
WC CMA will develop a recruitment plan that outlines the process for
identifying and hiring Other Personnel, and if necessary, Key Personnel from
Envision. This plan will include the steps to be taken, the timeline for the
recruitment process, and the resources required.
Page 1103
WC CMA will schedule interviews with potential hires from the closing
company (Envision). These interviews will be structured and will take place
in accordance with WCDHS HR hiring practices, policies, and protocols.
WC CMA will develop a customized onboarding plan that outlines the steps to
be taken to integrate new hires into our organization. This plan will include
training, orientation, and other forms of support to ensure that new hires
feel supported and valued.
WC CMA will develop a communication plan that outlines the steps to be
taken to keep employees informed about the recruitment process, the
onboarding process, and the transition to our organization.
Positions left vacant from this process, and any vacancies that occur before,
during, and after the transition to the new contract will be managed in
accordance with existing WCDHS recruitment and hiring processes, policies,
and protocols. This includes, but is not limited to; initiating the hiring
process by notifying the Employee Support and Resource unit of the need for
an acquisition meeting, conducting the acquisition meeting with the hiring
supervisor, HR Representative, and others to determine the job posting(s),
posting of the position(s), screening applicant(s), conducting virtual and
panel reviews, conducting candidate assessments, completing candidate
evaluations, making hiring recommendations that are subsequently
approved or denied by the Division Head, completing reference and
background checks, and making job offers.
WC CMA will follow WCDHS HR steps and processes until all positions are
filled and/or replaced.
Key Personnel positions are subject to the same process, though WCDHS
leadership is involved in the hiring and decision -making process, and
individuals selected for Key Personnel positions are presented to the
Department for review and approval prior to completing any of the Work
associated with the contract.
The WCDHS possesses the administrative resources to carry out an efficient
and effective recruitment and hiring process. Our long-standing procedures
and resources enable us to recruit, hire, and retain the employees necessary
Page 1104
for providing essential services to our community for their health, safety,
and well-being. WC CMA is led by experienced leaders who are dedicated to
structured and orderly training for new staff.
WC CMA is committed to employing qualified key personnel and staff to fulfill
the requirements of our contract and meet the needs of our members. We
will ensure adequate staffing and infrastructure to address the needs of our
members and complete the work outlined in the contract.
WC CMA has evaluated the contract demands, including the various waivers
and the number of members in our service area, to determine the necessary
personnel to perform the work of the contract. Our retention plan prioritizes
hiring and retaining talented and qualified staff by providing competitive
wages and benefits, a positive and safe work environment, and a focus on
wellness and professional development. We understand the importance of
retaining staff trained in our waiver programs during the case management
redesign process for continuity of services and a successful transition.
In addition to retention planning, WCDHS recognizes the significance of
succession planning to maintain business continuity. We have started
developing detailed training plans for key positions to facilitate a smooth
leadership change and prepare new employees to assume their
responsibilities.
WC CMA will work with surrounding community partners, including those
with previous experience with other Case Management Agencies (CMA),
CCBs, and CHCBS providers, to discuss employment opportunities.
WC CMA will provide the Department with a list of all key personnel assigned
to the contract for approval and notify the Department of any changes to
key personnel. WCDHS and our CMA understand the importance of building
and maintaining a strong workforce and are committed to serving our
members and their families.
OFFEROR'S RESPONSE 4.e: Subcontractor
If the Offeror intends to use a Subcontractor, the Offeror shall
provide a description of how the Offeror will use Subcontractors and
the percentages of the Work, which shall not exceed 40% of the
Page 1105
Work identified in Appendix B, that will be completed by each
Subcontractor.
i This description shall also include the anticipated positions
provided by the Subcontractor and the roles of those positions,
as well as a plan for how the Offeror will manage the
Subcontractor and all Subcontractor personnel to ensure that
the portions of the Work assigned to the Subcontractor will be
completed accurately and in compliance with all requirements
in Appendix B and state and federal regulations.
ii The Offeror attests that it understands that each of its
subcontractors must be pre -approved by the Department prior
to starting Work and must meet all requirements listed in this
solicitation, Appendix B and must meet Conflict Free Case
Management requirements.
WC CMA does not intend to use Subcontractors to complete any aspect of
the Work defined in this Solicitation and the County CMA Draft Contract in
Appendix B.2. Due to unforeseen circumstances, if WC CMA considers the
use of a Subcontractor after the contract start date, we understand that all
Subcontractors require pre -approval from the Department, and that any
approval will require a detailed plan that describes Subcontractor positions
and roles, how the Subcontractor will be managed, the portions of the work
assigned, and how WC CMA will ensure the Subcontractor completes the
Work accurately and in compliance with all requirements in Appendix B,
state and federal regulations.
OFFEROR'S RESPONSE 4.f: Maintaining Sufficient Staffing Levels
How the Offeror intends to maintain sufficient staffing levels to
include case managers, case aides, supervisors, and other staff as
necessary to complete the Work and to maintain caseload sizes that
do not exceed best practices as determined by the Department. This
must also include:
OFFEROR'S RESPONSE 4.f.i: A detailed plan identifying current
caseload sizes, if applicable, proposed caseload sizes if
awarded the contract and how the Offeror will ramp up
Page 1106
staffing, if needed, to meet current or future Department
requirements.
If awarded the contract for Service Area 9, WC CMA intends to meet or
exceed the staffing requirements necessary to provide consistent and quality
case management services in accordance with state and federal regulations,
the contract, this solicitation, the needs of our members and their families,
and WCDHS internal standards and expectations. We intend to apply our
current agency structure and caseload practices to the proposed design and
caseload sizes of the integrated case management agency that would come
to be as a result of being awarded the contract for Weld County.
Current Caseload Sizes
WC CMA's existing staffing structure for the Single -Entry Point contract
consists of twenty-nine (29) full time (FT) positions and one (1) part time
(PT) position:
Administrator: 1
Supervisors: 3
Specialist (Lead Case Manager): 1
Case Manager: 22 FT and 1 PT Case Manager
o Intake Case Managers: 5.5
o Ongoing Case Managers: 17
Case Aides: 2
As of January 2023, the number of Ongoing Members served by WC CMA is
one thousand six hundred forty-seven (1647), and the ongoing caseload size
per Ongoing Case Manager is ninety-seven (97).
Structurally, WC CMA has made business decisions that separate case
management functions and duties that could otherwise be consolidated into
a single position, such as combining intake, ongoing, and case aide functions
into one job description. Combining two or more functions into a position can
be disadvantageous because any combination of multiple functions
automatically equates to an increase in job complexity, something we try to
avoid when possible.
For this reason, Case Aide positions were created to lessen workload
complexity and the clerical workload burdens of Case Managers. WC CMA's
Page 1107
structural business decisions to differentiate Intake, Ongoing, and Case Aide
positions translates into the perception that the caseload average is ninety-
seven (97), but this is not quite accurate. If WC CMA made the business
decision to convert our Intake Team positions to Ongoing CM positions,
which we could do, the average caseload size would be seventy-three (73),
and we could do this by simply eliminating dedicated intake positions and
enfolding them and their responsibilities into Ongoing.
Similarly, if WC CMA folded Intake, the Case Management Specialist (Lead),
and Case Aide positions into Ongoing, today the caseload average would be
sixty-five (65). See the below for a more detailed breakdown.
The main point is a caseload average depends largely on the structural
business decisions of an agency that is impacted by the number of ongoing
case managers and the additional staff supporting case management
activities. What is the average caseload size at WC CMA? It is simultaneously
ninety-seven (97), seventy-three (73), seventy (70), sixty-seven (67),
sixty-five (65), and sixty-two (62). The actual number depends on how the
business decisions of an agency are viewed.
WC CMA 2O23 Ongoing Caseload Averages
CMA Positions Factored into Ongoing
Caseload Averages
Ongoing
Members
Served
Number
of Staff
Factored
2023
Caseload
Average
Ongoing Case Managers
1647
17
97
Ongoing + Intake Case Managers
1647
22.5
73
Ongoing + Intake Case Managers +
Specialist
1647
23.5
70
Ongoing + Intake Case Managers + Case
Aides
1647
24.5
67
Ongoing + Intake Case Managers +
Specialist + Case Aides
1647
25.5
65
Ongoing + Intake CMs + Specialist +
Case Aides + Supervisor
1647
26.5
62
Page 1108
WC CMA recently calculated the amount of time Ongoing, Intake, and Case
Aide positions contribute to the completion of case management tasks. We
did this to create a task and time -based caseload average. With this method,
if a multi -function (intake, ongoing, case aide) ongoing case management
position represents one hundred (100) percent of the Work, we estimate
that intake activities account for eighteen (18) percent of the work, case
aide tasks account for ten (10) percent, and ongoing activities account for
seventy-two (72) percent.
Applied to a non -consolidated caseload of one hundred (100) cases, where
Ongoing, Intake, and Case Aides positions are separate, the average
caseload would be seventy-two (72). This results in twenty-eight (28)
percent of the work being completed by other positions. Applied to the
existing average caseload of ninety-seven (97), the reformulated average
caseload size for WC CMA is seventy (70)
The percentages used in the formulas above are based on the following
workload and time estimates:
Case Management duties are completed in a forty (40) hour week.
One Intake Case Manager completes 18% of the work on a single, task
consolidated caseload (ongoing, intake, and case aide tasks):
Initial Level of Care Screen 2%
Initial Needs Assessment 5%
CDASS/IHSS Initial work 4%
Payment Source Change 2%
o Documentation 5%
One Case Aide completes 10% of the work on a single, task
consolidated caseload.
o Utilization review tasks 2%
o PMIP tasks 2%
o Referral packet work 2%
o Documentation 4%
One Ongoing Case Manager completes the remaining 72% of the work
on a single, task consolidated caseload.
Page 1109
Whether factoring the number of positions converted to ongoing positions, or
factoring the amount of work each separate position manages, WC CMA's
current caseload average is well below ninety-seven (97).
Proposed Caseload Size if Awarded the Contract
WC CMA understands the value of a staffing structure that differentiates
case management functions between multiple position types, and therefore,
it is our intent to continue to utilize this type of organization structure if
awarded the contract for Weld County.
WC CMA's plan to maintain staffing levels necessary to complete the Work
associated with this Contract includes keeping existing CMA staff that serve
Single Entry Point managed LTSS programs, interviewing staff at our local
CCB after the contract is awarded, and initiating current WCDHS recruitment
practices to fill any remaining positions necessary to bring our proposed
staffing plan to completion.
WC CMA proposes a total of sixty-seven and one half (67.5) positions
consisting of the qualified staff needed to fulfill contract requirements and
the proposed best practice standards set by the Department:
• Administrator: 1
• Case Management Director: 1
• Program Manager: 1
o Oversees IDD Waiver and State General Fund Programs
• Supervisors: 6
o Non-IDD, Adult Waivers Supervisors: 3
• HCBS-EBD, HCBS-BI, HCBS-CIH, HCBS-CMHS
o IDD Waiver and State General Fund Program Supervisors: 2
• HCBS-DD, HCBS-SLS, State Plan SLS, FSSP, OBRA-SS
o Children's Program Supervisor: 1
• HCBS-CHRP, HCBS-CES, HCBS-CLLI, CHCBS
• Case Managers: 47.5 (included 5.5 Intake CMs)
o Non-IDD, Adult Waiver CMs: 25.5
Page 1110
o IDD waiver and State General Fund Program CMs: 16
o Pediatric Program Case Managers: 6
Specialists (Lead Case Managers): 4
o Non-IDD, Adult Waiver Specialist: 2
o IDD waiver and State General Fund Specialists: 2
Fiscal Clerk: 1
Case Aides: 6
o Non-IDD, Adult Waiver Case Aides: 3
o IDD waiver and State General Fund Program Case Aides: 2
o Pediatric Programs Case Aides: 1
WC CMA intends to separate the case management team into three (3)
areas of specialization:
Non-IDD Adult Waiver Team
o Programs currently managed by SEPs
IDD Waiver and State General Fund Program Team
o Programs currently managed by CCBs.
Pediatric Waiver Team
o Programs currently managed by SEPs and CCBs
WC CMA will remain flexible and open to different configurations of positions
and teams, to include mixing IDD and non-IDD caseloads, if necessary. At
this time, we propose program group separations in order to reduce the
complexity associated with managing multiple waivers and programs
simultaneously.
Caseload Size Average - Agency Wide
RFP Section 1.5.2.10.1 reports a total of two thousand eight hundred forty-
eight (2,848) HCBS and non-HCBS Members in Weld County. Based on this
data, which does not make distinctions between waivers and age, WC CMA's
proposed level of Ongoing Case Managers (forty-two and one half (42.5) for
all programs combined creates an agency average of sixty-eight (68)
members per case manager.
Due to structural business decisions made in the development of this plan,
and factoring other positions into caseload average formulations like those in
Page 1111
the section on current caseloads, the agency -wide caseload average under a
new contract with the Department consists of four (4) simultaneously
applicable numbers:
WC CMA New Contract Caseload Averages by Agency
CMA Positions Factored into Ongoing
Caseload Averages
Ongoing
Members
Served
Number
of Staff
Factored
2023
Caseload
Average
Ongoing
2848
42
68
Ongoing, Intake
2848
47.5
60
Ongoing, Intake, Specialist
2848
51.5
55
Ongoing, Intake, Specialist, Case Aide
2848
57.5
50
Caseload Size by Program and Team
On average, in 2022 WC CMA served one thousand six hundred forty-seven
(1647) Ongoing Members on the SEP managed programs of HCBS-BI, HCBS-
EBD, HCBS-CIH, HCBS-CMHS, and HCA. Of the two thousand eight hundred
forty-eight (2,848) members reported to be on LTSS programs in Weld
County, two hundred sixty-seven (267) are on State General Fund
Programs. That leaves approximately nine hundred thirty-four (934)
members on programs currently managed by CCBs. In attempting to
develop a plan that is more program specific, there are several unknown
variables that require best guesses. These unknown variables include:
Does the proposed single caseload limit of sixty-five (65) assume that
case management across programs will be similar, and therefore
manageable at or around sixty-five (65) cases per case manager.
The exact number of Members on each waiver and programs in our
Defined Service Area.
The number of Members on pediatric programs.
The impact the new system, level of care assessment, and needs
assessment will have on workload and workflow.
Based on the data we have, to include years of experience managing SEP
managed waivers, WC CMA proposes the following staffing plan, patterns,
and caseload numbers for our new CMA:
Page 1112
Non-IDD Adult Waiver Team
Programs: HCBS-BI, HCBS-EBD, HCBS-CIH, HCBS-CMHS, and HCA
Number of Members: 1647
Number of Ongoing Case Managers: 20
Number of Intake Case Managers: 5.5
Number of Supervisors: 3
Number of Specialists (Leads): 2
Number of Case Aides: 2
WC CMA proposes an average caseload size of eighty-two (82) for the Non-
IDD Adult Waiver Team, with consideration of business decisions to structure
the agency with multiple position types. Based on the approval of this
method, and which positions can be factored into the formula for
determining an average caseload, WC CMA proposed caseload average(s)
are summarized in the following table.
Non-IDD Adult Waiver Team Caseload Averages by Position
CMA Positions Factored into Ongoing
Caseload Averages
Ongoing
Members
Served
Number
of Staff
Factored
Proposed
Average
Ongoing
1647
20
82
Ongoing, Intake
1647
25.5
65
Ongoing, Intake, Specialist
1647
27.5
60
Ongoing, Intake, Specialist, Case Aide
1647
30.5
54
IDD and State General Fund Programs
Programs: HCBS-DD, HCBS-SLS, State SLS, FSSP, OBRA-SS
Number of Estimated Members: 1025
Number of Ongoing Case Managers: 16 (12 waiver CMs, 4 State SLS)
Number of Intake Case Managers: 0
o Supervisors assist with intakes, then hands off to Ongoing.
Number of Program Managers: 1
Number of Supervisors: 2
Number of Specialists (Leads): 2
Number of Case Aides: 2
Page 1113
WC CMA proposes an average caseload size of sixty-four (64) for the IDD
and State General Fund Program Team, with consideration of business
decisions to structure the agency with multiple position types. Based on the
approval of this method and the positions that can be factored into the
formula for determining an average caseload, WC CMA proposed caseload
average(s) are summarized in the following table.
IDD and State General Fund Team Caseload Averages by Position
CMA Positions Factored into Ongoing
Caseload Averages
Ongoing
Members
Served
Number
of Staff
Factored
Proposed
Average
Ongoing
1025
16
64
Ongoing, Specialist
1025
18
56
Ongoing, Specialist, Case Aide
1025
20
51
Pediatric Programs
• Programs: HCBS-CHRP, CHCBS, HCBS-CES, HCBS-CLLI
• Number of Estimated Members: 305
• Number of Ongoing Case Managers: 6
Number of Intake Case Managers: 0
Number of Program Managers: 0
Number of Supervisors: 1
Number of Specialists (Leads): 0
Number of Case Aides: 1
WC CMA proposes an average caseload size of fifty (50) for the Pediatric
Team, with consideration for business decisions to structure the agency with
multiple position types. Based on the approval of this method and the
positions that can be factored into the formula for determining an average
caseload, WC CMA proposed caseload average(s) are summarized in the
following table.
Pediatric Caseload Averages by Position
CMA Positions Factored into Ongoing
Ongoing
Number
Proposed
Caseload Averages
Members
of Staff
Average
Served
Factored
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Ongoing
305
6
50
Ongoing, Case Aide
305
7
43
WC CMA is confident that our proposed staffing plan will meet the best
practice standards required by this contract. WC CMA believes that the
proposed case management model will allow case managers to operate more
effectively and efficiently, thereby achieving person -centered outcomes and
improving the overall experience and satisfaction of the individuals we serve.
We are committed to assessing the need to make changes and we are willing
to adjust as needed.
OFFEROR'S RESPONSE 4.f.ii: Detailed plan that outlines
recruitment and retention strategies to ensure that there are
sufficient staffing patterns to support quality case
management.
If awarded the contract for Service Area 9, WC CMA will implement the
following recruitment and retention strategies to ensure sufficient staffing
patterns are in place to support quality case management.
Recruitment Plan
WC CMA will use a variety of strategies to recruit staff to ensure sufficient
staffing patterns to support quality case management. The following steps
will be taken:
1. Identifying positions and defining job openings: We will identify the
positions required to fulfill staffing levels and create a job description
for each role. The job descriptions will include duties, responsibilities,
and required qualifications for each position, and ensure that all job
descriptions incorporate the qualification requirements as specified in
Department regulation, 10 CCR 2505-10, 8.519.5 et seq.
2. Establishing relationships with local organizations: WC CMA will
schedule a meeting with the local Community Centered Board (CCB),
Envision, to discuss the transition process and employment
opportunities at the WCDHS. We will also connect with local
organizations and community partners to inform them of potential job
opportunities.
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3. Developing a recruitment plan: WC CMA will develop a recruitment
plan that outlines the process for identifying and hiring Other
Personnel from Envision. This plan will include the steps to be taken,
the timeline for the recruitment process, and the resources required.
4. Estimating positions that will not be filled by Envision staff: WC CMA
will estimate the number of positions that will not be filled by
experienced and qualified Envision staff and establish an effective date
for activating standard WCDHS recruitment and hiring processes,
policies, and protocols. This includes advertising job openings on
multiple job boards (e.g., LinkedIn, governmentjobs.com), posting and
distributing job openings internally, and working with universities to
attract qualified candidates.
5. Developing a customized onboarding plan: WC CMA will develop a
customized onboarding plan that outlines the steps to be taken to
integrate new hires into our organization. This plan will include
training, orientation, and other forms of support to ensure that new
hires feel supported and valued.
6. Developing a communication plan: WC CMA will develop a
communication plan that outlines the steps to be taken to keep
employees informed about the recruitment process, the onboarding
process, and the transition to our organization.
Strategies for Ensuring Qualified Staff Are Hired
Job descriptions: We will create detailed job descriptions that outline
the essential duties and responsibilities, minimum qualifications,
preferred work experience, required skills, preferred skills, knowledge
and abilities, and any substitutions if applicable. This information will
be used to screen applicants to ensure that they meet the minimum
qualifications.
Supplemental questions: WC CMA's application will include
supplemental questions to gather more detailed information about
specific requirements and to ensure that qualified candidates are
identified.
Involvement of multiple departments: WC CMA will involve the County
Human Resource Department and the DHS Employee Support and
Resource Division in the position acquisition process to ensure that all
qualified candidates are identified.
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Candidate filtering and review: The Human Resource division will
review applications and filter those that meet minimum qualifications.
The hiring manager will review the remaining applicants to determine
who is most qualified to proceed to the interview process.
Interview process: Candidates will be asked to expand on their
qualifications and apply them to interview questions during the initial
screening and panel interviews.
Reference checks: We will conduct reference checks prior to job offers
to ensure the accuracy of reported qualifications and receive additional
information about the strengths and assets a candidate has to offer.
Background checks: WC CMA will conduct a criminal history
background check through Intermountain Data Corp. for all WCDHS
employees, and a CAPS check for all direct -care positions that interact
with at -risk or vulnerable adults. For those positions that require
fingerprinting, WC CMA partnered with IdentoGO on behalf of the
State of Colorado to provide fingerprinting service.
The Weld County Department of Human Services (WCDHS) possesses the
administrative resources to carry out an efficient and effective recruitment
and hiring process. Our long-standing procedures and resources enable us to
recruit, hire, and retain the employees necessary for providing essential
services to our community for their health, safety, and well-being. WC CMA
is led by experienced leaders who are dedicated to structured and orderly
training for new staff.
WC CMA is committed to employing qualified key personnel and staff to fulfill
the requirements of our contract and meet the needs of our members. We
will ensure adequate staffing and infrastructure to address the needs of our
members and complete the work outlined in the contract.
WC CMA has evaluated the contract demands, including the various waivers
and the number of members in our service area, to determine the necessary
personnel to perform the work of the contract. Our retention plan prioritizes
hiring and retaining talented and qualified staff by providing competitive
wages and benefits, a positive and safe work environment, and a focus on
wellness and professional development.
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Retention Plan: Weld County Department of Human Services (DHS) Case
Management Agency (CMA)
The WC CMA has established a retention plan to ensure stability throughout
the case management redesign process. We have focused on several areas,
both department wide and division (SEP) specific.
We are committed to providing competitive wages and benefits. We provide
a positive, respectful, and safe work environment. We focus on wellness and
professional development. We also recognize the importance of innovation
and service and strive for continuous improvement in all areas of our
program.
We understand the importance of retaining staff who are trained and
knowledgeable in our waiver programs throughout the case management
redesign process. This is vital to ensure continuity of services to the
individuals we serve and for a successful transition. Our multifaceted
approach to staff retention is outlined below.
Salary Increases
Weld County DHS has a graduated step process for incremental pay
increases throughout an employee's career. In addition, the county typically
considers cost of living adjustments (COLA) on an annual basis. This year,
the county awarded an unexpected 3% COLA mid -year and a 5% COLA for
the start of 2023.
Strategic Plan
Weld County DHS understands that staff are our greatest resource, and they
are a vital component to providing services to our community. Weld County
DHS has a strategic plan focused on staff recruitment, recognition, and
retention. This strategic plan initiative incorporates our core values and acts
as a framework to help guide our efforts. We strive to recruit, develop, and
retain mission -driven, service -oriented employees.
Wellness
Weld County DHS has a competitive benefits package, including an
Employee Clinic, where staff can receive medical care, free of charge at
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several different locations. They are also allotted paid time throughout the
year to attend medical appointments at the clinic, which is separate from
other accrued time off (such as sick time or vacation). In addition, Weld
County employees who are enrolled in the medical plan can participate in the
county's wellness program. This program encourages healthy choices and
activities throughout the year and provides a $300.00 annual bonus as
incentive for successful completion.
Weld County DHS leadership feels strongly about wellness and holds a
weekly broadcast called "Wellness Wednesday", focusing on various ways
staff can take care of themselves, reduce stress, and increase overall well-
being.
In addition to our Employee Assistance Program, DHS has also begun to
offer on -site, individual counseling sessions, through an outside agency, that
can be held in -person or virtually, during the regularly scheduled work week.
Employee Engagement
Each year, to strengthen our workforce with targeted human capital
management strategies, Weld County DHS conducts an employee
engagement survey, that includes information specific to our division. We
appreciate the benefits of employee engagement, including retention of
talented and committed staff. This year, in addition to our annual survey, we
dug deeper to ensure we were truly understanding our division strengths
and identifying any opportunities for improvement. We had extensive
discussions with our leadership team, they met with their staff individually
and/or as small groups, we met with supervisors individually, and followed
up on feedback with a short, division specific survey. We concluded this
year's research with a summary presentation and discussion with all staff.
Some of the areas we remain committed to are training, recognition, and
staff appreciation; team building activities to focus on relationship
development and personal growth; encouraging a work -life balance to
include flexibility and telework opportunities; and participation in various
department initiatives and committees.
Professional Development
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Weld County DHS understands the importance of investing in our staff and is
committed to continuous improvement, regularly providing training
opportunities for our division. Leadership engages with our staff to learn
their individual goals and aspirations and works to identify trends or
potential areas for growth that may exist on a program level. All Weld
County DHS staff are required to attend a minimum of twenty (20) hours of
continuous education training each year. Professional development
opportunities vary depending on the needs and/or interests of an individual
team member, but also include job specific topics, leadership, and various
other professional development areas that may be more person specific. Our
staff are encouraged to participate in professional development opportunities
and time is allotted for participation.
In addition to the various CMA trainings offered through the Department of
Healthcare Policy and Financing (HCPF), we disseminate information on a
variety of training opportunities. We have recently provided trainings to our
division that focused on safety related to home visits, mental health and
crisis situations, and trainings to enhance person centeredness, including a
Virtual Dementia Tour (an evidence based sensory experience) and Person -
Centered Trauma Informed Approaches with Dr. Sheri Gibson.
Communication
We understand that change can cause fear and anxiety. We also understand
the importance of clear and consistent communication throughout the
change management process and how vital it is to successful outcomes. We
remain committed to keeping our staff informed throughout the case
management redesign process. We are committed to keeping our staff
informed when there is new information to share and have started checking
in with them regularly. Our SEP Supervisors meet with their staff regularly
and all management have an open-door policy. In addition to individual staff
check -ins, the SEP has a monthly team meeting, which the AAA Division
Director and/or Deputy Division Director attend, to ensure accessibility.
Conclusion
Weld County DHS will continue to assess and revise our retention plans
within the SEP throughout the case management redesign process. As things
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progress and evolve, changes will be made as appropriate to ensure we are
supporting staff in the provision of quality service to our consumers, and
that we remain their employer of choice.
OFFEROR'S RESPONSE 5: Case Management Obligations
Please provide a detailed response on how the Offeror will meet
each obligation outlined in Case Management Obligations. The
Offeror's response must address the following:
OFFEROR'S RESPONSE 5.a: Business Function of CMA
How the Offeror will meet the obligations specifically outlined in
Sections 3.1.6. through and including 3.1.6.8. of this solicitation
3.1.6.1
The Contractor shall maintain a publicly accessible and
ADA compliant office within each Defined Service Area
and appropriate staffing pattern to serve the Defined
Service Area.
The Contractor shall ensure adequate staffing through
virtual or in -person services throughout the Defined
Service Area in addition to the physical office space,
providing access to its office for staff, Members, families,
services providers and others to best meet the needs of
individual Members.
WC CMA shall maintain a publicly accessible and ADA compliant office within
Weld County and shall ensure adequate staffing through virtual or in -person
services throughout the service area to best meet the needs of individual
Members. WC CMA's physical office, located at 315 N. 11th Avenue, Building
C, in Greeley, Colorado, is established and ready for continued use if
awarded the contract associated with this solicitation. The third (3rd) floor of
this building has offices for employees of the SEP program, Adult Protection
Unit, and the Older Americans Act Program. In addition to this location,
WCDHS has access to three buildings on the main campus in Greeley, two in
downtown Greeley, one in Fort Lupton, and one in Del Camino. The
abundance of accessible space and infrastructure within this network of
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county buildings enables WC CMA a high degree of flexibility to
accommodate growth and new staff.
WC CMA has several possible solutions to accommodate the estimated
thirty-five (35) additional employees necessary to staff the CMA, one of
which involved the relocation of Adult Protection Program and Older
Americans Act staff to the Chase Building in downtown Greeley prior to the
operational start date, thus ensuring all case management services are
centralized at Building C of the DHS campus. Our existing office shall remain
publicly accessible and ADA compliant, open during regular business hours,
Monday through Friday, with dedicated parking spaces for visitors and first
floor receptionists to greet and assist everyone who enters the building. First
floor meeting spaces are also available for in -person meetings with
Members, families, services providers, and others.
All WC CMA staff, including any new staff, will have a dedicated office space
on the third (3rd) floor, laptops, phones, monitors, and other required office
equipment necessary to effectively complete the work in this solicitation.
Staff will be available during regular business office hours, Monday through
Friday, with regular business hours posted and made available to the public
on our website and the front doors of the building. In addition, all staff will
have dedicated phone lines, secure and encrypted email capabilities,
Microsoft Teams accounts, and assigned secure business laptops to support
working virtually with Members, in the office, from home, the residences of
Members, and other locations as required.
WC CMA shall ensure all employees have a valid Colorado Driver's License,
liability insurance, and transportation to fulfill contract contact requirements
and Member contact preferences. WC CMA reimburses employees for all
work -related travel. As part of the hiring process, all employees must be
willing to drive, as needed, throughout Weld County to fulfill these
requirements.
WC CMA is fully staffed and equipped to address the case management
needs and contact preferences of LTSS program applicants and Members in
all areas of Weld County. WC CMA has demonstrated its ability to provide in -
person and virtual case management services since 1993. With the
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combination of its existing service area, access to Weld County resources,
and the availability of building space, departments, divisions, policies,
procedures, and experience, WC CMA is well -positioned to grow and expand
its case management agency into a fully integrated CMA as defined in this
solicitation.
3.1.6.2. The Contractor shall have internal procedures for
accommodating individuals, Members and families who
need assistance or consultation outside regular business
office hours.
WC CMA understands that individuals, Members, and families may have
needs for assistance or consultation outside of regular business hours due to
a variety of reasons, including disabilities, personal preferences, work and
school schedules, and other commitments. In order to better serve our
clients, WC CMA has established an internal procedure for accommodating
these requests.
WC CMA Internal Procedure for Accommodating Individuals, Members, and
Families Outside of Regular Business Hours
Assistance includes all case management services as defined in contract and
rule, to include activities that can be completed by phone, virtually, and in -
person.
Regular business hours for WC CMA are Monday through Friday, 8:00am to
5:00pm. We are closed on federal, state, or local holidays, as well as
unplanned closures due to inclement weather or other emergencies.
Procedure for Accommodating Requests:
1. Requests for assistance outside of regular business hours should be
made to a WC CMA staff member as soon as possible.
2. WC CMA staff must accommodate requests based on client preferences
and needs.
3. Staff are preauthorized to adjust workday and workweek schedules as
needed to adapt to outside of business hour requests, however for
safety reasons, they must notify their supervisor of the change.
Page 1123
4. Use of overtime to accommodate these requests is explicitly prohibited
without prior approval from a managing supervisor.
5. All requests for assistance outside of regular business hours will be
documented and reported to the appropriate supervisor and
documented in the Department information management system.
3.1.6.3.
The Contractor shall have an emergency on -call procedure
to respond to crisis situations outside of regular business
hours. Procedures must clearly document how the
Contractor will ensure timely response to emergency
situations such as hospital discharges, risk of
homelessness, unexpected termination of residential
services, etc. The Contractor shall make the procedure
available to the Department upon request. The Contractor
shall notify Members of the procedures and the procedure
posted or otherwise make it readily available to Members,
Member's families, providers and community partners
through a variety of methods.
This Emergency On -Call Plan outlines the procedures that WC CMA will follow
to respond to crisis situations outside of regular business hours. The plan is
designed to ensure a timely and effective response to emergency situations
such as hospital discharges, risk of homelessness, unexpected termination of
residential services, and others.
Procedures
1 Designation of On -Call Staff: WC CMA will designate a team of staff
members who will rotate on -call responsibilities and be available to
respond to emergency situations. On -call staff will answer a dedicated
cell phone for CMA emergencies and will assist with emergency calls,
after hours, weekends and holidays.
2 Contact Information: WC CMA shall ensure that stakeholders, including
Members, Member's families, providers, and community partners, have
access to the emergency on -call procedure and emergency contact
information. The procedure and emergency contact information shall
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be made readily available through a variety of methods, including
posting it on the CMA's website and including it in paperwork left with
members at assessments and other contacts.
3. Emergency Response Protocol: In the event of an emergency, the on -
call staff will adhere to the following protocol: a) Within (1) hour,
contact the member, their family, and/or provider to assess the
situation and determine the level of assistance required. b) If
necessary, the on -call staff will contact other agencies, departments,
etc. that may be able to assist the member c) On call staff may help
arrange or facilitate appropriate support services, such as temporary
housing, transportation, or medical support, to address the crisis
situation. d) The on -call staff will keep all relevant stakeholders
informed of the situation and the steps being taken to resolve it.
4. Documentation: All emergency response activities will be documented
in a clear and concise manner in Department information management
system(s). This documentation will include the date, time, and details
of the emergency, the steps taken to address it, the outcome, critical
incident reporting, and follow-up activities.
5. Availability of Procedures: WC CMA will make the Emergency On -Call
Plan available to the Department upon request and will also notify
members, their families, providers, and community partners of the
procedures through a variety of methods, such as posting the
procedure in a readily accessible location (www.weld.gov) and
including the plan in assessment and service plan documents.
6. Training: All staff assigned on -call responsibilities shall be trained on
all applicable procedures and responsibilities.
7. Regular Review: WC CMA will regularly review and update the
Emergency On -Call Plan to ensure its effectiveness and to incorporate
any necessary changes.
By following this Emergency On -Call Plan, WC CMA is committed to providing
prompt and effective support to its members in the event of a crisis.
Page 1125
3.1.6.4.
The Contractor shall have an internal policy and procedure
to respond to all telephone calls, voicemails, and emails
from Members and families on average within two
Business Days of receipt by the Contractor.
WC CMA Internal Policy for Responding to Member and Family
Communications
1. Purpose: This policy outlines the procedures for responding to all
communication from Members and families in a timely and professional
manner.
2. Scope: This policy applies to all WC CMA employees who receive
communication from Members and families.
3. Timeliness of Response: All WC CMA staff shall respond to all
telephone calls, voicemails, and emails from Members and families
within two (2) Business Days of receipt of the communication. Issues
of an urgent nature, such as hospital discharges or the sudden loss of
services will be prioritized and reduced, when possible, to a one (1)
day timeframe. After hour emergencies shall comply with WC CMA
emergency on -call procedure timelines.
5. Documentation: WC CMA shall document all communication received
from Members and families and the response provided. This
documentation shall be recorded in the Department information
management system.
6. Availability of Policy: WC CMA shall make this policy available to
Members, families, and the Department upon request.
7. Training: WC CMA shall provide training to all staff on this policy and
procedures for responding to Member and family communication.
8. Monitoring: WC CMA shall regularly monitor compliance with this policy
and take appropriate corrective action as needed.
9. Review: This policy shall be reviewed on an annual basis and updated
as needed to ensure that it remains relevant and effective.
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3.1.6.5.
The Contractor shall overcome any geographic barriers
within the Defined Service Area, including distance from
the agency office to provide timely assessment and case
management services to individuals, Members and
families, as required by Contract, Federal or State statutes
and regulations. This may include staff who reside
throughout the Defined Service Area to best meet the
needs of individuals and members.
WC CMA is committed to providing timely and effective assessment and case
management services to individuals, Members, and families within the
Defined Service Area 9 (Weld County). To ensure that we are fulfilling our
obligations as required by Contract, Federal or State statutes and
regulations, if awarded the CMA contract associated with this solicitation, we
will continue to overcome any geographic barriers within Weld County.
As stated in 10 CCR 2505-10-8.519.2.A.6, WC CMA provides waiver and
non -waiver program case management services to any individual in Weld
County enrolled or enrolling in Long -Term Services and Supports (LTSS).
This includes, but is not limited to, intake and referral, level of care screen
and assessments, support needs assessments, person -centered support
planning, critical incident reporting, service brokering and monitoring, and
other activities.
Despite the size and geography of Weld County, WC CMA has extensive
experience serving all residents, regardless of their location or distance from
our main office. Our extensive experience includes managing the challenges
of finding and setting up HCBS services for Members far from more
populated areas, working with providers and community partners to enhance
service access in remote areas, driving long distances for home visits, and
disseminating information county -wide through multiple modes of
communication.
To address geographic barriers, WC CMA ensures all employees have a valid
Colorado Driver's License, liability insurance, and transportation to fulfill
Member contact requirements and preferences. Employees are reimbursed
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for all work -related travel, and as part of the hiring process, all employees
must be willing to drive throughout Weld County as needed.
In addition, WC CMA has access to buildings in northern and southern Weld
County to aid in Member case management service access. We will continue
to leverage the varied geographic locations of case managers to allow for
shorter commute times when conducting Member home visits. This further
underscores our commitment to fulfilling our obligations and serving all
residents of Weld County.
WC CMA complies with all rules and regulations outlined in contract,
including those in 8.393.1.H. Access. As stated in Section 8.393.1.H 1., WC
CMA does not have any physical barriers that prohibit individual participation
and complies with the Americans with Disabilities Act (ADA), 42 U.S.C.
12101 et seq. In accordance with Section 8.393.1.H.1.a., individuals
receiving services are not required to come to the Agency's office to receive
SEP services.
3.1.6.6. The Contractor shall protect Members' rights as they
relate to the responsibilities of Case Management
Agencies as described in the Contract.
WC CMA is committed to safeguarding the rights of individuals and
members. As a Case Management Agency, WC CMA is obligated to abide by
the provisions outlined in its contracts and to establish written policies that
guarantee the rights of each individual, including the right to dignity,
respect, and privacy.
In compliance with relevant regulations, Title XIX of the Social Security Act,
and other applicable federal and state laws, WC CMA will ensure that the
rights of individuals and members are protected. This includes, but is not
limited to the following rights; the right to be treated with respect, to receive
services, to participate in decisions concerning their services, to select
service providers, to be fully informed of their rights and responsibilities, to
be free from any form of restraint or seclusion, to access a uniform
complaint system, to access a uniform appeal process, to confidentiality, and
the right to be free from discrimination.
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To ensure that everyone is aware of their rights, WC CMA will provide
information about these rights to individuals, members, their families,
providers, case workers, and stakeholders, and will make sure that this
information is posted on our website and distributed at home visits, and by
mail and email, depending on Member preference. Additionally, if awarded
the contract associated with this solicitation, WC CMA will establish a Human
Rights Committee (HRC) to act as a safeguard for the legal rights of persons
receiving services on the HCBS-CES waiver, HCBS-CHRP, HCBS-SLS, HCBS-
DD, State SLS, OBRA-SS, and FSSP. The HRC will be responsible for
informed consent, monitoring the suspension of rights, behavioral
development programs, the use of psychotropic medication, and reviewing
mistreatment investigations.
All WC CMA staff will undergo training on member rights and how to inform
individuals, members, their families, providers, case workers, and
stakeholders of these rights in person, in writing, and virtually.
WC CMA is steadfast in its commitment to upholding these rights and to
ensuring that each individual and member is treated with the utmost dignity,
respect, and privacy.
3.1.6.7.
The Contractor shall provide access to a telephone system
and trained staff to ensure timely response to messages
and telephone calls received after hours.
WC CMA is dedicated to providing its members with timely and efficient
access to its services, during and outside of normal business hours. To
achieve this goal, the organization has put in place several key systems and
processes to ensure that all incoming calls, voicemails, and emails are
responded to promptly.
Telephone System: All WC CMA employees have been assigned a network
phone, providing them with direct access to the organization's telephone
system. Additionally, front desk receptions have access to the telephone
system, enabling them to assist members as they come in and to contact
CMA staff if necessary. The telephone system has been designed to be user-
friendly and intuitive, making it easy for staff to access the information they
need and to respond to incoming calls efficiently.
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Receptionist: WC CMA has a dedicated phone team of clerical staff to answer
incoming calls, provide information and referral, and assist case
management agency staff with clerical duties. This role is crucial in ensuring
that all incoming calls are handled promptly and professionally, and that
members can receive the support they need in a timely manner.
Interpreter Services: WC CMA understands the importance of being able to
communicate effectively with its diverse member population. The
organization has put in place an interpreter services system, which allows
CMA staff to easily access interpreter or bilingual services over the phone, as
needed. This ensures that all members have equal access to the support
they require, regardless of language barriers.
Response Time: WC CMA is committed to responding to all telephone calls,
voicemails, and emails within two business days of receipt. This ensures that
members can receive the support they need in a timely manner and that the
organization is able to maintain high levels of customer satisfaction.
Voicemail System: All WC CMA staff have dedicated phone numbers,
network telephones, and access to voicemail. Voicemails can be accessed
through the phone or through audio file attachments sent to staff inboxes,
which include Caller ID information, date and time stamps, and message
duration information. The voicemail system is encrypted and managed by
Weld County's IT department, ensuring that all messages are secure and
protected. Although on -call staff are expected to check voicemails outside of
business hours, staff working a regular schedule are expected to check
voicemails the next business day.
On -Call Staff: WC CMA will have a dedicated cell phone to be used by on -call
staff to address after -hour emergencies. This ensures that the organization
can respond to urgent issues quickly and effectively, even outside of normal
business hours.
Training: All new CMA staff receive comprehensive training in the first week
of their employment, including how to use the telephone system, menu
systems, and voicemail. They are also trained on relevant timeline
procedures related to returning calls and emails from members and their
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families. This ensures that all staff are equipped with the knowledge and
skills they need to provide the best possible support to members.
3.1.6.8.
The Contractor shall provide access to telecommunication
devices and/or interpreters for the hearing and vocally
impaired and foreign language interpreters as needed to
fulfill all Contract requirements. The Contractor shall
conduct an assessment of the communication needs of the
Members they serve and ensure their interpretation and
telecommunication services sufficiently meet the
Members needs in a timely fashion.
WC CMA provides comprehensive communication support to its members,
including those who are hearing and vocally impaired, those who speak a
foreign language, and those with communication barriers. Our agency is
committed to fulfilling all Contract requirements in a professional and
informative manner to ensure effective communication with our members.
To ensure the communication needs of our members are met, our case
management staff will conduct an evaluation during all intake and annual
assessments, as well as during other contacts with members, as needed.
During these evaluations, our staff will work to identify any communication
barriers and determine the individual's preferred method of communication.
This may include assessing the preferred language of the member and
assigning a bilingual staff member who speaks the same language, if
available. Our agency recognizes the importance of effective communication
and is equipped to address any communication needs using various methods
and technologies.
WC CMA also has strong relationships with community partners, including
the local Refugee and Asylum Program, to provide in -person interpretation
services when needed. In addition, we have access to interpretation services
through our agency, including Language Line Solutions, Voiance Language
Interpretation Services, and Voiance for Sign Language, which includes web -
based video. Our case managers can access these services in the office or
remotely through cell phones and laptops, ensuring that communication
support is always readily available.
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WC CMA staff are and will continue to be familiar with various methods of
communication, including talk -to -text options for emails and text messages,
and are experienced working with clients who use teletypewriters or text
telephones (TTY) to communicate over the phone. Our staff is aware of how
to access and use Telecommunication Relay Services (TRS) and are familiar
with Relay Colorado, a statewide service that connects standard voice
telephone users with those who use TTYs or voice carry-over (VCO) phones.
WC CMA staff are knowledgeable about Augmentative and Alternative
Communication (AAC) devices that are used to help individuals with
communication disorders express themselves. WC CMA uses the following
services to address communication needs: 711- Relay Colorado, TTY, Voice
Caller, Voice Carry Over, and Telebraille Relay Service. TTY is a device used
by individuals who are deaf, deafblind, hard of hearing, or have a speech
disability to communicate over the phone. Voice Caller is a standard
telephone service used by those with hearing loss or speech disabilities who
use TTYs or VCO phones. Voice Carry Over (VCO) allows a caller with
hearing loss to speak directly to a hearing person. Telebraille Relay Service
is a service used by individuals who are deafblind or have low vision to
communicate over the phone through a TTY or Telebraille device. English -to -
Spanish and Spanish -to -English translations are also available for Telebraille
Relay customers, ensuring that all members have access to effective
communication support, regardless of their language preferences.
The platform utilized by WC CMA for virtual meetings has closed captioning
available, and staff may use paper, pen, or whiteboards during in -person
visits as necessary. Our agency is dedicated to providing accessible and
effective communication for all members, and our experienced staff work to
ensure all communication needs are met.
WC CMA recognizes the importance of effective communication in serving its
members and is equipped with the resources and experience to address any
communication needs in a professional and informative manner. If awarded
the contract associated with this solicitation, WC CMA will carry over our
existing experience, services, and practices, and will then further enhance
our communication tools and resources, as needed and required, to be a
fully integrated CMA committed to serving all our members.
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OFFEROR'S RESPONSE 5.b: Maintaining Relationships (e.g., RAEs,
CCBs, Medicaid Assistance Sites)
How the Offeror will build and maintain relationships with the RAEs,
CCBs, BHAs, Medicaid Assistance Sites, community advocacy
organizations, and other CMAs and ensure continued collaboration
occurs for shared individuals and/or Members.
WC CMA fosters strong relationships and collaborations with various entities
in the community. At WC CMA, we understand the significance of
partnerships and collaborations in providing comprehensive and effective
services and supports for the individuals we serve. Our agency has
established robust relationships with a broad network of community
partners, including the Regional Accountable Entity (RAE), Community
Centered Boards (CCB), county departments of human services and medical
assistance sites, other case management agencies, behavioral health
administration, advocacy organizations, and others. Our involvement in
various committees, meetings, groups, partnerships, and events keeps us
informed and engaged with the broader community and ensures that we are
able to provide the best possible services to those in need.
Our response to this section provides a comprehensive overview of our
relationships with these entities, including our commitments and plans for
continued collaboration and growth. We believe that these partnerships and
collaborations are essential to ensuring that our services are of the highest
quality and that we are meeting the needs of our community.
Regional Accountable Entity (RAE)
WC CMA is committed to establishing and maintaining strong relationships
with the Regional Accountable Entity (RAE) with the goal of ensuring a
seamless and continuous collaboration between both entities for the benefit
of shared individuals and/or Members. To this end, WC CMA has established
the below plan and has assigned the position of RAE Liaison to a member of
our CMA management team.
The RAE plays a crucial role in coordinating physical health services and
arranging for behavioral health services, including mental health services
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and non -waiver behavioral services and supports available through Medicaid.
The RAE is instrumental in promoting the overall health and well-being of
the population, coordinating care across disparate providers, and
collaborating with various agencies to address complex needs that cross
multiple geographic catchment areas.
To preserve its relationship with the RAE, WC CMA will continue to utilize the
established referral plan to direct Members to the RAE, as required by their
specific needs. Case managers from both WC CMA and the RAE will work in
close collaboration on shared cases, communicating via telephone, email,
virtually, and if deemed appropriate, in -person to ensure appropriate
coordination of services.
WC CMA has a well -established relationship with the RAE for Weld County,
Northeast Health Partners (NHP), and their care coordination subcontractor,
Northern Health Alliance (NHA), and intends to leverage this relationship to
further enhance its collaborative efforts. To this end, the CMA will educate its
staff on the services provided by the NHP and NHA and will provide practical
examples of when referring Members to the RAE is appropriate. WC CMA and
NHA will periodically conduct in-service trainings and presentations for one
another. Additionally, WC CMA will confer with the RAE to create a
comprehensive guide that clearly defines the services and responsibilities of
both entities, thereby facilitating the identification of the agency responsible
for facilitation and follow-up on shared cases. WC CMA and the RAE will use
existing resources that contribute to this aspect of this collaborative project,
to include the utilization of a twenty-nine (29) page PowerPoint training
created by Northeast Health Partners that covers topics such as "Care
Coordination Roles and Responsibilities," and "Working with Care
Coordinators."
For shared Members who require assistance in accessing or coordinating
physical, behavioral, or mental health needs, WC CMA will work in
collaboration with the RAE. This will encompass, but not be limited to,
Members with complex medical or behavioral support needs, changes in
conditions, or involvement with Child Welfare or Adult Protection. The CMA
will also coordinate with the RAE for shared Members who are admitted to a
Page 1134
hospital, communicating the reasons for admission, Member's hospital
status, plans for discharge, and discharge service planning and coordination.
WC CMA will enter into a data sharing agreement with the RAE for the
exchange of necessary information for the RAE to assist Members in
accessing and coordinating physical and behavioral health needs. The CMA
will also create a complex and creative solutions process with the RAE and
designate staff to address needs that span multiple Medicaid systems for all
shared Members. This will include regular joint coordination and consultation
meetings to guarantee in-depth, comprehensive, holistic case management
and care coordination.
Finally, WC CMA supervisors will continue to participate in NHP's Program
Improvement Advisory Committee (PIAC) and will always have at least one
(1) voting member on the PIAC at any given time. At least one (1) WC CMA
supervisor will participate in a monthly forum called First Friday Quality
Forum, hosted by NHP. WC CMA will collaborate with the Department and
RAEs to identify a Key Performance Indicator (KPI) to assess the efficacy of
coordination between the Contractor and RAE. The CMA will also respect
Members' preferences for case management and care coordination, where
applicable, while ensuring collaboration with the RAE occurs.
In conclusion, WC CMA is dedicated to establishing and maintaining strong
relationships with RAEs to ensure continued collaboration for shared
individuals and/or Members.
Community Centered Boards (CCB)
WC CMA recognizes the critical importance of Community Centered Boards
(CCBs) in addressing the unmet needs of individuals with Intellectual and
Developmental Disabilities (IDD) and their families. To ensure seamless
collaboration for shared individuals and/or Members, WC CMA will dedicate
significant time and effort to build and maintain strong relationships with
CCBs.
WC CMA has an excellent relationship with the CCB for this area, Envision,
and will be leveraging that relationship to help fulfill several requirements of
this contract, such as the establishment of a Family Support Council and
Page 1135
Human rights Council under the new integrated CMA for the area, and the
recruitment of existing CCB staff to fill positions for historically CCB
managed waivers and programs. WC CMA will maintain a relationship with
Envision by sharing resources and participating in joint meetings, and joint
trainings and community initiatives. Envision will continue to be a service
provider for IDD programs, such as providing day program services and job
coaching, therefore we will be collaborating with them on the ground in our
efforts to provide and monitor services for our mutual clients.
WC CMA will make referrals as necessary to assist members and their
families, to include referrals for the Early Intervention program. We will
make sure that Envision always has the most current contact information for
WC CMA to ensure ease of access for individuals and their families that walk
through their doors looking for help.
WC CMA shall collaborate with CCBs, this may include, but not be limited to
receiving referrals or sharing information necessary for the CCB and/or CMA
to assist individuals and Members in accessing LTSS programs targeted for
individuals with an intellectual and developmental disability or children with
disabilities and coordinating care for non -waiver services for members with
an intellectual and developmental disability where applicable or appropriate.
County Department of Human Services and Medical Assistance (MA) Sites
WC CMA recognizes the crucial role played by the County Department of
Human/Social Services and Medical Assistance (MA) Sites in determining
eligibility for State -authorized Medical Assistance programs, such as Child
Health Plan Plus (CHP+) and Health First Colorado (Colorado's Medicaid
Program). To ensure seamless collaboration and support for its Members,
WC CMA is dedicated to working closely with these entities, and has done so
for over twenty (20) plus years.
WC CMA works alongside and in collaboration with our Assistance Payments
Long -Term Care Financial Eligibility Unit (LFEU). The LFEU is a part of our
Weld County Area Agency on Aging (AAA) division. Being under the same
division and located on the same floor in the same building as the WC CMA,
allows us to seamlessly collaborate between our CMA and our county
medical assistance eligibility unit pertaining to application, renewal, case
Page 1136
changes and/or re -application status for members in our designated service
area. Under the larger umbrella of Weld County DHS, the LFEU and CMA are
connected in important and useful ways, such as being linked by the same
IT infrastructure and systems, shared secure communication methods
(email, telephones, Teams, Outlook, onsite in -person meetings), a shared
mission, and an ease of access to staff, supervisors, managers, and
directors; people and positions with established relationships in close
proximity and shared purpose. If awarded the contract associated with this
solicitation, the physical arrangement of the two programs (LFEU and CMA)
will not change, thus allowing for continued ease of contact and member
benefits coordination.
Also, the LTC Technicians manage our Burial Benefits Program. WC CMA
staff work together assisting families and supports to apply for needed
benefits during a very difficult time.
WC CMA will continue to work with other county eligibility units statewide, as
needed for case transfers to other CMAs. WC CMA will continue to use the
standardized DHS communication form developed by the Department to
facilitate communications between CMA and county sites, and WC CMA will
continue to access a Single Entry Point developed, statewide shared, contact
document that includes information for every Colorado county financial
eligibility team.
WC CMA works with a few medical assistance sites to complete similar case
activities to those handled by our financial unit. We have worked
successfully with Denver Health Hospital and Authority and Banner Hospital,
among others. Communication with MA Sites primarily takes place through
encrypted email services, and WC CMA can obtain MA Site contact
information via the Department's Medical Assistance Site Directory located at
https://hcpf.colorado.gov.
In summary, WC CMA shall collaborate with the appropriate counties and/or
Medical Assistance sites in order to ensure proper follow up and
communication to support members in obtaining and maintaining their
benefits.
Other Case Management Agencies
Page 1137
WC CMA administrators and supervisors have cultivated long time
relationships with CMAs statewide, to include active participation in the
Options for Long Term Care Association (OLTCAA). The OLTCAA, comprised
of members from all Single Entry Points, meets quarterly to address system
issues, get updates from Department staff, process CMA Quarterly meetings,
streamline work processes and establish agreements about cross agency
practices, such as those involving county transfers, and to exchange best
practices and tips on all topics and tasks relevant to providing case
management services in Colorado.
A WC CMA supervisor has been the OLTCAA Chair for over two years, and
WC CMA staff have served the OLTCAA in numerous capacities over the
years, including holding Chair, Vice Chair, and Secretary positions. Weld has
led several projects for this group, and the Chair has functioned as the
liaison between the association and the Department. WC CMA make every
effort to ensure this association or some version of it persists into the new
contracts associated with this solicitation.
WC CMA will maintain several close relationships with surrounding CMAs,
creating opportunities for collaboration and support with individuals and
small groups of people. Well CMA will continue to use the shared information
systems created for Single Entry Points, such as a universally updated
contact information document, and an online shared file system used to
coordinate efforts on projects and store documents related to our meetings.
In summary, WC CMA will continue to nurture and develop existing CMA
relationships, to take lead on projects and efforts impacting all CMAs, and
will ensure the continuity of the OLTCAA and the inclusion of new members
after contract awards take place for all catchments, statewide.
Behavioral Health Administration, Advocacy Organizations, and Other
WC CMA is a program within the Weld County Department of Human
Services Area Agency on Aging (Weld County AM), and its primary goal is
to provide comprehensive and effective services and supports to the
individuals serves. To achieve this goal, WC CMA recognizes the importance
of establishing, maintaining, and optimizing partnerships and collaboration
with various organizations and communities.
Page 1138
WC CMA has a broad network of community partners, including Catholic
Charities, Meals on Wheels, Colorado Legal Services, and 60+ Rides. In
addition, WC CMA is a part of the Older Americans Act (OAA) program,
which is responsible for several resources for the community, including the
Long -Term Care Ombudsman, Senior Nutrition Program, and Aging and
Disability Resources for Colorado (ADRC). These partnerships allow WC CMA
to provide a multitude of resources to individuals in need, ensuring
comprehensive and effective care plans.
In addition to these partnerships, WC CMA has strong connections with local,
state, and national organizations. The agency actively participates in
committees, meetings, conferences, trainings, and other networking events
to foster collaboration and combined efforts in delivering quality services.
WC CMA's leadership team is involved in various boards, teams, and
committees, including the Health Care Policy and Financing (Department)
County Directors Leadership Meeting and the Case Management Agency
(CMA) Executive Meeting, to stay informed and engaged with the broader
community. WC CMA is also a voting member with the Regional Accountable
Entity's (RAE) Program Improvement Advisory Committee (PIAC) and is on
the Birchwood Advisory Board, the ADEO Human Rights Committee, the
Older Americans Act Advisory Board, the Adult Protection Community Team,
the SEP Advisory and Resource Development Committee, the Aging and
Adult SubPAC, the CHSDA Aging and Adult Sub -Committee, the
Administrative Review Division (ARD) Steering Committee, the C4A - Area
Agency on Aging Director's Association, and the Aging Policy Advisory
Council (APAC).
WC CMA also attends various stakeholder and educational sessions provided
by the Colorado Department of Human Services (CDHS) and Health Care
Policy and Financing (HCPF) to stay current on policy and practice issues
that impact the individuals it serves. This includes, but is not limited to,
stakeholder and community engagement sessions, PHE Unwind, ARPA
Funds, CMRD, Assessment and CCM, Community of Practice, Home delivered
Meals subcommittee, CDHS State Unit on Aging (SUA) Future Planning
Meetings, and the CDHS Weekly County Call. In addition, WC CMA attends
numerous networking and educational opportunities in the community, such
Page 1139
as the Northern Colorado Quarterly Community Consultation (hosted by
Lutheran Family Services Rocky Mountains and the Colorado Refugee
Services Program) and the Community Action Collaborative (led by North
Colorado Health Alliance).
WC CMA understands the importance of mutual benefit in its community
partnerships and works hard to provide value to these relationships. The
agency receives updates and newsletters from organizations such as
Advancing States, National Adult Protective Services (NAPSA), the American
Society on Aging, the American Association of Intellectual and
Developmental Disabilities (AAIDD), Alliance, and The Arc to stay informed.
WC CMA is also committed to continuous improvement and plans to develop
additional connections with organizations to diversify its community
involvement and foster strong relationships that benefit the individuals it
serves. These planned partnerships include the Regional Transition
Committee, the Colorado Transition Team, the Weld County Mobility Council
(North Front Range Metro Planning Organization), the Adaptive and Inclusive
Recreation Program Board (City of Greeley), the Early Childhood Council,
and several local Program Approved Service Agencies (PASAs).
WC CMA is also actively involved with the Behavioral Health Administration
through its Director's participation on the Behavioral Health Administration
Advisory Council (BHAAC). The agency actively participates in initiatives,
communicates, and shares information, and works hard to provide value to
its relationships with its partners.
In conclusion, WC CMA recognizes the importance of community
partnerships and collaboration in achieving its goal of providing
comprehensive and effective services for the individuals it serves. The
agency has a broad network of community partners, strong connections with
local, state, and national organizations, and is committed to continuous
improvement in its community involvement.
OFFEROR'S RESPONSE 5.c: Complaint and Grievances
The Offerors proposed process, if awarded the Contract, for ensuring
Members are informed of the complaint and grievance process to
include but not limited to how the Offeror will:
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i Receive and address complaints and grievances
ii Will take action to resolve individual concerns
iii Identify trends requiring immediate action.
As an existing SEP, in accordance with Section 8.519.20, WC CMA has
Grievance/Complaint (G/C) procedures in place. If awarded the contract
associated with this solicitation, WC CMA proposes the following
Grievance/Complaint Procedure/Process.
Notification Methods
All Clients, the parents of a minor, guardian and/or authorized
representative, as applicable, applying for and/or receiving case
management services from WC CMA, shall be notified verbally and in writing
about the G/C procedure at the a) initial assessment, b) annual
reassessment, c) off -schedule assessments, and c) at any point in time a
case manager, supervisor, or other employee of the case management
agency becomes aware of a grievance or potential grievance during the
relationship with the Member.
Verbal notification shall consist of a review of the G/C procedure. Written
notification shall consist of the dissemination of assessment paperwork to
the Member, the parents of a minor, guardian and/or authorized
representative, as applicable, that among other things contains the G/C
procedure for WC CMA. Written notification shall also include the
dissemination of the G/C Procedure by email, fax, and mail. The G/C
Procedure will be posted on the website for WC CMA at www.weld.gov. The
CMA section of the website includes a link to a dedicated email account for
complaints (CMAcomplaints@weld.gov). All emails sent to this account are
distributed to the entire WC CMA management team, and this will continue
as a contact method if WC CMA is awarded the contract associated with this
solicitation.
Notification Content
In accordance with Sections 8.605.5.B and 8.519.20.C, all verbal and
written notifications shall include:
Page 1141
Contact name and contact information for the person(s) at WC CMA
who is responsible for receiving complaints (Sections 8.519.20.C.1
and 8.605.5.B.1)
Contact information for the Department of Healthcare Policy and
Financing (Sections 8.519.20.C.2 and 8.605.5.B.2)
Identification of support person(s) to assist in the submission of the
grievance (Sections 8.519.20.C.3 and 8.605.5.B.3), such as contact
information for the Department, legal services, and publicly and
privately funded advocacy organizations, RAEs, and CCBs.
Receipt of Complaints
WC CMA shall receive, document, and track any complaint about services
provided through this Contract to include, but not limited to general business
functions, administration, State General Funded Programs, and case
management functions outlined in contract and rule.
G/Cs shall be received by any method of communication preferred by the
Member, the parents of a minor, guardian and/or authorized representative,
as applicable, such as by phone, in -person, by mail, and email. WC CMA's
G/C Procedure shall include contact information for the agency
administrator, Kelly Morrison, all supervisors, the Department, and our
dedicated emails address for complaints (CMAcomplaints@weld.gov).
All incoming complaints and grievances about WC CMA supervisors shall be
processed by the agency administrator. All incoming complaints about any
other employee shall be received and processed by the supervisory team for
a first level review and response.
All incoming complaints and grievances shall be processed within twenty-
four (24) hours, to include initiating contact with the Member, the parents of
a minor, guardian and/or authorized representative, as applicable, to
ascertain the nature of the complaint and to discuss possible resolutions.
Complainants will be assured that providing feedback about Weld County
CMA is not only encouraged and important, but it is their right as a
participating Member.
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Weld County CMA staff shall never coerce, intimidate, threaten, or retaliate
against a Member, the parents of a minor, guardian and/or authorized
representative, as applicable, that file a complaint/grievance of any type.
Non -adherence to this requirement shall result in strong disciplinary action.
Addressing Complaints
The administrator and/or supervisor managing the complaint/grievance shall
work directly with the Member and other individuals identified, as needed, in
a location of their choosing (in -person, virtual, phone, etc.)
Options to resolve the complaint shall be provided and discussed. Agreed
upon resolutions shall be clearly summarized and assigned a timeframe. The
Member and/or other parties shall be informed of their right to request a
new case manager at any time. Mediation shall be presented as an option if
a mutually agreed upon resolution cannot be reached.
All complaints about Weld County CMA and staff shall be logged in the
Department prescribed Complaint Log and shall include complaint/grievance
details such as Member name, the name of the person who filed the
complaint, the name of the WC CMA employee(s) who are involved in the
complaint, the type of complaint, a detailed description of the complaint,
measures taken to resolve the complaint, and timelines.
Complaint Trend Analysis
On a quarterly basis, supervisors will analyze the complaint log for
trends/patterns, such as:
o A comparison of complaint types.
o The number of complaints over a period.
o The number of type of complaint against the Contractor, time,
location, individuals involved, staff involved, and/or any additional
relevant information.
Other discernable patterns not listed above.
An examination of potential reasons for the increase or decrease in
complaints by total number, subcontractor, individual, or staff.
An examination of potential reasons for the increase or decrease in
complaints by total number, subcontractor, individual, or staff.
Page 1143
o An examination of preventative measures that can be implemented
to reduce the number or frequency of future complaints.
o Implementation of a plan of action or any future actions to take
place.
o An analysis of whether the plan of action and changes made were
effective or if additional changes need to occur.
Documentation
WC CMA shall maintain all supporting documentation related to the collection
and follow-up to complaints and make it available to the Department upon
request.
External Review
On a quarterly basis, all complaints/grievances shall be submitted to the
Community Advisory committee for review, input, guidance, and if needed,
resolution assistance.
On a quarterly basis, in accordance with contractual requirements, WC CMA
shall submit the Complaint Trends Analysis to the Department for review,
feedback, and approval.
OFFEROR'S RESPONSE 5.d: Required Training for Case Managers
How the Offeror will ensure case managers receive and meet the
required training by the Contract's Operational Start Date.
In order to ensure that case managers are equipped with the necessary
training to meet the requirements of the contract, WC CMA will undertake an
operational readiness training assessment several months prior to the start
date. This assessment will include an evaluation of all current staff to
determine their compliance with updated training requirements specified in
the contract and any amendments to 10 CCR 2505-10 8.519 et seq.
Additionally, the assessment will identify any gaps in program knowledge,
particularly related to the following non-SEP programs:
• Children's Home and Community Based Services Waiver
• Family Support Services Program
• HCBS Children's Extensive Supports Waiver
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HCBS Children's Habilitation Residential Program Waiver
HCBS Developmental Disabilities Waiver
HCBS Supported Living Services Waiver
Intermediate Care Facilities - Intellectual and Developmental Disability
Omnibus Reconciliation Act of 1987 Specialized Services Program
State Supported Living Services Program (State SLS)
Any training deficiencies found will be addressed at least one month prior to
the start of the contract through training staff on new programs. Post award,
WC CMA will reach out to Weld County's local non-SEP program expert,
Envision, to request any training guides, checklists, videos, presentations,
PowerPoints, and any other training materials deemed useful and
advantageous to getting staff ready for rolling out multi -program case
management services on the operational start date.
Post award, WC CMA intends to implement an Envision staff specific
recruitment process, and as a result of this effort, any candidates who
express interest, meet the qualifications, and are subsequently hired after
going through all the interview and review process will be assessed for
compliance with updated training requirements specified in the contract and
any amendments to 10 CCR 2505-10 8.519 et seq. Additionally, WC CMA will
request Envisions' training tracking deliverable to use as a tool in the
training readiness assessment. WC CMA will also collaborate with Envision to
address staff training gaps before the start of the contract and will work with
Envision staff to receive training in anticipation of coming under WC CMA.
WC CMA will subject all new hires to its new hire training plans and
procedures, whether from Envision or other sources.
To guarantee that all case managers receive the required training in
accordance with the contract's provisions and state regulations, WC CMA will
leverage its existing training strategies, materials, and plans. The training
materials and processes will be modified as necessary to include information
about new programs and services.
The New Hire Training Plan is comprised of two parts: General and Specific.
General training includes topics that every employee must know, while
Specific training concentrates on areas that require expertise and
application. For example, all case managers will receive an overview of all
programs and their corresponding services and eligibility requirements, but
only those assigned to specific programs and teams (Non-IDD, IDD,
Page 1145
Pediatric) will receive in-depth trainings for programs they will be managing.
WC CMA does not anticipate every employee to have a grasp of the
intricacies of all eighteen (18) programs associated with this Solicitation, and
hence, the staff will rely on each other, internal trainings, presentations, and
meetings to remain informed about the programs.
To illustrate, the Offeror has developed a fifteen -day training plan that is
specific to a non-IDD Adult program, which includes the training
requirements and guidelines mandated by the contract. This plan can be
adjusted to suit the team and programs assigned to the new hire.
Training Requirements, Guidelines, and Attestations
WC CMA shall ensure that all Other Personnel have sufficient training and
experience to complete all portions of the Work assigned to them. WC CMA
shall provide all necessary training to its Other Personnel, except for State -
provided training specifically described in this Contract. WC CMA shall ensure
that all staff assigned to perform the Work in this Contract pass
competency -based training requirements as defined by the Department,
including, but not limited to, disability/cultural competency, person-
centeredness, soft skills, as well as program -specific knowledge and skills.
WC CMA shall ensure that all case management staff receive training within
one -hundred twenty (120) calendar days after the staff member's hire date
and prior to being assigned independent case management duties. All other
case management staff must receive retraining as required by the
Department, a Department -approved vendor, or WC CMA.
Training modalities may include the Department's Learning Management
System (LMS), web -based training, virtual instructor -led training, in -person
training sessions, and training materials available on the Department
website. WC CMA shall utilize training materials provided by the Department
when available. Case management staff shall complete all training
requirements in the contract and at 10 CCR 2505-10 8.519.5.E et. seq., to
include but not be limited to:
• Applicable Federal and State laws and regulations for LTSS programs
• Critical Incident Reporting
• Determination of Developmental Disability or Delay
• Disability and Cultural Competency
• Equity, Diversity, Inclusion, and Accessibility (EDIA)
• Intake and Referral
Page 1146
• Level of Care Screen and Needs Assessment
• Long Term Home Health (LTHH)
• Long Term Services and Supports Eligibility
• Mandatory Reporting
• Notices and Appeals
• Nursing Facility Admissions
• Participant Directed Training
• Person -Centered Support Planning & Person -Centered Support Plan
• Pre -Admission Screening and Resident Review (PASRR)
• State General Fund Program Requirements and Services
• State General Fund Program Ongoing Case Management
• System Documentation
• Waiver Requirements and Services
WC CMA shall ensure that Case Managers meet competency requirements
determined by the Department to perform case management tasks,
including the correct application of the Colorado Single Assessment and
Person -Centered Support Plan. WC CMA understands Case Managers must
pass assigned training competency requirements to independently perform
Case Management activities. Case Managers shall receive oversight reviews
of their performance, including their competency with completing the Level
of Care Screen. WC CMA shall shadow case management staff completing
the Level of Care Screen on an annual basis and prior to the end of each
Contract Fiscal year to establish the case managers' competency
administering the Level of Care Screen. Supervisors, lead workers, or a case
manager with at least three years of case management experience may
perform this shadowing. WC CMA shall maintain documentation on case
manager performance and provide it to the Department upon request. WC
CMA shall provide the date all case management staff, including new and
existing staff, were hired and the dates of received training in the areas
identified in Section 1.2.3, using the reporting template provided by the
Department for review, approval, and payment.
New Hire Training Plan - First 15 Days
Page 1147
Preparation Prior to Start Date: Set up the new hire's desk and office
equipment. This includes ensuring that the new hire has all the necessary
office supplies, a computer, scanner, and phone.
Next, the training team will prepare training documents and desktop aids
that the new hire will use as references during their training period. The
documents include the 100.2 Certification Dates Chart, which provides
information on the certification requirements for Medicaid clients; the 803
Denial Reasons and Regulations, which outlines the regulations for Medicaid
denials; the County Holidays, which provides information on the county's
holiday schedule; the Staff List and Extensions, which provides a directory of
staff members and their contact information; the LTC Acronyms, which is a
glossary of acronyms commonly used in the long-term care industry; the
APS Flyer, which provides information on the Adult Protective Services
program; the Cisco Phone Quick Guide, which explains how to use the phone
system; and several others such as client file and OnBase guidelines; waiver
and non -waiver program charts; financial rate sheets; email encryption; PAR
codes; and more.
The new hires will be assigned a training team, which will include a
Supervisor and/or a Specialist who will oversee training. In addition, an
oversight team will be assigned to review one hundred (100) percent of the
new hire's work for six (6) months to ensure they are meeting the required
standards and to provide feedback and support as needed.
Day 1: On the first day of training, the new case manager (NCM) will attend
a human resources orientation and receive a tour of the building and
department. They will be introduced to the staff and complete paperwork
related to the Care and Case Management System (CCMS) access. The NCM
will have a one-to-one meeting with their team supervisor to discuss
expectations and answer any questions they may have. The day will also
include an introduction to the Area Agency on Aging & LTSS Program
PowerPoint, and they will cover the history of case management redesign,
lines of responsibility and authority, and WC CMA's three (3) case
management teams, including the Non-IDD Program Adult Team, IDD
Program Adult Team, and Pediatric Program Team. They will also receive an
overview of the various departmental summaries, including the SEP Map,
CCB Map, Non-IDD Programs Overview, IDD Programs Overview, and
Pediatric Programs Overview. By the end of this day, the NCM will have a
general understanding of the LTSS program and how WC CMA operates.
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Day 2: The NCM will learn about financial eligibility and long-term care
Medicaid, including what Health First Colorado is, the application process for
LTSS programs, and financial requirements such as income limits, assets,
and income trusts. They will also learn about DHS financial assistance
programs and Medicare programs and services. The NCM will participate in
the HCBS Waivers & Services PowerPoint, which will cover waivers, program
eligibility criteria, HCBS services, HCBS provider agencies, program -
approved service providers (PASA), nursing facility care, PACE, LTHH, and
private case management. The NCM will also receive Waiver 101, CIH waiver
state PowerPoint, LTSS video, and LTSS glossary training.
Day 3: The NCM will participate in the intake and referral PowerPoint, which
will cover information and referral, developing care plans, intake and
screening, timeframes, ongoing case management processes, assessment
types, PASRR, tracking examples, and case closures. They will also
participate in the Alzheimer's and dementia training from the state training
site.
Day 4: The NCM will receive training on scoring the ULTC 100.2 PowerPoint,
which will cover ADL's; IADL's; scoring guidelines; pediatric and age -
appropriate scoring guidelines; behavior vs. memory scoring; documentation
guidelines; contingency plans and goals; narrative statements; and ULTC
100.2: determining level of care from the state training site.
Day 5: The NCM will learn about Monitoring and will participate in monitoring
for HCBS Case Managers from the state training site. They will also receive
disability and cultural competency training, person -centered service plans
training, and will review tracking and organization.
Day 6: The NCM will participate in PMIP training, which will include
instructions, attestation forms, and the CLLI physician statement. They will
receive an introduction to CDASS, covering reasons for the program, initial
paperwork and process, task worksheets, and overspending process. They
will participate in CDASS/IHSS CDCO training from the CDCO site and will
review Skilled vs. Unskilled Health Maintenance guidelines.
Day 7: The NCM will receive training on the introduction to IHSS and will
participate in the IHSS overview from the state training site. They will also
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receive training on Telligen, including the URUM user guide, review types,
and tip sheets. The NCM will participate in a Telligen overview from the state
training site.
Day 8: The NCM will participate in the Bridge, PARS & PETI training, which
will cover the introduction to Bridge navigation, decoding PARS, inventory of
needs, PETI, goals, and the CDASS worksheet. They will receive Bridge
training from the state training site, Bridge Proration training, and CDASS
DXC training from the state training site. The NCM will also receive ACF PETI
training from the state training site. This day will provide the NCM with an
in-depth understanding of the processes and tools used in the LTSS
program. The NCM will learn how to navigate the system and to work within
the program's guidelines to support members effectively.
Day 9: The NCM will receive Critical Incident Report (CIRS) training
PowerPoint - Section 16, as well as CIRS training from the state training
site. They will receive the CIRS Technical Guide, Critical Incident Type Desk
Aid, and Fatal Five training. The NCM will also receive training on home
modifications, which will cover initial paperwork, referral process and
checklist, and SEP home mod training from the state training site. This day
will provide the NCM with an understanding of the different types of critical
incidents that can occur and how to report them appropriately. They will also
learn how to work with members who require home modifications to ensure
their safety and well-being.
Day 10: The NCM will receive training on over cost containment and rights
modifications. They will participate in the individual rights and rights
modification training from the state training site and will learn about notices
and appeals. The NCM will also learn about the HCBS final settings rule from
the state training site. By the end of this training, the NCM will understand
how to work within the program's regulations to contain costs and ensure
members receive appropriate and affordable services.
Day 11: The NCM will receive more in-depth training on LTSS Medicaid
Waivers, which will cover the various waivers available, HCBS agencies, and
Program Approved Service Providers (PASA). They will learn about program
eligibility criteria and HCBS services, including nursing facility, PACE, and
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LTHH. The NCM will also receive Waiver 101 for Case Managers training from
the state training site. This day will provide the NCM with an in-depth
understanding of the LTSS Medicaid Waivers available and the services they
provide.
Day 12: The NCM will receive training on HIPAA and PHI, including an
overview and in-depth understanding of the policies and procedures related
to HIPAA and PHI. They will also receive training on Long Term Home
Health, which will cover the services available and the program's eligibility
criteria. By the end of this training, the NCM will have a comprehensive
understanding of the HIPAA and PHI policies and procedures and the Long
Term Home Health program.
Day 13: The NCM will receive training on transition services from the state
training site, which will cover the process for transitioning clients from one
program to another. They will also receive training on electronic visit
verification and remote supports to understand how to document services
provided to members. The NCM will also receive training on incident
management and prevention strategies to learn how to prevent incidents
and handle them appropriately if they occur.
Day 14: The NCM will receive training on PASRR, including an overview of
the PASRR program, nursing facility admission, and the client file and
OnBase, which will cover the guidelines for client file documentation and
scanning. By the end of this training, the NCM will have a comprehensive
understanding of the PASRR program and the requirements for member file
documentation and scanning. By the end of this training, the NCM will have
a comprehensive understanding of the LTSS program's various aspects and
will be ready to start working with members under supervision.
Day 15 - Day 25: During this time, the NCM will meet with various DHS
personnel and other related professionals to learn more about their roles and
how they fit into the LTSS program. They will review and read LTSS program
regulations to gain a better understanding of the program requirements. The
NCM will shadow a case manager at their desk to learn more about how to
navigate the system and manage member needs. They will also shadow a
case manager on member visits to learn more about how to interact with
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members and provide case management services. The NCM will complete
contacts under supervision, including quarterly calls, a six-month review,
reassessments, intake assessments, nursing home assessments, and PACE
assessments. The NCM will also receive training from DHS personnel,
including DHS orientation, the LTSS program director, the ombudsman, APS,
and long-term care technicians, to name a few. By the end of this training,
the NCM will have a comprehensive understanding of the LTSS program and
be ready to work independently with members. The supervisor training and
monitoring plan will ensure that the NCM receives the necessary support and
guidance during the early stages of their career.
OFFEROR'S RESPONSE 5.e: Continuous Quality Improvement
Provide a detailed Continuous Quality Improvement Plan outlining
the organizational oversight of internal quality performance
including process and corrective measures to address identified
performance concerns. Plan must detail oversight of quality at each
leadership level.
WC CMA understands the importance of providing oversight of internal
quality performance to enhance and support case management services,
contract, and regulatory compliance. We offer the following Continuous
Quality Improvement Plan (CQIP).
Quality Improvement Plan
Weld County
Case Management Agency
Weld County Case Management Agency (WC CMA) is committed to the
ongoing improvement of the quality of services it provides. A Quality
Improvement Plan (QIP) is a comprehensive approach to ensure that the
services provided by a case management agency meet the needs of the
individuals it serves. This Quality Improvement Plan serves as the
foundation of this commitment.
Purpose and Introduction
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Executive Summary
This plan is part of the Weld County Case Management Agency's
commitment to protecting and improving the health, safety, and well-being
of the residents within Weld County. This Continuous Quality Improvement
Plan (CQIP) links directly to the Weld County Mission and Vision, the Weld
County AAA Mission statement, to maintain an individual's independence and
dignity in their home and community, and the overarching strategic goals for
the Weld County Department of Human Services.
Mission & Vision
Weld County Vision: The people of Weld County are connected to the
resources needed to thrive in the community and feel safe and empowered.
Weld County Mission: Engaging and partnering with the community to
improve the safety, health, and well-being of individuals and families
through the delivery of responsive and collaborative services.
Weld AAA Mission: Our mission is to help maintain an individual's
independence and dignity in their home and community.
Levels of Leadership
Weld County Department of Human Services (WCDHS) consists of four (4)
main levels of leadership in relation to the Weld County CMA:
Human Services Director, who reports to the Board of County
Commissioners.
Human Service Deputy Director, who reports to the Human Services
Director and provides support to the Area Agency on Aging (W -AAA)
Division and the Weld County CMA.
WC AAA Division Director CMA Administrator, who reports to the
Human Services Division Director.
Weld County CMA consists of four (4) internal levels of leadership. Internal
applies to positions that directly interface with the Work as required by the
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contract, and positions that occupy CMA Key Personnel or Supervisor
positions/roles:
Administrator. Reports to the Human Services Division Deputy Director
Case Management Director. Reports to the Administrator
IDD Program Manager. Reports to Case Management Director
Supervisors. Reports to Program Manager, CM Director, and the
Administrator.
CQIP Contract Requirements
The Contractor shall create and implement a Continuous Quality
Improvement Plan for the contract period. The Continuous Quality
Improvement Plan shall include, but not be limited to a description of how
Weld County CMA:
o Oversees the work performed by Case Managers as outlined in the
Contract to ensure all tasks are being performed according to
requirements.
o Reviews work to determine whether the work is being completed in a
correct and high -quality manner.
o Identifies and addresses Case Management performance issues.
o Notifies the Department of identified performance issues.
Additional CQIP related efforts include:
o Participate in the Department hosted Quality Community of Practice.
o Submitting the Continuous Quality Improvement Plan to the
Department for review, approval, and payment. The Department will
establish a regularly scheduled cadence with the Contractor to review
and discuss CQI Plan, data, and an agency specific quality dashboard.
CQIP Timeline Requirements - Deliverables
o Submit the CQIP to the Department within forty-five (45) business day
after the Effective Date
o Submit the CQI Plan Update annually, by August 15th.
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Definitions & Acronyms
Area Agency on Aging (AAA)- Division within Weld County Human Services
that houses the Case Management Agency program.
Case Management Agency (CMA) A public or private not -for-profit or for-
profit organization contracted with the state of Colorado to provide case
management services and activities pursuant to C.R.S. 25.5-6-1702- Case
management agency for Long -Term Care Medicaid programs.
Complaints and Grievances - Any complaint received by the Contractor as it
relates to the services provided through this Contract to include, but not
limited to general business functions, administration, State General Fund
program functions, and case management functions. Excludes any
complaints regarding activities outside the scope of this Contract.
Continued Stay Review (CSR) -Yearly reassessment of an individual's
functional eligibility.
Consumer Directed Attendant Support (CDASS)- the service delivery option
for services that assist an individual in accomplishing activities of daily living
when included as a waiver benefit that may include health maintenance,
personal care, and homemaker activities.
Continuous Quality Improvement (CQI): a systematic, department -wide
approach for achieving measurable improvements in the efficiency,
effectiveness, performance, accountability, and outcomes of the processes or
services provided. Applies use of a formal process (PDSA, etc.) to "dissect" a
problem, discover a root cause, implement a solution, measure
success/failures, and/or sustain gains.
Corrective Action Plan: a written plan, which includes the specific actions the
agency shall take to correct non-compliance with regulations and contractual
obligations, which stipulates the date by which each action shall be
completed.
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Deliverable: a specific output or result that the contractor is required to
produce in accordance with the Department's approved format and content
requirements. This may include documentation or other materials that meet
specific criteria and must undergo a review and approval process by the
Department. The contractor is responsible for gathering requirements,
creating a draft, performing internal quality control reviews, and making
modifications as directed by the Department.
Department - The Colorado Department of Health Care Policy and Financing,
a department of the government of the State of Colorado.
Employee Development Plan (EDP)- may be used when an employee is not
meeting the expectations of their position consistently. An EDP is a more
formal process used to support an employee and achieve consistent and
sustained performance.
Home and Community Based Services (HCBS) Waivers - Services and
supports authorized through a 1915(c) waiver of the Social Security Act and
provided in community settings to a client who requires an institutional level
of care that would otherwise be provided in a Hospital, Nursing Facility, or
Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF-
IID). This includes: Home and Community Based Services Waiver for
Persons with Brain Injury (HCBS-BI), Home and Community Based Services
Children's Extensive Services Waiver (HCBS-CES), Home and Community
Based Services Children's Residential Habilitation Program Waiver (HCBS-
CHRP), Home and Community Based Services Waiver for Children with a Life
Limiting Illness (HCBS-CLLI), Home and Community Based Services
Community Mental Health Supports Waiver (HCBS-CMHS), Home and
Community Based Services Waiver for Persons with Developmental
Disabilities (HCBS-DD), Home and Community Based Services Waiver for
Persons who are Elderly, Blind and Disabled (HCBS-EBD), Home and
Community Based Services Supported Living Services Waiver (HCBS-SLS),
and Home and Community Based Services Waiver for Persons with Spinal
Cord Injury (HCBS-CIH).
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Level of Care Screening (LOC)- a review of the individual's service and
support needs.
Long Term Services and Supports (LTSS)- A range of supportive services for
people with physical, cognitive, or mental disabilities or conditions that limit
their ability to care for themselves.
In Home Support Services (IHSS): services that are provided by an
attendant and include health maintenance activities, support for activities of
daily living, personal care services and homemaker services.
Performance Improvement Plan (PIP)- a formalized approach to performance
management used when an employee is consistently under performing and
previous training and support measures have not been successful. It
includes specific performance concerns, performance expectations, action
steps, and expected outcomes.
Performance Standards: specific requirements or expectations for the
quality, timeliness, or completeness of work that the contractor is expected
to meet. These standards may be listed in the Statement of Work or in an
appendix to the contract and may include measurable criteria for evaluating
the contractor's performance. The contractor is responsible for meeting
these standards and must provide deliverables that meet the specified
requirements within the designated timeframe.
Plan, Do, Study, Act (PDSA): A four -stage, problem -solving model for
improving a process or carrying out change.
Quality Improvement (QI): Raising the quality of a product/service to a
higher standard.
Quality Improvement Plan: A plan that identifies specific areas of current
operational performance for improvement within the agency. These plans
can and should cross-reference one another, so a quality improvement
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initiative that is in the QI Plan may also be in the Strategic Plan. (PHAB
Acronyms and Glossary of Terms, 2009)
Quality Culture: QI is fully embedded into the way the agency does
business, across all levels, departments, and programs. Leadership and staff
are fully committed to quality, and results of QI efforts are communicated
internally and externally. Even if leadership changes, the basics of QI are so
ingrained in staff that they seek out the root cause of problems without
prompting.
Quality in Agency
Commitment to Quality
Weld County CMA is committed to identifying areas of improvement, setting
goals, and implementing strategies to improve the quality of services for the
people we serve. All levels of leadership demonstrate confidence in staff and
are supportive in efforts to improve and succeed. We expect contractual and
regulatory compliance from all positions, and we have processes, plans, and
procedures in place that ensure compliance and drive improvement.
Quality Leadership Team
The Weld County CMA quality program is managed by the existing
leadership group.
CMA Administrator/Division Director for Weld County AAA
o The Division Director is responsible for complete oversight of the
program and the quality measures within the program.
CMA Administrator/Deputy Division Director for Weld County AAA
o The Deputy Division Director is responsible for components of the
quality measures based on direction from the Division Director
CMA Manager
o The Manager providers oversight and support for Supervisors, and
quality assurance related to their work.
CMA Supervisors
o Supervisors are responsible for the day-to-day accuracy and
timeliness of the work completed by Case Managers
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Administrative Leadership - CQIP Responsibilities and Activities
On a monthly basis, Administrative Leadership conducts one-on-one
supervision meetings with CMA Supervisors to review program
performance, identify any quality issues, and ensure the implementation
of quality improvement measures.
Administrative Leadership convenes to ensure that program and contract
requirements are met consistently across various waivers and
supervisors.
Administrative Leadership is responsible for overseeing the completion of
contract deliverables and are responsible for completing and submitting
higher level deliverables, such the Operation Guide, Operation Guide
Update, Long Range Plan, Committee Updates, the Continuous Quality
Improvement Plan, Complaint Trend Analysis.
Administrative Leadership is responsible for the development and
successful implementation of the Long -Range Plan.
Administrative Leadership is responsible for evaluating performance
standard success and addressing inadequate performance.
Regular meetings are held between Administrative Leadership and all
staff to support quality and performance measures and ensure that
quality is ingrained in the culture of our organization.
Administrative Leadership bears the responsibility of providing resources
necessary for staff to accomplish quality work.
Administrative Leadership analyzes complaints on a quarterly basis for a
multitude of trends, such as those related to case managers, type,
Members, and others.
If quality concerns are identified, they are also responsible for ensuring
the development and implementation of corrective action. Upon receiving
written notification from the Department, a formal Corrective Action Plan
(CAP) will be developed and submitted.
Administrative Leadership ensures that Case Management Training
documentation is submitted to the Department semi-annually.
Administrative Leadership conducts an extensive performance evaluation
for every staff member they supervise, including the Case Management
Agency Supervisors. In addition to training requirements, staff new to a
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position undergo an evaluation after 6 months and then at 12 months,
followed by annual evaluations thereafter. Performance evaluations
assess competency in various areas, including Weld County Core
Competencies (reliability, integrity, accountability, flexibility,
diversity/respect, and Customer Focus), Job Responsibilities (position -
specific), Employee goals, and an overall summary of strengths and
opportunities for growth. Leadership positions also include additional
Manager Core Competencies (leadership, coaching, collaborative
leadership, innovation, and risk -taking).
Each CMA Administrator receives a performance evaluation, including a
self -evaluation as part of their annual review. This allows them to assess
their own work, identify opportunities for growth, and set goals.
Administrative Leadership is accountable to the Department (HCPF) for
quality and contract compliance. They will ensure that all deliverables are
met and submitted to the Department as required.
Supervisory Team - CQIP Responsibilities and Activities
Supervisors are responsible for providing oversight, training, and
monitoring of case management performance standards, as defined in the
contract.
Each case manager's work is spot-checked by their supervisor using
prescribed audit tools specific to their role. Intake case managers and
ongoing case managers each have their own designated tools.
Whenever an IHSS or CDASS case is initiated, changed, or updated
during a CSR, it must be reviewed with a supervisor.
New intake cases are audited by supervisors to ensure all necessary
intake procedures have been completed before being transferred to an
ongoing case manager.
After a trainee has been deemed ready for independent work, the
supervisor continues to audit their work for accuracy during all six-month
and CSR reviews until they achieve program competency.
The audit tools are dynamic documents that are adjusted based on the
specific needs identified by the leadership team.
During monthly one-on-one supervision meetings, supervisors review any
areas identified in the pinpoint or comprehensive audits with their staff,
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documenting the discussion to monitor staff performance. They determine
if a simple reminder is sufficient to correct errors or if more formal
measures such as an Employee Development Plan or Performance
Improvement Plan are needed for recurring or significant deficiencies.
Supervisors maintain supporting documentation demonstrating that case
managers attended all required trainings.
During monthly one-on-one meetings, supervisors review all CIRs due
from the previous month to ensure work was completed within timelines.
Supervisors review the training manual annually to ensure it includes all
required and relevant competency areas and is up to date.
Supervisors ensure that all staff have the necessary training and
equipment to accomplish quality work.
Supervisors receive, document, and track any complaints, working with
administrative leadership to analyze trends and implement corrective
action as needed.
When necessary, supervisors operationalize a formal Corrective Action
Plan (CAP) and maintain supporting documentation demonstrating that
deficiencies have been resolved.
Supervisors support compliance with all deliverables and maintain
thorough documentation as required.
Supervisors complete an extensive performance evaluation for every staff
member they supervise, including Specialist/Trainers, Case Managers,
and Case Aides. For new staff, evaluations are completed after 6 months
and 12 months, and annually thereafter. Evaluations review competency
in several areas, including Weld County Core Competencies (reliability,
integrity, accountability, flexibility, diversity/respect, and customer
focus), job responsibilities (position -specific), employee goals, and an
overall summary of strengths and opportunities for growth.
Each supervisor receives a performance evaluation, including a self -
evaluation as part of their annual review. This allows them to assess their
own work, identify opportunities for growth, and set goals with their
supervisor.
Specialist/Trainer CQIP Responsibilities and Activities
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The Specialist position is responsible for a comprehensive audit of two
cases per case manager a month for those case managers not in New CM
Training.
The Specialist position is responsible for completing a trend analysis on
monthly audits to determine future areas for the supervisor's pin -point
audits.
The Specialist position in conjunction with the supervisors use this
information from all audits to plan future trainings for staff.
The Specialist position conducts the new employee training using the
Weld County CMA training Manual. Trainees are given a copy of the
manual and training sessions are scheduled to step through the manual.
The specialist discusses learning style with the trainee to ensure the
trainee is getting the most out of their time together. The specialist or
supervisor review all work completed by the trainee until such time that
both the supervisor and the specialist sign -off stating the trainee is ready
to complete work on their own.
The Specialist position will communicate any identified revisions to the
training manual with their supervisor, so that it can be updated
accordingly.
Each Specialist/Trainer receives a performance evaluation. They complete
a self -evaluation as a part of their annual performance review. This allows
them to assess their own work, identify any opportunities for growth, and
set goals with their supervisor.
The Specialist position in conjunction with the supervisors use audit findings
as a learning opportunity and a method to plan future training for staff. For
example, a one-on-one training for someone who is struggling with a
particular part of the work, a small group training or all -staff training for
topics trending across all case managers.
Case Managers — CQIP Responsibilities and Activities
o Case managers have a Self -Audit Tool available when needed. The case
manager in conjunction with their direct supervisor make the
determination when this tool needs to be completed.
o Case managers schedule time each month to review their client list and
ensure that all demographic and provider information is up to date.
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Case Managers meet with their supervisor monthly to review and answer
caseload specific questions and review timeliness with completion of
required activities.
Case Managers meet monthly with their direct supervisor to staff cases
and receive input on challenging situations.
Each Case Managers receives a performance evaluation. They complete a
self -evaluation as a part of their annual performance review. This allows
them to assess their own work, identify any opportunities for growth, and
set goals with their supervisor.
Quality Goals, Objectives, and Implementation
Strategic Plan
The 2021-2024 Strategic Action Plan includes our core values as a
framework to help guide the work.
Accountability -Takes ownership for decisions and actions.
Integrity -Demonstrates authentic, ethical actions in all circumstances.
Service -Provides timely and dedicated assistance in a genuine and
effective manner.
Communication -Catalyzes the ongoing exchange of information and
ideas, ensuring effective collaboration to achieve optimal outcomes.
Innovation -Supports an environment of creative solutions with a
commitment to continuous improvement.
Strategic Action Teams
Staff members can participate on Strategic Action Teams to improve the
overall quality within the Department.
Team 1: Recruit, Develop, and Retain Mission -Driven, Service -Oriented
Employees
Team 2: Redesign, Simplify, and Integrate Services to Achieve Positive
and Equitable Outcomes
Team 3: Leverage and Enhance Community Partnerships to Support
Positive Client Outcomes and Access to Services
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Contract Goals - Performance Measures
Deliverables - One hundred (100) percent compliance with all aspect
of contract deliverable requirements, such as the creation and timely
submission of deliverables to the Department, and timely follow-up on
corrections.
Performance Standards - Compliance with all performance standards
and success thresholds as identified in the contract, and performance
standards established internally by WC CMA.
Compliance - Compliance with all other aspects of the contract, state
and federal regulations, Department training and operational memos
not defined as a deliverable or performance standard. Includes
meeting all case management, program, and service timelines, the
maintenance of records, accurate and timely completion of the Work.
Training - New Employees
Weld County SEP's training staff and supervisors participate in the training of
each new staff member using a comprehensive formal training plan. Each
staff member is assessed upon hire to determine their learning style, their
knowledge of LTSS and specifically the CMA and SEP rules and
regulations. All newly hired case management staff receive training within
one hundred twenty (120) calendar days after their hire date and prior to
being assigned independent casework.
The Specialist position conducts most of the new employee training using
the Weld County CMA Training Manual. Each new employee is given a copy
of the manual and intensive training sessions are scheduled to step through
the manual and learn the art of client interaction. The specialist provides
written material, conducts phone calls and assessments to allow new staff to
witness the requirements and later shadows the new employee, providing
feedback to allow for adjustments with future work. The specialist or
supervisor review all work completed by the trainee providing timely
feedback to allow for adjustments until such time that both the supervisor
and the specialist sign -off stating the trainee is ready to complete work on
their own.
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Training Guidelines
Weld County CMA shall ensure that all Other Personnel have sufficient
training and experience to complete all portions of the Work assigned to
them. Weld County CMA shall provide all necessary training to its Other
Personnel, except for State -provided training specifically described in this
Contract.
Weld County CMA shall ensure that all staff assigned to perform the Work in
this Contract pass competency -based training requirements as defined by
the Department, including, but not limited to, disability/cultural competency,
person-centeredness, soft skills, as well as program -specific knowledge and
skills.
Weld County CMA shall ensure that all case management staff receive
training within one -hundred twenty (120) calendar days after the staff
member's hire date and prior to being assigned independent case
management duties. All other case management staff must receive
retraining as required by the Department, a Department -approved vendor,
or WC CMA.
Training modalities may include the Department's Learning Management
System (LMS), web -based training, virtual instructor -led training, in -person
training sessions, and training materials available on the Department
website.
Weld County CMA shall utilize training materials provided by the Department
when available. Case management staff shall complete all training
requirements in the contract and at 10 CCR 2505-10 8.519.5.E et. seq., to
include but not be limited to:
• Applicable Federal and State laws and regulations for LTSS programs
• Critical Incident Reporting
• Determination of Developmental Disability or Delay
• Disability and Cultural Competency
• Equity, Diversity, Inclusion, and Accessibility (EDIA)
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• Intake and Referral
• Level of Care Screen and Needs Assessment
• Long Term Home Health (LTHH)
• Long Term Services and Supports Eligibility
• Mandatory Reporting
• Notices and Appeals
• Nursing Facility Admissions
• Participant Directed Training
• Person -Centered Support Planning & Person -Centered Support Plan
• Pre -Admission Screening and Resident Review (PASRR)
• State General Fund Program Requirements and Services
• State General Fund Program Ongoing Case Management
• System Documentation
• Waiver Requirements and Services
Weld County CMA shall ensure that Case Managers meet competency
requirements determined by the Department to perform case management
tasks, including the correct application of the Colorado Single Assessment
and Person -Centered Support Plan.
WC CMA understands Case Managers must pass assigned training
competency requirements to independently perform Case Management
activities. Case Managers shall receive oversight reviews of their
performance, including their competency in completing the Level of Care
Screen.
Weld County CMA shall shadow case management staff completing the Level
of Care Screen on an annual basis and prior to the end of each Contract
Fiscal year to establish case manager competency administering the Level of
Care Screen. Supervisors, lead workers, or a case manager with at least
three years of case management experience may perform this shadowing.
Weld County CMA shall maintain documentation on case manager
performance and provide it to the Department upon request. Weld County
CMA shall provide the date all case management staff, including new and
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existing staff, were hired and the dates of received training in the areas
identified in Section 1.2.3, using the reporting template provided by the
Department for review, approval, and payment.
Weld County is committed to professional development. We require each
staff member to complete twenty (20) hours of continuous education
(training) each year. We provide time and access to additional learning
opportunities that we believe enhance the quality of our work, such as
Person-Centeredness trainings, Compassion Fatigue and Burnout, De-
escalation and Crisis Intervention, Trauma Informed Care, Effective
Communication, Leadership, etc.
Communication — Quality
To facilitate an organizational culture committed to quality, we have
frequent and consistent communication about quality -related topics. This
ensures we have clear and consistent expectations throughout the case
management agency. It provides the ability to identify any quality related
issues early on so they can be addressed promptly and effectively. We want
to ensure we are meeting and striving to exceed quality expectations and
that we are delivering quality services to our members. This section outlines
the ways in which information about quality and quality -related initiatives is
disseminated.
All Employees - Communication
Electronic Newsletters are shared at both the County level and the
Department level. These communications provide regular updates on
initiatives including project outcomes, policy changes and training
opportunities.
Opportunities for staff to participate in Roundtables with Department
leadership.
Ask the Director button -allows staff to ask a quick question and share
ideas for quality improvements with the Weld County DHS Director.
Comment Suggestion Box for improvements within AAA
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CMA Administrator holds Office Hours for open discussion/ideas
surrounding quality initiatives and ideas.
Quarterly Division meetings with Leadership
One-on-one monthly meetings with direct supervisor
SEP monthly staff meetings give the supervisors and trainer an
opportunity to share quality related results, updates to changes in policies
and general reminders.
Desk Aids are provided for more complex work such as CIRs
Subject specific emails sent to staff providing timely updates to changes
in policy and/or procedures.
Supervisors provide daily consultation opportunities for case management
staff to discuss difficult cases/situations.
Strategic Action Team updates are provided to the Department
Leadership Team, the Divisions and Units monthly for discussion and
updates.
AAA Quarterly Meeting allows for cross division information sharing.
Leadership Team - Communication
Weekly or Biweekly meetings with the Administrator and Case
Management Director
Monthly Supervisor meetings
One-on-one monthly meeting with CMA Administrators
Bi-weekly or monthly meetings with WCDHS Director and/or Deputy
Director
Community — Communication
Program and contact information are available on our website. In
addition, Facebook, Twitter, YouTube, Instagram, and LinkedIn are used
to provide updates to the community.
Pamphlets and Brochures for resources
A Department Annual Achievement Summary is published.
CMA resource and significant work information is reported at various
community councils and meetings that the CMA is involved in, including
but not limited to:
• Human Service Advisory Commission
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• AAA Advisory Board
• Adult Protective Services Community Team
• Human Rights Committee (HRC)
• Family Support Council
• Community Advisory Committee
Monitoring and Evaluation
In order to address progress toward and/achievement of goals the Quality
Improvement Plan will be reviewed on an annual basis and submitted to the
Department for approval. Notification to the department of identified
performance issues will be provided through the submission of various
deliverables (including compliant trend analysis reports, revisions to the
Quality Improvement Plan, and/or Corrective Action Plans). Additionally,
specific quality issues that significantly impact quality service delivery and/or
may generate higher level inquiries will be reported in writing to the
Department. The effectiveness of Division -wide communication, auditing,
and training, lessons learned and new goal setting through the PDSA method
to carry out change, will be an instrumental part of our continuous quality
improvement plan. We will work collaboratively with the Department, our
community partners, and members to ensure all tasks are being performed
according to requirements, work is being completed in a correct and high -
quality manner and that any identified performance issues are remediated.
OFFEROR'S RESPONSE 5.f: Disability and Cultural Competency
How the Offeror will ensure disability and cultural competency
standards are met and executed with each case management
interaction between the Offeror's staff and Members or families.
At WC CMA, we understand the importance of promoting disability and
cultural competency standards within our agency. We recognize that
disability is not just a medical issue, but also a social and cultural one, and
that it is our responsibility to acknowledge and be sensitive to the barriers
and discrimination faced by individuals with disabilities and to advocate for
their rights and inclusion. Our goal is to provide a person -centered approach
that values the perspectives and experiences of people with disabilities and
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recognizes their strengths and contributions to society. To achieve this goal,
we will ensure that all case managers meet the qualification requirements
established in 10 C.C.R. 2505-10, Section 8.519.5 et seq, and that staff
assigned to perform the work pass contract required Disability and Cultural
competency -based training. All new staff will receive Disability and
Competency training within thirty (30) calendar days after their hire date
and will complete all the training(s) recommended and required by the
Department, to include those in the department's learning management
system, web -based trainings, virtual instructor -led trainings, in -person
training sessions, and training materials available on the department's
website and elsewhere.
To ensure that disability and cultural sensitivity and understanding remain at
the forefront of the awareness of staff, refresher trainings will be completed
as needed and will include insights derived from working with and receiving
feedback from our members and their families. Complaints indicating an
insensitivity to an individual's disability and/or cultural background will be
documented and reported to the Department in accordance with the
complaint reporting requirements of the contract. These complaints will be
addressed immediately and may result in the retraining of staff as
necessary. WC CMA administrator and supervisors will review and act on
any survey information collected by the department and other organizations
that indicate an issue with disability and cultural intelligence and sensitivities
in our agency.
By prioritizing disability and cultural competency in our training and
practices, WC CMA is committed to creating a welcoming and inclusive
environment for all members and families.
OFFEROR'S RESPONSE 5.g: Community Engagement and
Coordination
How the Offeror sees their role as a Case Management Agency in
leading and facilitating community engagement and coordination
with agencies including but not limited to: schools, nursing facilities,
hospitals, advocacy partners, Arcs, Early Intervention, Aging and
Disability Resource Center, etc.
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As a Case Management Agency (CMA) for Weld County, our role in leading
and facilitating community engagement and coordination with various
organizations is integral to our mission, vision, department values, and Weld
County guiding principles. Our commitment to community engagement and
coordination is a fundamental aspect of our work and is deeply rooted in our
culture. We understand the importance of building strong relationships with
community organizations, such as schools, nursing facilities, hospitals,
advocacy partners, Arcs, Early Intervention, Aging and Disability Resource
Center, and others, to ensure efficient, thorough, and effective service
provision to our members.
In this capacity, we see ourselves as a facilitator and bridge between the
community and Long -Term Services and Supports (LTSS) programs offered
in the state of Colorado. As such, our goal is to build strong partnerships and
collaborate with these organizations to ensure seamless coordination and
delivery of services to our members. We also see ourselves as educators,
actively engaging the community through meetings, committees, in-service
training, publicizing, and events to increase awareness of and access to
LTSS programs.
As a facilitator of community engagement, we work to bring together
different stakeholders, including members, families, advocacy partners, and
service providers, to engage in dialogue and collaboration to improve
services and support for our members and their families. We also see
ourselves in the role of capacity building, working to support and empower
community organizations to better serve members. This may involve
providing training and technical assistance, engaging in resource
development efforts through existing committees and staff meetings, and
reaching out to agencies to encourage participation in LTSS programs, such
as becoming Medicaid providers and State General Fund Program
subcontractors.
Advocacy and awareness -raising are also critical components of our work as
a CMA. In this role, we work to raise awareness of the needs of members
and advocate for policies and services that support their well-being and
quality of life. If awarded the contract associated with this solicitation, we
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see the establishment of a Human Rights Subcommittee as a concrete step
towards facilitating member advocacy and protecting their rights.
In addition to our role as a facilitator and educator, we also play a critical
role in facilitating information sharing and referrals between different
organizations and agencies. This ensures that members receive timely and
accurate information about available services and resources and are referred
to the appropriate organizations for support. This is evident in multiple Offer
Responses (OR) through this bid, such as OFFEROR'S RESPONSE 1.c, 2.a.iv,
and 2.c.
As a CMA, we also see ourselves in a community outreach and engagement
role. We actively engage with the community, including members, families,
and advocacy partners, to understand their needs and concerns. This
information informs our work and helps us advocate for policies and services
that support the well-being of members. We also play a key role in
coordinating resources to support the delivery of services to our members,
and work to ensure that resources are used effectively and efficiently and
are aligned with Member needs.
Data collection and analysis are also important aspects of our work as a
CMA. We collect and analyze data on the needs and experiences of members
to inform our work and monitor the effectiveness of our services. This
information helps us identify areas for improvement and advocate for
changes that support the well-being of members.
We work to engage and collaborate with stakeholders, including members,
families, advocacy partners, and service providers, to promote effective
coordination and delivery of services. Our goal is to bring together different
perspectives and expertise to develop solutions that support the well-being
of members.
WC CMA, in conjunction with Weld County DHS (WCDHS) and the Weld
County Area Agency on Aging (Weld County AAA), is dedicated to promoting
community engagement and coordination with a multitude of organizations,
departments, and divisions.
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Weld County has established guiding principles that WCDHS follows,
including being "customer focused, and customer driven", focusing on
"viable solutions that improve the quality of life", and providing "leadership,
cooperation, and collaboration aimed at improving service". These principles
are reflected in WCDHS' mission and vision. The mission, "Engaging and
partnering with the community to improve the safety, health and well-being
of individuals and families through the delivery of responsive and
collaborative services", highlights the importance placed on community
engagement and coordination. The vision, "the people of Weld County are
connected to the resources needed to thrive in the community and feel safe
and empowered", represents the goal WCDHS strives to achieve through its
efforts.
WCDHS, including the Case Management Agency (CMA), recognizes the
responsibility to remain connected to a wide range of community partners,
as this is crucial in meeting the needs of the community. This responsibility
is embodied in the agency's culture and is reflected in the department values
of Communication, Integrity, Innovation, Accountability, and Service. The
agency's commitment to building and maintaining relationships is
demonstrated in its formalized comprehensive strategic plan, which was
developed in collaboration with the Board of County Commissioners, Weld
County Department representatives, Community Partners, and Human
Services Staff. The 2017-2020 strategic plan focused on three main areas:
Human Capital Management, Member -Centered Delivery, and Partnerships
and Collaboration.
The "Partnerships and Collaboration" initiative aimed to strengthen
partnerships internally within WCDHS and among other Weld County
Departments, to identify opportunities for collaboration, to develop and
recommend community engagement activities, and to actively engage in
community planning opportunities. The current strategic plan continues this
commitment to leading and facilitating community engagement and
coordination, with goals to recruit, develop, and retain mission -driven,
service -oriented employees, to redesign, simplify, and integrate services;
and leverage and enhance community partnerships to support positive
member outcomes and access to services.
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WC CMA takes the initiative to establish connections, build relationships, and
facilitate collaboration. This includes regularly providing training about
waiver services, the intake and assessment process, and other county
services available, to local hospitals, nursing facilities, HCBS providers, and
other community providers. The agency also invites its community partners
to regular team meetings, providing an opportunity for both case
management staff and provider staff to remain up to date on the services
available for the individuals they serve, and to improve communication and
facilitate better service delivery.
The WC CMA is part of the Weld County AAA division, which includes the
Long -Term Care Medicaid (Financial) Eligibility unit, Adult Protective
Services, and Older Americans Act Programs (including the Senior Nutrition
Program, ADRC- Aging and Disability Resources for Colorado, and Long -
Term Care Ombudsman). The integration of multiple programs in one
division, all involved with Long -Term Care determinations and invested in
ensuring the disabled and aging population have access to the services they
need, allows for a more efficient processing of referrals and better
coordination of services.
The Weld County Department of Human Services is dedicated to developing
and disseminating external marketing communications to inform its
community about its programs and resources. The department utilizes
various communication channels such as its website and social media
platforms like Facebook, Instagram, and Twitter to provide updates,
changes, and important notices to its audience.
One of the key resources offered by WCDHS is the AAA HelpSource Program
and Resource Guide, which is a comprehensive guide to both the internal
programs of Weld County AAA and the community resources available for
older adults living with disabilities, family caregivers, community members,
and service providers in Weld County and beyond. The HelpSource can be
accessed both online and in hard copy and provides information about the
programs offered by the department, including an Options for Long -Term
Care guide that outlines the services offered, the application process, the
functional and financial qualifications required, and the Medicaid Waivers and
other programs available.
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In addition to its website and social media presence, WCDHS has a strong
relationship with the local newspaper, the Greeley Tribune, and is often
invited to submit articles and written information to the "Beyond 60 Active
Living" section of the paper. This provides the department with an
opportunity to reach a wider audience and share information about its
programs and resources.
WCDHS and its Case Management Agency also participate in local resource
fairs, such as Project Connect and the Weld Senior Symposium, which allows
them to network with other providers and meet individuals in the community
who need support. This provides the department with the opportunity to
inform people about the services available, the eligibility requirements, and
to start an application or referral process immediately.
The department has established Key Community Partnerships, which are
working relationships, either formal or informal, with other agencies, service
providers, or organizations that share the mission, vision, and values of
WCDHS and support the citizens of Weld County. There are approximately
150 local agencies on the Key Community Partner list, including Adult Day
Programs, ARC, Community Centered Boards, North Range Behavioral
Health, Hospitals and Hospice agencies, Assisted Living Facilities, Nursing
and Long -Term Care Facilities, State Ombudsman, United Way,
Senior/Active Adult Centers, Faith Organizations, Boys and Girls Club,
Housing Authorities, Guadalupe Community Center and Shelter, local School
Districts, and the Immigrant and Refugee Center of Northern Colorado.
When referrals to other agencies and resources are deemed appropriate,
WCDHS works to collaborate with everyone involved to ensure an efficient
and effective process. The department provides individuals with as much
information as possible to make informed decisions and supports them in
obtaining necessary documents and completing paperwork. WCDHS also
facilitates introductions between its members and other service providers to
ensure successful referrals for services.
WCDHS is committed to developing positive community relationships and
collaborating whenever possible. This dedication was recently recognized
beyond Weld County, as the WCDHS Director was nominated and selected as
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the Director of the Year by the Colorado Human Services Directors
Association in 2022. This accomplishment acknowledges the department's
dedication to leading and facilitating community engagement and
coordination and shows that this practice is embedded in its culture,
expected, and modeled at every level.
OFFEROR'S RESPONSE 5.h: HIPPA and PHI Training
The Offeror's plan for training staff regarding HIPAA and PHI, as
well as the encryption/secure system used to send emails with PHI.
At WC CMA, we understand the critical importance of Health Insurance
Portability and Accountability Act (HIPAA) and Protected Health Information
(PHI) regulations in protecting the privacy and security of our patients'
health information. We take our obligations under HIPAA very seriously and
are committed to ensuring that our staff receive regular training and
education on HIPAA compliance. We recognize that our members trust us
with their personal and sensitive information, and we are dedicated to
maintaining that trust by implementing robust security measures, following
privacy regulations, and providing our staff with the resources they need to
handle PHI responsibly. Our goal is to provide our members with the highest
quality care while always ensuring the confidentiality and protection of their
health information.
To ensure compliance with HIPAA regulations, all new hires are trained on
HIPAA and PHI within (2) two weeks of their start date, including the use of
the encryption service for email communications. Current employees receive
updated training within (2) two weeks of any changes to HIPAA and PHI
policies and procedures.
To provide comprehensive training, WC CMA utilizes a multi -method
approach that combines in -person training, interactive dialogue, videos, and
independent review of HIPAA and PHI documents and websites. Resources
used for training include a two -page summary of HIPAA and PHI guidelines,
a HIPAA basics training on NeoGov.com, a HIPAA overview created by the
Department, and a link to Weld County Article XV: HIPAA Policies and
Procedures. Training topics include:
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1. Introduction to HIPAA and PHI: a. Overview of HIPAA regulations and
purpose b. Explanation of PHI (Protected Health Information) c.
Discussion on the importance of HIPAA and PHI compliance.
2. HIPAA Compliance Obligations: a. Discussion on the requirements of
HIPAA regulations b. Explanation of the responsibilities of the WC CMA
staff in terms of HIPAA compliance c. Overview of HIPAA breaches and
consequences of non-compliance.
3. Handling PHI: a. Overview of the different types of PHI b. Explanation
of the proper handling and storage of PHI c. Discussion on how to
protect PHI from unauthorized access, use or disclosure.
4. HIPAA Security: a. Explanation of the importance of data security and
privacy b. Discussion on the HIPAA Security Rule and its requirements
c. Overview of the steps WC CMA staff must take to maintain the
confidentiality, integrity, and availability of PHI.
5. HIPAA Privacy: a. Explanation of the HIPAA Privacy Rule and its
requirements b. Discussion on how WC CMA staff must handle PHI in
accordance with the privacy rule c. Overview of the rights of patients
and the procedures for providing access to their PHI .
6. HIPAA and Technology: a. Discussion on the use of technology in the
handling of PHI b. Explanation of the technology requirements of
HIPAA regulations c. Overview of the steps WC CMA staff must take to
ensure the secure use of technology when handling PHI.
As a component of the above six (6) training topics, WC CMA provides
training to our staff on using encrypted email when sending PHI through
Outlook. Our training program covers the proper use of encryption, including
when it is necessary and how to encrypt an email in Outlook. We also
emphasize the importance of following proper email security protocols to
prevent unauthorized access to PHI. By training our staff on the use of
encrypted email, we aim to ensure that all PHI transmitted electronically is
always protected and kept confidential.
OFFEROR'S RESPONSE 5.i: Appeals Tracking and Timelines
Page 1177
How the Offeror will ensure appeals are tracked and all timelines,
contacts, and submissions are met for each step in the appeals
process.
WC CMA Supervisors shall be responsible for ensuring all recipient appeal
requirements and timelines are adhered to in accordance with Recipient
Appeals, 10 CCR 2505-10, Section 8.057. et seq., Section 8.393 et sec.,
Sections 8.519.21 and 8.519.22, and all other waiver and service specific
rules pertaining to adverse actions.
The WC CMA Supervisory Team shall be responsible for the documentation
and tracking of all appeal related notices, activities, timeframes, and
submissions. The Supervisor Team will also be responsible for working with
and overseeing all appeal related activities completed by case managers, to
include training all new staff on appeal requirements and timelines within
one hundred and twenty (120) days of the start date.
Receipt of Notices
All incoming appeal related notices from the Office of Administrative Courts
(OAC) and the Office of Appeals (e.g., Notice of Initial Decision) will be sent
to WC CMAs dedicated appeals email account at CMAappeals@lweld.gov. All
supervisors will have access to this shared account and are responsible for
processing all incoming paperwork in accordance with a predefined
assignment system. This consolidated and streamlined method of
communication helps ensure notices are seen by multiple people, provides
automatic backup coverage if someone on the Supervisory Team is out, and
it simultaneously consolidates all notices into a single location that functions
as historical record of all incoming notices and appeal documents.
The OAC currently has the capacity for sending notices by email. If this is
not an option with the Office of Appeals, then all mailed hearing appeal
notices and documents from the Office of Appeals will be sorted by WC CMA
case aides and assigned to the managing supervisor. Supervisors will be
responsible for processing, tracking, and responding to all appeal related
documents.
Internal Tracking of Notices and Timeline Management
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All outgoing notices for adverse actions (reductions, terminations, and
denials) sent to Members, the parents of a minor, guardian and/or
authorized representative, as applicable, will be tracked by the case
manager, to include the effective date and appeal by dates documented on
the Notice of Action.
For Members, the parents of a minor, guardian and/or authorized
representative, as applicable, that do not file a request for a hearing by the
effective date or appeal by date, case managers will process the closure of
services and/or the program in accordance with Colorado rules and
regulations.
When a hearing notice is received from the OAC, the managing supervisor
will process the notice by completing two activities: a) a review of the
notice, and b) data entry into the tracking spreadsheet.
A review of the notice shall include verification that the Request for a
Hearing was filed within the required timeframes set forth in the Notice of
Action, a review of what reasons(s) the Member listed for requesting a
hearing, and a review of any attached documents submitted by the Member
or the Member designated representative.
Appeal notice information shall be entered into a centralized, agency wide,
protected appeal tracking Excel spreadsheet by the managing supervisor.
The data entered will include Member name, a second identifier (e.g., DOB),
Case Manager name, notice type (e.g., service reduction, waiver denial),
notice reason (e.g., functionally ineligible, no services for thirty [30] days),
relevant dates (mailed date, effective date, appeal by date), the date of
receipt, the hearing date and time. A hearing packet submission due date
(no later than twenty [20] days prior to the hearing) field shall auto
calculate and auto populate for the supervisor and case manager, thus
ensuring the avoidance of mathematical errors and inadvertent oversights.
In accordance with RFP Section 3.6.1.1, an additional due date field will be
used to indicate the date the supervisor must notify the Department of any
conflict of interest related to the hearing (no later than forty-five [45] days
prior to the hearing). As a backup measure, both "due date" fields will be
conditionally formatted to turn red five (5) days prior to the due date.
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The managing supervisor will notify the case manager of the hearing notice.
Both parties will then enter the packet due date and the hearing due date in
their respective Outlook calendars and the dedicated shared appeals
calendar that is accessible to the Supervisory Team with reminder alerts
enabled. The packet sent date will be entered into the tracking
spreadsheet.
Notices from the Office of Appeals, such as Initial Decisions and Final Agency
Decisions, will be processed in the same way as other notice types and will
have dedicated fields, such as the date the Initial Decision was received; the
outcome of the decision (upheld, overturned, dismissed); the exception file
by date if decision is overturned; date sent; date transcripts requested; and
the date and extension to file an exception was sent; final agency decision
receipt and corresponding timelines; and any dates related to district court
level appeals.
All dates and notices have a correlative response and steps that are
completed by the supervisor and/or case manager, to include logging all
activities in the Department information management system log note
section and any appeal related specific sections within five (5) days of the
activity, creating packets and responses, attending hearings, etc.
WC CMA's approach to tracking appeal related work and timelines is based
on entering information in multiple ways (i.e., spreadsheet, shared Outlook
account) to ensure that no aspect of an appeal is missed.
OFFEROR'S RESPONSE 5.j: CIRS
How the Offeror will collaborate with providers to ensure Critical
Incidents are reported to the CMA and how Case Managers will
ensure appropriate follow-up when a Critical Incident occurs in
alignment with regulations and the Contract resulting from this
solicitation.
Provider Education and Awareness
WC CMA will adopt a proactive approach to enhancing provider education
and awareness of critical incidents to help ensure case managers are notified
of incidents in accordance with existing definitions, requirements, and
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timelines. To this end, WC CMA will engage in several efforts that utilize
multiple methods of communication and information sharing, such as adding
information to provider communications, creating a dedicated CIRS email
account (CMACIRS@weld.gov), educating providers at the time of incident
notification, and referring providers to Department and Colorado Department
of Health and Environment (CDPHE) CIRS trainings.
WC CMA will create a dedicated shared CIRS email address that will
centralize all CIRS email communications in one location that is accessible by
the entire CMA management team. This email address will be posted on our
website, added to fax cover pages, and will be given to the Department for
use in all critical incident related communications, such as those requiring
follow-up activities.
CIRS information will be added to the WC CMA fax cover page template
which will include our CIRS email address, and a link to the Department
website for HCBS Waiver Critical Incident Reporting at
https://hcpf.colorado.gov/hcbs-waiver-critical-incident-reporting. This is an
effective way to share information with providers and put it at the forefront
of their awareness.
WC CMA will create a dedicated shared CIRS email address that will
centralize all CIRS email communications in one location that is accessible by
the entire CMA management team. This email address will be posted on our
website, added to fax cover pages, and will be given to the Department for
use in all critical incident related communications, such as those requiring
follow-up activities.
At the time of a critical incident notification from a provider, case managers
will take the opportunity to discuss the CIRS process and educate them on
the importance of prompt reporting, timelines, and possible follow-up
activities that may require provider involvement. When necessary, CMA staff
will refer providers to the Department's critical incident website referenced
above and to Department and CDPHE training resources.
WC CMA has a long history of providing case management services which in
turn has created an extensive and well -established relationship with HCBS
providers in our area. This familiarity makes collaboration on critical
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incidents and other service issues more efficient and appropriately
responsive.
Appropriate Follow -Up
The Department requirement for timely CIRS follow-up is currently ninety
(90) percent. In Fiscal Year 2019 WC CMA scored ninety (90) percent on
entering CIRs within (24) twenty-four hours of notification and forty-two
(42) percent for timely critical incident follow-up activities. Fast forward to
fiscal year 2023, where to -date we are averaging ninety-four (94) percent
compliance in both entering critical within twenty-four (24) hours of
notification and completing follow-up activities on time. In OFFEROR'S
RESPONSE 3 of this bid, WC CMA's improvement in critical incident related
timelines is apparent and impressive. WC CMA attributes this success to
training and monitoring activities, supervisory involvement, and a sustained
commitment by our staff to process and complete critical incident related
activities quickly and in accordance with state rules, the contract,
department operational memos, and trainings. Should WC CMA be awarded
the contract associated with this solicitation, Weld County will continue
existing critical incident practices and will make changes along the way, to
include engaging in education and awareness outreach efforts in the first
part of this response.
Within sixty (60) days of new hire start dates, new case managers will be
trained in critical incident definitions, timeframes, responses, expectations,
and documentation requirements. Training shall include training Department
created webinars at https://hcpf.colorado.gov/long-term-services-and-
supports-training, Department and WC CMA created materials, one-on-one
training with supervisors, and one hundred (100) percent reviews of CIRS
activity for six (6) months. New case managers will be required to
successfully complete the training requirements before managing an
independent caseload.
Existing staff will receive annual refresher training, training updates when
new materials or guidelines are released, and performance based targeted
monitoring and reviews.
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All critical incident notifications will be reviewed at one hundred (100)
percent for timely entry by the supervisory team, and to conduct the review,
they will use critical incident data reports from the Department and critical
incident reporting features in the Department information management
systems. Timely follow-up activities will also be reviewed at one hundred
(100) percent, with an emphasis on real time reviews and monitoring to
ensure WC CMA as whole is performing to Department and contract
standards. Follow-up notices from the Department will be copied to a
forthcoming supervisor managed shared inbox, CMACIRSC@weld.gov.
Supervisors will monitor the follow-up activities and corresponding
timeframes to ensure all CIR follow-ups are completed and entered in the
Department's prescribed system within the timelines established by the
Department and/or the Department's Quality Improvement Organization.
Attestations
Per RFP Section 3.7.1.1., WC CMA shall be responsible for entering critical
incident reports (CIR) in the Department prescribed system as soon as
possible, but no later than twenty -fours (24) hours (one business day)
following notification.
Per RFP Section 3.7.1.2., WC CMA shall ensure all suspected incidents of
abuse, neglect, and exploitation are immediately reported consistent with
current statute; Section 19-3-301 through 19-3-318 C.R.S. Colorado
Children's Code, Section 18-8-115 C.R.S. (Colorado Criminal Code - Duty to
Report a Crime), 18-6.5-108 C.R.S. (Colorado Criminal Code -Wrongs to At -
Risk Adults), and Section 26-3.1-102, C.R.S. (Social Services Code -
Protective Services).
Per RFP Section 3.7.1.3., WC CMA shall document all CIR follow-up
information in accordance with Department direction in the Department
prescribed system and maintain detailed documentation.
Per RFP Section 3.7.2.1., WC CMA shall ensure all CIRs follow-up is
completed and entered into the Department's prescribed system within the
timelines established by the Department and/or the Department's Quality
Improvement Organization.
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Per RFP Section, 3.7.2.2. et. Seq., WC CMA shall adhere to follow up
timelines determined by the Department, and understand that they will
depend on the type and severity of the CIR, such as:
High Priority Follow Up: CIRs which require immediate attention and
must be addressed to ensure the immediate health and safety of a
waiver participant must be remediated within and responded to in the
Department prescribed system within twenty-four to forty-eight (24-
48) hours
Medium Priority Follow Up: CIRs which require additional information
or follow up to ensure appropriate actions are taken and there is no
immediate risk to the health and safety of the waiver participant must
be completed in the Department prescribed system within three to four
(3-4) Business Days.
Low Priority Follow Up: CIRs that have been remediated by CMAs,
have addressed immediate and long-term needs, have implemented
services or supports to ensure health and safety, and those that have
protocols in place to prevent a recurrence of a similar CIR but may
require an edit to the CIR or additional information entered into the
Department prescribed system. The follow up for CIRs in this category
must be completed and entered within five (5) Business Days.
WC CMA is committed to ensuring timely reporting and appropriate follow-up
of critical incidents in compliance with regulations, the contract, training, and
memos. The approach to critical incident reporting in general, which includes
training case managers, monitoring, and supervisory involvement and
oversight has significantly contributed to our ever -improving success in
critical incident timelines, responsiveness and quality, which will carry
forward into the new contract.
OFFEROR'S RESPONSE 5.k: Investigations
How the Offeror will operationalize the investigation of, follow up to
and related extensive documentation of all allegations of abuse,
neglect, and exploitation for members enrolled in HCBS-CES, HCBS-
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CHRP, HCBS-DD, HCBS-SLS, State SLS, OBRA-SS, and FSSP which
meet or exceed Department requirements.
If awarded the contract for Service Area 9, WC CMA will commit to
conducting a comprehensive and thorough investigation of all allegations of
abuse, neglect, and exploitation among members enrolled in HCBS-CES,
HCBS-CHRP, HCBS-DD, HCBS-SLS, State SLS, OBRA-SS, and FSSP. In
response to OFFEROR'S RESPONSE 5.j, we offer this plan for investigating
allegations of abuse, neglect, and exploitation.
Policies and Procedures: WC CMA will formulate policies and
procedures to guarantee a thorough investigation process in line with
the requirements of the Department and 10 CCR 2505-10 8.608.8.
Reporting: Any incident, allegation or report of abuse, neglect,
exploitation, or mistreatment (MANE) shall be reported within 24 hours
in accordance with mandatory reporting regulations.
Action and Documentation: The assigned case manager or covering
case manager will immediately act upon any received allegations,
inform the parent or guardian of a minor or adult and the supervisory
authority over the agency where the incident is said to have taken
place, and document the incident in the Department's prescribed
system, all within 24 hours.
Confidentiality: All WC CMA staff shall maintain confidentiality and will
not discuss the MANE allegations with unauthorized individuals. WC
CMA will make every effort to protect the privacy of those involved.
Responsibilities of the Case Manager: The case manager shall be
responsible for verifying that the PASA has taken necessary steps to
protect the client and will complete a CIR. The CM will ensure that the
PASA has taken care of the member's health and safety needs and
that local law enforcement has been contacted. The CM will also work
with provider agencies to adjust service provision as necessary,
including changes to host home placement, suspension or addition of
services, and ensuring medical attention is received.
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• Investigation by Qualified Staff: WC CMA's investigations will be
carried out by qualified staff assigned to the Quality Assurance and
Specialist positions to ensure expertise, consistency, and objectivity
throughout the process.
• Cooperation with Adult Protective Services: WC CMA will sign a
cooperative agreement with Adult Protective Services if awarded this
contract. The Investigator will not interfere with law enforcement or
Adult Protection and will work with APS to conduct joint investigations
when possible.
Review and Interviews: The Investigator will review the Critical
Incident Report, related Incident Reports, log notes, and medical
documentation, and request additional information if needed. The
Investigator will conduct interviews with the member, the parent or
guardian of a minor member, and any other relevant parties and
document all interviews and supporting documentation into the
Department's prescribed system.
Results and Follow -Up: The Investigator will submit preliminary results
to the person with supervisory authority for review within forty-five
(45) days, including a summary of the investigation, conclusion, basis
for conclusion, recommendations, and all supporting documentation.
The person with supervisory authority will review the preliminary
results and provide a written response within five (5) days, indicating
any follow-up action required, including a date for resubmission if
additional information is needed. If no further action is required, the
response will indicate that the investigation is complete and ready for
review by the Human Rights Committee (HRC). The Investigator will
schedule the incident/investigation report review with the HRC.
• Documentation and Results: The final HRC report will be permanently
documented in the record of the person receiving services in the
Department's prescribed system and a copy will be provided upon
request to the member, the parent or guardian of a minor member,
and/or the PASA involved. The Investigator will also forward the
results to the agencies involved and the CMA Administrator if the
Page 1186
allegations of abuse, neglect, or exploitation were substantiated, to be
recorded in the employee's personnel file.
WC CMA will provide training to all staff on mandatory reporting
requirements and the process for responding to and investigating allegations
of abuse, neglect, and exploitation.
WC CMA will regularly review and update policies and procedures to ensure
that they are in line with current regulations and best practices.
WC CMA will work closely with the Department and other relevant agencies
to ensure that the rights and safety of individuals receiving services are
protected and that incidents of abuse, neglect, and exploitation are
prevented and handled effectively.
WC CMA will provide regular reports on the status of investigations and
actions taken to the Department and any other relevant parties, as
required.
WC CMA is committed to maintaining the privacy and confidentiality of all
parties involved and will take all necessary steps to protect the privacy of
individuals involved in any investigation.
WC CMA is committed to ensuring a fair and impartial process for all parties
involved and will take steps to prevent retaliation against individuals who
report or assist in the investigation of abuse, neglect, and exploitation.
OFFEROR'S RESPONSE 5.1: Human Rights Committee
How the Offeror will establish at least one HRC as a third -party
mechanism or continue an already established HRC in their Defined
Service Area, to safeguard the rights of persons enrolled in HCBS-
CES, HCBS-CHRP, HCBS-SLS, HOBS -DD, State SLS, OBRA-SS, and
FSSP.
If awarded the contract for Service Area 9, WC CMA is committed to creating
a Human Rights Committee (HRC) in order to safeguard the rights of
persons enrolled in HCBS-CES, HCBS-CHRP, HCBS-SLS, HCBS-DD, State-
SLS, OBRA-SS, and FSSP. The (re)establishment of a HRC within our service
area serves as an opportunity for our agency to make a meaningful
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contribution to the individuals we serve. Not only will this HRC ensure that
their rights are protected, but it also presents an opportunity for our agency
to bring its collective experience, expertise, and community partnerships to
contribute to the development and implementation of a successful HRC.
With an aim to establish an HRC that offers continuity and expertise, we will
leverage our existing relationship with our local CCB, Envision, to assist in
the possible migration of their HRC members to the new HRC managed by
WC CMA. We acknowledge the value that these experienced individuals could
bring to our agency's HRC, and if there is room for new members, we would
also welcome fresh perspectives to enhance its depth and effectiveness. Our
agency boasts a robust network of community partners and has a history of
fostering good relationships with the individuals we serve and their families,
both of which we can utilize to solicit interest from qualified candidates for
HRC membership. In addition to identifying persons receiving services, their
parents, legal guardians or authorized representatives, we also have a
collaborative relationship with local agencies such as the University of
Northern Colorado, where we can reach out to their Special Education and/or
Psychology departments for qualified candidates.
Upon the award of the contract, we will promptly request a meeting with
Envision and their current HRC members to assess their interest in
transitioning. This will help us determine how many members we will need,
what qualification gaps we would need to fill, and the timeline and audience
required for recruitment efforts.
All interested existing and/or new candidates for HRC membership will
submit a letter of interest and documentation of their qualifications, which
we will use to ensure that our committee meets the requirements pursuant
to §25.5-10-209(h), C.R.S. and 10 C.C.R. 2505-10 Section 8.608.5 et seq.
We will retain this information and make it available to the Department upon
request, and we will provide an annual list of our HRC members to the
Department by August 15th. In the event of a change in membership, we
will promptly notify the Department within ten (10) business days.
Our agency is fully committed to adhering to the policies and procedures
outlined by the Department. To that end, we will develop policies and
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procedures to address any potential conflicts of interest, and we will utilize
Department -required universal documents for all HRC reviews. We will also
orient all members of our HRC regarding their duties and responsibilities and
make this information available to the Department upon request. Our HRC
will receive the necessary staff support to facilitate its functions, and we will
maintain proper documentation and will record all HRC recommendations
and make sure that this documentation is a part of the individual's master
record. Additionally, we will promptly submit HRC meeting minutes,
attendance logs, and supporting documentation to the Department within
ten (10) business days of receiving the request, and we will promptly notify
the Department in writing of any changes to the HRC membership. Lastly,
we will document all reviews within the Department's prescribed system
within ten (10) business days of the date of the HRC review.
OFFEROR'S RESPONSE 6: Pre -Enrollment for LTSS
Please provide detailed information on the Offeror's experience and
how the Offeror shall meet the requirements as it relates to Pre -
Enrollment Activities for LTSS Programs. The Offeror must include
the following:
OFFEROR'S RESPONSE 6.a: Assessing A Member Needs
The Offeror's experience assessing a Member's needs, to include
obtaining information from multiple sources to ensure a thorough
assessment.
Over the past five (5) years, WC CMA has conducted all Level of Care Screen
Assessments (RFP Section 3.17.2) and Needs Assessments (defined below)
in accordance with the current level of care screening guidelines at 10 CCR
2505-10-8.401 et. seq, the initial assessment requirements at 10 CCR 2505-
10-8.393.2.C et. seq., the assessment, reassessment, and informal
assessment requirements at 10 CCR 2505-10-8.393.2 et seq., the
comprehensive assessment, periodic reassessment, the identification of
client needs and service plan development requirements at 10 CCR 2505-10-
8.519.11.B et. seq., the SEP Contract, and Department Operational Memos.
Page 1189
In 2022, WC CMA case managers completed one thousand two hundred
forty-two (1,242) Initial Level of Care Screen Assessments for all SEP
managed LTSS programs (HCBS, Nursing Home, PACE, LTHH, HBU). Seven
hundred twenty-nine (729) of those Initial Assessments were for HCBS
waivers and therefore included a Needs Assessment. In 2022, WC CMA also
completed over thirteen hundred (1,300) Level of Care Screen and Needs
Reassessments for Members receiving services from one (1) of five (5) HCBS
waivers (HCBS-BI, HCBS-CIH, HCBS-CLLI, HCBS-CMHS, HCBS-EBD).
Since 2003, WC CMA case managers have utilized the Department
prescribed Uniform Long -Term Care 100.2 Assessment (100.2) and its
supplemental assessment and needs tools to conduct all Level of Care
Screen and Needs Assessments. When the state implemented the ULTC
100.2 in 2003, in addition to conducting assessments, case managers were
newly assigned the regulatory responsibility of being the Utilization Review
Contractor (URC). This role meant that case managers had to determine if
an applicant was approved or denied for a program based on the information
contained within a complete assessment. No longer functioning as just
assessors, case managers have made level of care eligibility decisions, and
WC CMA has two (2) decades of completing level of care assessments that
include, but are not limited to the following components:
Conducting in -home and virtual assessments (Section 8.393.2.C.4 and
8.393.1.M.c).
Gathering assessment information and client history from multiple
sources (e.g., Member, family, physician, medical records) for
Colorado's existing assessment tool in accordance with rules at Section
8.393.2.C.5 et seq. and Section 8.519.11.B.1.b.
Obtaining diagnostic information from the individual's medical provider
(8.393.2.C.5.a).
Determining specific program eligibility based on target population
criteria definitions at Section 8.400.16 and waiver specific criteria in
waiver specific rules, such as those at Section 8.515 for the HCBS-BI
waiver, and Section 8.517 for the HCBS-CIH waiver.
Page 1190
Determining functional capacity, functional capacity score, and the
functional need for a nursing facility level of care in accordance with
8.393.2.C.5.b and 8.401.15.A.
Assigning length of stays for individuals seeking nursing facility care as
required in 8.393.C.5.c, and according to guidelines in Section
8.402.15.
Completing initial assessments within the timeframes specified at
Section 8.393.2.C.1.a et. seq., RFP Section 3.17.2.3, the
reassessment timeframes at Section 8.393.2.D.1 and in RFP Section
3.17.3.1.
Utilizing the Department's information management systems (IMS) to
document assessment activities per Section 8.393.5.2 and the record
keeping and documentation requirements at Sections 8.519.12 and
8.393.1.1.
Issuing Notice of Actions for all program approvals and denials per
Sections 8.393.5.A, 8.393.3.A.2, and the recipient appeal rules at
8.057; and preparing for and attending hearing related 803s sent by
WC CMA in accordance with Section 8.057.
In addition to decades of experience conducting assessment activities, WC
CMA has the same amount of experience completing needs assessments for
HCBS waiver programs. Currently, the level of care assessment is the ULTC
100.2, an assessment that considers eight activities of daily living (ADLs) for
eligibility: bathing, dressing, toileting, mobility, transfers, eating, behaviors,
and memory/cognition. The ULTC 100.2 is the core of eligibility
determinations, and it is the only assessment required for all programs. For
all HCBS waiver assessments, WC CMA needs assessments have consisted of
the completion of the ULTC 100.2, an assessment of an individual's
Instrumental Activities of Daily Living (IADL), and the completion of a
Service Plan. In addition to ADLs, the IADL assessment considers a person's
deficits and needs in the areas of hygiene, medication management,
transportation, meal preparation, accessing resources, laundry, money
management, housework, and shopping. An assessment of the ADLs and
IADLs creates a more complete picture of an individual's deficits and
corresponding service and non -service needs. The service plan represents
the service need response to all that was disclosed in the ADL and IADL
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assessments, the individual's preferences, services decisions, and an
opportunity to further discuss and refine areas in need of support. WC CMA
case managers currently engage in the following needs assessment
activities, and have done so for twenty (20) years:
Completion of the UTLC 100.2 assessment in accordance with all
relevant rules at Section 8.393 et. seq., 8.401 et seq., and 8.519 et
seq
Completion of the IADL assessment.
Identification of an individuals' strengths, needs, and preferences for
service and support as required in Section 8.393.2.G.1.a
Service plan development in accordance with Section 8.393.2.G.1.b
that addresses individual goals, assessed needs, and preferences.
Identifying client needs, health and safety concerns, and gathering
information from multiple sources, Sections 8.519.11.b and 8.519.11.
Being sensitive to cultural considerations and communication needs
per Section 8.393.2.E.d.
Providing necessary information and support to ensure the individual
directs the assessment and service planning process as defined in
Section 8.393.2.E.4.
Documenting needs assessment activities in Department IMSs, to
include entering the ADL, IADLs, Service Plan, and an Inventory of
Member Needs.
To ensure the completion of comprehensive assessments (Section
8.519.11.b), WC CMA has thirty (30) years of experience assessing
Member's needs by obtaining information from multiple sources. WC CMA
makes important distinctions between five (5) types of sources: the
Member, the Case Manager, context, others, and documentation.
Every person, with their inherent complexity, is a source of multiple forms of
information that aid in identifying and differentiating various sources of
information during and after the assessment. These sources include verbal
communication, tone and affect, non-verbal communication, ability to
participate in the assessment, level of engagement, behaviors, and other
aspects. Engaging with all these aspects of an individual requires the Case
Manager to participate in various ways. For WC CMA staff, this means being
Page 1192
calm, attentive, empathetic, engaged, aware, and responsive, while
communicating clearly and effectively.
The Case Manager is considered a source of information, mainly in the form
of seeing and reporting what is observed physically, relationally,
emotionally, and behaviorally. Trained by the Department and WC CMA
Supervisors, Case Managers know the importance and value of observation
and the documentation of those observations in Department information
managed systems (e.g., BUS), log notes, and assessment ADL and IADL
comment sections.
Context as a source includes the location of the assessment, and more
importantly, the status of the living environment, how it appears, anyone
else that lives there, the presence and use of durable medical equipment or
the lack thereof, and perceived gaps in actual equipment (e.g., shower
chair) and barriers to accessibility (e.g., narrow doorways, non -accessible
showers, steps).
For over two (2) decades Case Managers have been trained and are
accustomed to gathering information from others. This includes gathering
information from new and existing Members, their family members, friends,
healthcare providers (hospital staff, nursing facility staff), community
partners (e.g., Adult Protection, RAE) and other relevant sources, as needed
and permitted, to develop a comprehensive understanding and holistic
picture of a member's needs. Others as a source is incredibly valuable,
especially at times when Members themselves are unable to be accurate
historians or are reluctant to request assistance simply because they do not
wish to be a burden to the system. Case Managers also know that gathering
information from others is an excellent way to a) substantiate eligibility, b)
add multiple perspectives to an individual's strengths and needs, c) and to
identify and refine the needs picture and the corresponding person -centered
service plan response.
Documentation as source includes activities such as reviewing medical
records, professional medical information pages from physicians, historical
documentation (e.g., past assessments, log notes) in Department
information management system, and other information.
Page 1193
Lastly, Case Managers are trained to use multiple communication modalities
to obtain information from multiple sources. This includes conducting in -
person and virtual assessments (Zoom, Teams); contacting people by
phone, secure email, and fax; and in -person meetings with people that come
to the building where WC CMA is housed.
In summary, WC CMA has extensive experience and a long history of
completing level -of -care screens and needs assessments for thousands of
people across a wide range of disabilities and income ranges, spanning the
entire age spectrum from birth to older adults. Over the past twenty (20)
years, the sheer volume of assessments and member interactions has
resulted in the development of a refined and deep understanding of people,
disabilities, and the needs of our community. We have also learned how to
conduct effective and meaningful evaluations and understand the importance
of being empathetic and engaged while simultaneously meeting contractual,
federal, and state requirements.
OFFEROR'S RESPONSE 6.b: Providing Oversight and Assessing
Quality
Describe the Offeror's experience providing oversight and assessing
the quality of case management activities performed and
implementing a quality improvement strategy to ensure regulatory
and contractual timeline requirements for each function are met.
WC CMA has thirty (30) years of experience providing supervision,
monitoring, review, and oversight for all HCBS and non-HCBS programs
associated with our existing SEP contract. Our capacity to provide oversight
is based on an in-depth knowledge of state and federal requirements,
contract and program requirements, Department Dear Administrator Letters
(DAL), operational memos, Quality Improvement Strategy (QIS)
performance measures and data, and Department created training materials.
WC CMA also has years of experience implementing quality improvement
strategies in response to internal and external audit results and QIS findings.
Throughout this time, WC CMA has provided oversight, training, and
monitoring for all SEP case management functions/activities, including but
not limited to:
Page 1194
Intake, screening, and referral functions/activities and timelines in
accordance with 10 CCR 2505-10 8.393.2.B. et seq.
Initial Assessment functions/activities and timeline requirements in
accordance with 10 CCR 2505-10 8.393.2.C.
Reassessment functions/activities and timeline requirements in
accordance with 10 CCR 2505-10 8.393.2.D.
Support planning functions/activities and timeline requirements (e.g.,
develop the support plan within 15 days) in accordance with 10 CCR
2505-10 8.393.2.E.
Ongoing case management functions/activities and corresponding
timeline requirements (e.g., monitoring, contact frequency, critical
incident reporting) per 10 CCR 2505-10 8.393.2.G.
Case record functions/activities and corresponding timeline
requirements (e.g., documenting activities within 5 days) per 10 CCR
2505-10 8.393.2.H.
Denial and discontinuation functions/activities and corresponding
timeline requirements (e.g., notifying providers within 1 day, case
closure procedures) per 10 CCR 2505-10 8.393.3.B.
Case record functions/activities and corresponding timeline
requirements (e.g., documenting activities within 5 days) per 10 CCR
2505-10 8.393.2.H.
Other general case management requirements and those specific to
LTSS programs (e.g., HCBS-EBD, HCBS-CMHS) and services (e.g.,
CDASS and corresponding timeline requirements, IHSS, Home
Modifications).
Over the past five years, WC CMA has employed a variety of specific
oversight and assessment measures to ensure that regulatory and
contractual timeline requirements are met. For example, supervisors review
ten (10) to twenty (20) percent of new cases for timeline compliance and
the completion of intake, screening, and referral activities. Additionally,
supervisors meet with individual case managers monthly to review caseloads
Page 1195
and required contacts, ensuring corresponding timeline compliance. All home
modifications are reviewed by supervisors prior to approval, and program
and service reductions and denials, CDASS allocations, and IHSS care plans
are reviewed on an ongoing basis.
Supervisors perform monthly spot check audits on case managers to monitor
for contractual and regulatory timeline compliance, including the completion
of required contacts such as quarter calls, 6 -month reviews, annual
reassessments, and monitoring contacts, as well as the completion of bi-
annual HCBS provider checks, intake activities, the documentation of case
management activities in the Department information management system
(the BUS and Bridge), and adequate maintenance of member records/files.
Over the past three years, supervisors have reviewed all intake and
continued stay review assessments for completion and timeliness, all
monitoring contacts, log notes, and the entry and approval of HCBS service
prior authorization requests (PAR) into the Department information
management system (the Bridge). For the past two years, WC CMA
supervisors have reviewed all Critical Incident Reporting (CIR) activities,
including monitoring for timely entry of all critical incidents and timely
response to all follow-up requests. On an ongoing basis, WC CMA
supervisors have audited all cases closed by case managers to ensure all
required steps have been completed, and all approved HCBS intakes are
reviewed prior to being assigned to an ongoing case manager. Additionally,
all new hires are reviewed at one hundred (100) percent for the first 6
months.
To ensure that regulatory and contractual timeline requirements are met,
WC CMA has implemented quality improvement strategies over the past five
years. For example, WC CMA has responded to Department Quality
Improvement Strategy (QIS) results by providing remediation, creating, and
implementing quality improvement plans, which include conducting root
cause analyses of all QIS findings, remediating deficiencies by conducting
focused QIS result related trainings, developing QIS focus review tools and
plans, and conducting reviews of all areas. Areas reviewed include, but are
not limited to, ULTC 100.2 assessment comments and scoring, level of care
determinations for intake and ongoing programs, person -centered support
Page 1196
planning activities, assessment and service plan alignment, needs
assessments, participant goals, and critical incident reporting activities.
WC CMA was cited for nine (9) to (10) HCPF reviewed QIS deficiencies for
Fiscal Years 2018 - 2021, and in Fiscal 2022, only two (2) citations were
found. WC CMA's implementation of quality improvement measures resulted
in a four hundred (400) percent reduction in findings from FY2021 to
FY2022, demonstrating the effectiveness of the quality improvement
strategies.
To address underperformance issues in CIRS follow-up activities, CIRS
training and retraining occur at least once per year, and all CIRS are
reviewed by the supervisory team. Follow-up activities are monitored, and if
needed, reminders are sent to case managers. These efforts account for the
increase in performance from FY19 to FY23. In FY22, based on a Department
review of one hundred forty (140) Critical Incidents in the fourth (4th)
quarter, WC CMA scored 98% compliance with on -time notification entry and
100% on -time follow-up responses.
WC CMA conducts trainings at staff meetings, which are mandatory for all
staff to complete. QIS trainings are given to new staff and incorporated into
new case manager training. They are also available for all staff to reference
when needed. WC CMA's supervisors check for any deficiencies more
regularly during staffing and spot checks, and the organization has
completed all QIS remediation in a timely manner.
In addition to these efforts, WC CMA uses a full weighted audit tool for both
ongoing and intake case management activities, as well as Department
Quality Improvement Strategy (QIS) annual review results, Department QIS
tools specifically designed to address annual QIS findings, and Department
IMS assessment and log note reports as part of their quality assurance
program. WC CMA has also participated in other Department required audits,
such as audits of CLLI paperwork, CDASS cases paperwork, and Home Mod
justifications.
Overall, WC CMA has extensive experience providing oversight and assessing
the quality of case management activities performed, implementing a quality
improvement strategy, and ensuring that regulatory and contractual timeline
Page 1197
requirements are met. The organization's commitment to quality
improvement has resulted in significant improvements over the past five (5)
years, as demonstrated by the reduction in QIS findings and high compliance
rates with critical incident reporting and follow-up activities.
Lastly, as a Single Entry Point, WC CMA has no experience to report for
several areas in RFP Section 3.10, Pre -Enrollment Activities, to include
Developmental Disability Determinations (RFP Section 3.12), Wait List
Management (RFP Section 3.13, 3.14), Wait List Records Maintenance, the
Authorization and Reporting of HCBS-DD Enrollments (RFP Section 3.16, the
Supports Intensity Scale (RFP Section 3.17.6), and a Support Needs Level
Assessment (RFP Section 3.17.7).
OFFEROR'S RESPONSE 6.c: OHCDS Experience
The Offeror's plan for performing and overseeing OHCDS functions.
If no previous experience, please describe the Offeror's experience
and ability to pay a third -party entity for services rendered.
As a SEP, WC CMA has no experience performing and overseeing Organized
Health Care Delivery System (OHCDS) functions that hitherto have been
provided by Community Centered Boards. Although WC CMA lacks direct
experience with OHCDS functions, as a program under the Weld County
AAA, we can access their expertise and resources to adopt, perform, and
oversee OHCDS functions.
WC CMA understands that the OHCDS function is a part of the contract
associated with this solicitation, and that it includes signing a Medicaid
provider agreement with the Department and reimbursing subcontractors for
services rendered. We understand that, pending CMS approval, we will be
responsible for performing the purchase of items for services such as
assistive technology, specialized medical equipment and supplies, vehicle
modification, vision, and recreational fees/passes, and will be required to
have a purchase agreement with vendors, to ensure fair market values and
vendor certification and authorization, and document attempts to find two
bids where possible.
Page 1198
Weld County AAA has successfully managed several voucher programs that
require staff to work with individuals, community providers, and the WCDHS
Fiscal Department. There is the Chore Service Program that pays for chore
services for the elderly. After program approval, participants hire their own
provider to complete chore services, and then they pay the provider for
services rendered and are subsequently reimbursed by the program. The
Visually Impaired Program provides financial assistance and support to
access assistive devices such as personal magnifiers, talking watches or
clocks, and other devices. The Family Caregiver Support Program provides
caregiver respite vouchers to provide in -home respite service, adult day
program services, and out of home respite care. There is also a program for
in -home care in which providers are contracted and monthly billings are
submitted directly to Weld AAA. Regardless of the program, bills submitted
for reimbursement are entered and tracked in an in-house information
management system, and requests for payment are submitted to the
Finance Department for review and approval.
Through the Weld County AAA, WC CMA has the experience, systems,
support, and infrastructure to provide OHCDS functions to our community.
OFFEROR'S RESPONSE 6.d: Experience Conducting Each Function
The Offeror's experience conducting each function described in this
section;
For thirty (30) years WC CMA has engaged in SEP pre -enrollment activities
as described in this solicitation. In particular, and in accordance with state
and federal regulations and the contract, we have performed intake,
screening and referral activities as defined in RFP Section 3.10.1, maintained
member records as defined in RFP Section 3.11, and have completed level of
care and needs assessments as defined in RFP Section 3.17. WC CMA has no
experience with remaining CCB areas/functions, to include Developmental
Disability Determinations (RFP Section 3.12), Wait List Management (RFP
Section 3.13, 3.14), Wait List Records Maintenance, the Authorization and
Reporting of HCBS-DD Enrollments (RFP Section 3.16), the Supports
Intensity Scale (RFP Section 3.17.6), and a Support Needs Level Assessment
(RFP Section 3.17.7).
Page 1199
Intake, Screening, and Referral
Since 1993, WC CMA has provided intake, screening, and referral services to
people of all ages, disabilities, and income levels who are currently on or
applying for CO HCBS waiver and non -waiver LTSS programs in Weld
County. Intake, screening, and referral services have been core LTSS
services since the inception of the CO SEP system in the early 1990's. Over
the past five (5) years, WC CMA has and continues to provide these services
to all Weld County residents in accordance with the Intake, Screening, and
Referral requirements in 10 CCR 2505-10-8.393.B, 10 CCR 2505-10-
8.519.11.B, the current SEP Contract with the Department, (Contract
Number 21-160398, Exhibit B, section 2, p. 8 of 22), and RFP Section
3.10.1.2 (p. 38). In 2022, WC CMA completed a total of one thousand eight
hundred seventy-seven (1,877) HCBS and non-HCBS referrals (see
OFFEROR'S RESPONSE 3 for referral type summary), in 2021 one thousand
seven hundred and fifty-seven (1,757) referrals were completed, and in
2020 one thousand seven hundred forty-nine (1,749) were completed.
The specific intake, screening, and referral service activities WC CMA has
provided to program applicants and existing Members for the past five (5)
years, include, but are not limited to: completing and documenting intake,
screening, and referral activities in the Department's information
management system (Section 8.393.2.B.1.a); the provision to information
and referral to other agencies as needed (Section 8.393.2.B.1.b); functional
eligibility assessment screens (Section 8.393.2.6.1.c); review of potential
pay sources (Section 8.393.2.B.1.d); and the prioritization of urgent
inquiries (Section 8.393.2.B.1.e).
WC CMA has an extensive referral network it has relied on for years to fill
gaps and meet the needs of people seeking help and assistance. If referrals
to other agencies and resources are deemed appropriate and useful to the
person seeking assistance, over the past five (5) years, WC CMA will refer
them to any number of possible departments and agencies, to include, but
not be limited to: Community Centered Boards (e.g., Envision); CHCBS case
management agencies (e.g., Access and Ability); Regional Accountable
Entities (e.g., Northeast Health Partners); North Range Behavioral Health;
North Colorado Health Alliance; Connections for Independent Living; low -
Page 1200
income and senior housing providers; transportation providers; senior
centers; Colorado Legal Services; United Way; Catholic Charities; and the
numerous programs housed within the WCDHS, including but not limited to
those housed within the AAA (Adult Protective Services, Long Term Care
Financial, ADRC, Older American Act programs, Senior Nutrition Program
and Ombudsman Program); Child Protection and the Wraparound team;
Employment Services; Family Resource Division (Outreach, Prevention,
Emergency Rental Assistance and SSI/SSDI Specialists); and others.
For the past five (5) years, WC CMA has experience in receiving referrals
from a variety of sources, such as individuals in need of long-term services
and supports, their friends and families, numerous agencies and community
partners, hospitals, nursing facilities, other county departments and
divisions, other case management agencies, mental health agencies, PACE
sites, and others. WC CMA has years of experience receiving these referrals
by phone, in person, by fax, and secure email.
As an intake, screening, and referral process outcome, if an individual needs
services and supports through a publicly funded LTSS program such as an
HCBS waiver, WC CMA staff move the application forward by verifying
individual demographic information collected at intake (Section
8.393.2.B.2.a), coordinating the completion of the financial eligibility process
(Section 8.393.2.B.2.b) by verifying current financial status (Section
8.393.2.B.2.b.i), referring individuals to the county department of social
services (Section 8.393.2.B.2.b.ii), providing financial application forms
(Section 8.393.2.B.2.b.iii), and documenting follow-up activities to complete
the functional eligibility determination and the completion of the financial
eligibility determination (Section 8.393.2.B.2.b.iv). At the conclusion of the
process, WC CMA staff provides recipient appeal rights in accordance with
Sections 8.393.2.B.2.d and 8.057 et. seq.
Regardless of age, disability, income level, and location within the county,
anyone can enter through the front doors of WC CMA to receive the above
intake, screening, and referral services. While there are many ways WC CMA
works with people, for the past (5) years, WC CMA has primarily interfaced
with people through LTSS waivers and non -waiver programs.
Page 1201
For children aged birth through eighteen (18), WC CMA has provided intake,
screening, and referral services for the HCBS Waiver for Children with a Life -
Limiting Illness and the Home Care Allowance program, and for ages sixteen
(16) to eighteen (18) years of age, the HCBS Waiver for Persons with a
Brain Injury. For adults aged eighteen (18) and older, for the past five (5)
years WC CMA has provided intake, screening, and referral services through
the HCBS Waiver for Persons who are Elderly, Blind, and Disabled, the HCBS
Waiver for Complimentary and Integrative Health (e.g., spinal cord injuries,
multiple sclerosis), the HCBS Community Mental Health Supports Waiver and
HCBS for Persons with a Brain Injury Waiver. Additionally, WC CMA
completes intake, screening, and referral services for individuals in need of
Long -Term Home Health services (RN, CNA), Hospital Backup admissions,
elderly persons in need of the Program for All -Inclusive Care for the Elderly
(PACE), for all individuals, regardless of disability and income status, and for
nursing facility admissions under Medicaid.
Individual/Member Records
WC CMA has twenty years (20) of experience in documenting individual and
Member records within multiple Department -prescribed systems, in
accordance with the rules set forth by the Department for these systems.
The systems include the Benefit Utilization System (BUS); the Colorado
interChange Medicaid Management Information System (MMIS) and its
subsystem; the Bridge; CDASS FMS Vendor web -based systems; the
Telligen web -based utilization review system; and outdated and discontinued
systems such as the DDM PASRR database and CDASS FMS vendor sites no
longer in operation.
WC CMA's experience in maintaining individual and Member records within
the Department -prescribed systems follows the guidelines specified in 10
CCR 2505-10 8.393.1.E and H., and 10 CCR 2505-10 8.519.12. This
includes, but is not limited to, completing and maintaining all required
records included in the State -approved IMS, maintaining individual case
records at the agency level for any additional documents associated with the
individual, including identifying information in all records and State -required
forms, documenting all case management activity required by these
regulations, making entries within five (5) days that are objective and easily
Page 1202
understood for review by relevant parties, including information about
sources of information, and making entries that are concise but include all
pertinent information.
WC CMA also has experience in keeping records and documentation together
in a logical, organized sequence for easy access and review by case
managers, supervisors, program monitors, and auditors, in compliance with
relevant rules and regulations. The agency is required to maintain records
for at least seven (7) years after a client's discharge from a waiver program,
as per 10 CCR 2505-10 8.519.3.A.7.
Level of Care and Needs Assessments
Over the past five (5) years, WC CMA has conducted all Level of Care Screen
Assessments (RFP Section 3.17.2) and Needs Assessments (defined below)
in accordance with the current level of care screening guidelines at 10 CCR
2505-10-8.401 et. seq, the initial assessment requirements at 10 CCR 2505-
10-8.393.2.C et. seq., the assessment, reassessment, and informal
assessment requirements at 10 CCR 2505-10-8.393.2 et seq., the
comprehensive assessment, periodic reassessment, the identification of
client needs and service plan development requirements at 10 CCR 2505-10-
8.519.11.B et. seq., the SEP Contract, and Department Operational Memos.
In 2022, WC CMA case managers completed one thousand two hundred
forty-two (1,242) Initial Level of Care Screen Assessments for all SEP
managed LTSS programs (HCBS, Nursing Home, PACE, LTHH, HBU). Seven
hundred twenty-nine (729) of those Initial Assessments were for HCBS
waivers and therefore included a Needs Assessment. In 2022, WC CMA also
completed over one thousand three hundred (1,300) Level of Care Screen
and Needs Reassessments for Members receiving services from one (1) of
five (5) HCBS waivers (HCBS-BI, HCBS-CIH, HCBS-CLLI, HCBS-CMHS,
HCBS-EBD).
Since 2003, WC CMA case managers have utilized the Department
prescribed Uniform Long -Term Care 100.2 Assessment (100.2) and its
supplemental assessment and needs tools to conduct all Level of Care
Screen and Needs Assessments. When the state implemented the ULTC
100.2 in 2003, in addition to conducting assessments, case managers were
Page 1203
newly assigned the regulatory responsibility of being the Utilization Review
Contractor (URC). This role meant that case managers had to determine if
an applicant was approved or denied for a program based on the information
contained within a complete assessment. No longer functioning as just
assessors, case managers have made level of care eligibility decisions, and
WC CMA has two (2) decades of completing level of care assessments that
include, but are not limited to the following components:
o Conducting in -home and virtual assessments (Sections 8.393.2.C.4
and 8.393.1.M.c).
o Gathering assessment information and client history from multiple
sources (e.g., Member, family, physician, medical records) for
Colorado's existing assessment tool in accordance with rules at Section
8.393.2.C.5 et seq. and Section 8.519.11.B.1.b.
o Obtaining diagnostic information from the individual's medical provider
(Section 8.393.2.C.5.a).
o Determining specific program eligibility based on target population
criteria definitions at Section 8.400.16 and waiver specific criteria in
waiver specific rules, such as those at Section 8.515 for the HCBS-BI
waiver, and Section 8.517 for the HCBS-CIH waiver.
o Determining functional capacity, functional capacity score, and the
functional need for a nursing facility level of care in accordance with
Sections 8.393.2.C.5.b and 8.401.15.A.
o Assigning length of stays for individuals seeking nursing facility care as
required in 8.393.C.5.c, and according to guidelines in Section
8.402.15.
o Completing initial assessments within the timeframes specified at
Section 8.393.2.C.1.a et. seq., RFP Section 3.17.2.3, the
reassessment timeframes at Section 8.393.2.D.1 and in RFP Section
3.17.3.1.
o Utilizing the Department's information management systems (IMS) to
document assessment activities per Section 8.393.5.2 and the record
keeping and documentation requirements at Sections 8.519.12 and
8.393.1.1.
o Issuing Notice of Actions for all program approvals and denials per
Sections 8.393.5.A, 8.393.3.A.2, and the recipient appeal rules in
Page 1204
Section 8.057; and preparing for and attending hearings related to
803s sent by WC CMA in accordance with Section 8.057.
With decades of experience conducting the above assessment activities, WC
CMA has the same amount of experience completing needs assessments for
HCBS waiver programs. Currently, the state prescribed level of care
assessment is the ULTC 100.2, and it addresses eight activities of daily living
(ADLs): bathing, dressing, toileting, mobility, transfers, eating, behaviors,
and memory/cognition. The ULTC 100.2 is the core of eligibility
determinations, and is the only assessment required for all programs. For all
HCBS waiver assessments, the needs assessments completed by WC CMA
have consisted of a combination of the ULTC 100.2, the individual's
Instrumental Activities of Daily Living (IADLs), and the completion of a
Service Plan.
In addition to ADLs, the IADL assessment considers a person's deficits and
needs in the areas of hygiene, medication management, transportation,
meal preparation, accessing resources, laundry, money management,
housework, and shopping. An assessment of the ADLs and IADLs creates a
more complete picture of an individual's deficits and the corresponding HCBS
service and non-HCBS service needs. The service plan represents the service
need response to information from the ADL and IADL assessment, to include
the individual's preferences, chosen services, and the opportunity to further
discuss and refine areas in need of support. WC CMA case managers engage
in the following needs assessment activities, and have done so for twenty
(20) years:
o The completion of the UTLC 100.2 assessment in accordance with all
relevant rules at Section 8.393 et. seq., Section 8.401 et seq., and
Section 8.519 et seq.
o The completion of the IADL assessment.
o The identification of an individual's strengths, needs, and preferences
for services and supports as required in Section 8.393.2.G.1.a
o Service plan development in accordance with Section 8.393.2.G.1.b
that addresses individual goals, assessed needs, and preferences.
o Identifying client needs, health and safety concerns, and gathering
information from multiple sources, Section 8.519.11.b and 8.519.11
Page 1205
Being sensitive to cultural considerations and communication needs
per Section 8.393.2.E.d.
o Providing necessary information and support to ensure the individual
directs the assessment and service planning process as defined in
Section 8.393.2.E.4.
o Documenting needs assessment activities in Department IMSs, to
include entering the ADL, IADLs, Service Plan, and an Inventory of
Member Needs.
In summary, WC CMA has extensive experience and a long history of
completing intake, screening, and referral activities, maintaining member
records, and conducting level -of -care screens and needs assessments for
thousands of people across a wide range of disabilities and income ranges,
and the entire age spectrum spanning from birth to older adults.
OFFEROR'S RESPONSE 6.e: Experience Meeting Timeline
Requirements
Previous experience in meeting regulatory and contractual timeline
requirements for each function;
WC CMA, serving as the SEP for Service Area 9, possesses more than twenty
(20) years of experience in carrying out pre -enrollment activities defined in
RFP Section 3.10, and we have a corresponding twenty (20) years of
experience in meeting the associated timeframes for each function. Our
extensive experience includes effectively meeting and monitoring timeline
requirements for various pre -enrollment functions, including but not limited
to:
Intake, screening, and referral functions/activities and timelines in
accordance with 10 CCR 2505-10 8.393.2.B. et seq. and our existing
contract, to include:
o Processing information regarding Client Medicaid eligibility within
two (2) Business Days of receipt from the eligibility site.
o Facilitating the Medicaid application process and responding to
all referrals of potentially eligible individuals within two (2)
Business Days of receipt of the referral.
Page 1206
o Finalizing referrals within the Department within one (1) day of
receiving a complete referral.
Initial Assessment functions/activities and timeline requirements in
accordance with 10 CCR 2505-10 8.393.2.C. and our existing contract,
to include conducting an Initial and Annual Functional Eligibility
Assessments in accordance with the following timelines:
Ten (10) Business Days after receiving confirmation that the
Medicaid application has been received by the county
Department of Human or Social Services for Clients residing in
the community. HCBS assessments include Needs Assessment
(100.2 and IADLs)
Ten (10) Business Days after receiving a referral from a provider
for the PACE.
Five (5) Business Days after receiving a completed referral from
the nursing facility.
Five (5) Business Days after receiving a completed approval for
the CLLI Waiver.
Two (2) Business Days after receiving a completed referral from
the hospital.
Support planning functions/activities and timeline requirements (e.g.,
developing the support plan within fifteen [15] days) in accordance
with 10 CCR 2505-10 8.393.2.E.
Reassessment functions/activities and timeline requirements in
accordance with 10 CCR 2505-10 8.393.2.D.
Case record functions/activities and corresponding timeline
requirements (e.g., documenting activities within five [5] days) per 10
CCR 2505-10 8.393.2.H
In addition to having extensive direct experience with pre enrollment
functions and meeting there corresponding timelines, WC CMA has an equal
amount of experience providing oversight, monitoring, and training for these
functions.
Page 1207
Over the past five years, WC CMA has employed a variety of supervisory
level measures to ensure that regulatory and contractual timeline
requirements are met. Every month, supervisors review ten (10) to twenty
(20) percent of all intakes assigned to ongoing case managers, and these
reviews include an audit of intake, screening, and referral activities and
timelines, timeliness with assessment activities, level of care decisions, and
service planning. Supervisors also perform monthly spot check audits on
case activities to monitor for contractual and regulatory timeline compliance
in all aspects of the Work. Additionally, as part of the payment process
associated with the SEP contract, every month supervisors are reviewing log
notes, assessments, monitoring contacts, and other activities to ensure
activities were completed and done do in a timely manner. Also, all new
intake and ongoing case management new hires are reviewed at one
hundred (100) percent for the first six (6) months to ensures a
comprehensive understanding of the work, to include the timeline
requirements associated with every case management activity they are
assigned.
WC CMA uses various tools, such as complete and weighted audit tool for
ongoing and intake case management activities, Department Quality
Improvement Strategy (QIS) annual review results, QIS tools specifically
designed to address annual QIS findings, and Department IMS reports that
can generate substantial amounts of timeline data quickly and easily.
It is important to note that WC CMA has no experience to report for the
remaining areas/functions, including Developmental Disability
Determinations (RFP Section 3.12), Wait List Management (RFP Section
3.13, 3.14), Wait List Records Maintenance, the Authorization and Reporting
of HCBS-DD Enrollments (RFP Section 3.16), the Supports Intensity Scale
(RFP Section 3.17.6), and a Support Needs Level Assessment (RFP Section
3.17.7). Despite this, we are committed to building capacity and expanding
its expertise to ensure that we meet all regulatory and contractual
requirements for these functions associated with the contract associated
with this solicitation.
OFFEROR'S RESPONSE 6.f: Plan to Meet Timeline Requirements
Page 1208
The Offeror's plans to meet regulatory and contractual timeline
requirements for each function;
Providing quality care and support services requires strict adherence to both
regulatory and contractual timelines. At WC CMA, we are dedicated to
upholding these timelines to deliver exceptional service to our clients. To
ensure compliance, we have created a general plan that outlines agency
procedures for meeting regulatory and contractual timelines for the pre -
enrollment activities contained in this RPF and the new contract. WC CMA's
plan consists of training, providing oversight, conducting reviews, refresher
trainings, providing training materials, and outlining and summarizing the
timeline requirements for each function.
Trainina
New hires will receive training on the regulatory and contractual timeline
requirements for the programs and services they are assigned. Training will
cover all timelines related to Intake, Screening, Referral, Individual/Member
Records Management, Developmental Disability and Delay Determinations,
Waiting List Management, Level of Care Screen, Annual Level of Care Screen
Reassessment, Needs Assessment, Supports Intensity Scale -A Assessment,
and Support Need Level Assessment. Training will include a review of the
relevant state regulations, as well as the procedures and processes that WC
CMA has in place to meet the requirements.
Supervisory Support and Oversight
WC CMA will provide supervisory support and oversight to ensure that all
staff members are following the procedures and processes that are in place
to meet the regulatory and contractual timeline requirements. This will
include conducting regular reviews of staff members' work to identify areas
where additional training or support may be needed.
Monthly and Random Timeline Reviews
WC CMA will conduct monthly and random timeline reviews to ensure that all
regulatory and contractual timeline requirements are being met. These
reviews will involve a thorough examination of the timelines and
documentation associated with each requirement, as well as any corrective
actions that may be needed.
Refresher Trainings
Page 1209
WC CMA will provide refresher trainings to staff members on an as -needed
basis to ensure that they remain up to date on the regulatory and
contractual timeline requirements of pre -enrollment functions. These
trainings will be tailored to address any specific areas of concern that are
identified through the monthly and random timeline reviews.
Training Materials and Guides
WC CMA will provide staff members with training materials and guides that
outline the procedures and processes that are in place to meet the
regulatory and contractual timeline requirements. These materials will be
regularly updated to reflect any changes to the requirements or the
processes and procedures that are in place.
Addressing Non -Compliance
WC CMA will have a process in place for addressing instances of non-
compliance with the regulatory and contractual timeline requirements for all
case management activities, to include pre -enrollment functions. This
process will involve identifying the root cause of the non-compliance,
developing a corrective action plan to address the issue, and ensuring that
the corrective action plan is implemented in a timely manner.
Pre -Enrollment Activity Timelines
To meet pre -enrollment regulatory and contractual timelines, WC CMA will
create training tools and other materials to assist our case management
team with timeline awareness and tracking. Based on this RFP and the
contract associated with it, WC CMA will ensure the following timelines are
met:
Intake, Screening, and Referral: WC CMA shall perform all intake,
screening, and referral functions/activities in accordance with §25.5-6-
104, C.R.S. and 10 CCR 2505-10, Sections 8.500.1 and 8.393.2.B. et
seq.
o Facilitating the Medicaid application process and responding to
all referrals of potentially eligible individuals within two (2)
Business Days of receipt of the referral.
o Processing information regarding an individual's Medicaid
eligibility within two (2) Business Days of receipt from the
eligibility site.
Page 1210
Individual/Member Records: WC CMA shall correct one hundred
percent (100%) of data errors, discovered by the Department, and
confirm the accuracy of the data it enters into the Department
prescribed system within ten (10) Business Days of notification from
the Department of an error.
Developmental Disability and Delay Determinations:
WC CMA shall determine whether an applicant meets the
definition of an individual with a Developmental Disability or
Delay as defined under 10 CCR 2505-10, section 8.600.4 et seq
and 8.508.20 T et seq, in accordance with 10 C.C.R. 2505-10
section 8.607.2 et seq.
WC CMA shall complete the individual's determination record and
assessment record in the Department prescribed system with all
applicable dates and information within ten (10) Business Days
after a determination is complete.
Waiting List Management:
WC CMA shall maintain a program -specific waiting list within the
Department's prescribed system for all eligible individuals for
whom funding is not available.
When funding has been made available for an individual, WC
CMA will remove the person from the "As Soon As Available"
(ASAA) waiting list within ten (10) business days.
WC CMA shall complete data entry of Waiting List record into the
Department prescribed system within ten (10) Business Days of
any addition or change to the Waiting List.
HCBS-DD Enrollment from the Waiting List:
WC CMA shall notify the individual of the enrollment offer within
five (5) Business Days.
WC CMA shall make three (3) attempts to contact the individual
within a thirty (30) calendar day period.
If the individual does not respond to the offer of enrollment, WC
CMA shall change the individuals waiting list timeline to Safety
Net
Waiting List Records Maintenance:
Page 1211
WC CMA shall remove individuals from the Waiting List after an
enrollment is authorized to the individual and the individual or
guardian accepts or refuses the authorization for enrollment
within ten (10) Business Days of the individual or guardian's
response or the last communication attempt.
If an individual or guardian declines an enrollment, WC CMA
shall enter the reason for declining an enrollment into the
Department prescribed system Waiting List record within ten
(10) Business Days of the enrollment being declined.
Compilation and Correction of Waiting List Data:
o WC CMA shall correct one hundred percent (100%) of Waiting
List data errors, discovered by the Department, within ten (10)
Business Days of notification from the Department of an error.
Authorization and Reporting of HCBS-DD Enrollments:
WC CMA shall inform the Department of all authorizations of
HCBS-DD Waivers within five (5) Business Days of the
authorization.
WC CMA shall report all enrollment dates or changes to
enrollment status for the HCBS-DD waiver to the Department
monthly on the date and template prescribed by the
Department.
Level of Care Screen:
o The Level of Care Screen shall be conducted within ten (10)
Business Days after receiving confirmation that the Medicaid
application has been received by the county Department of
Human or Social Services for individuals residing in the
community.
Within ten (10) Business Days after receiving a referral from a
provider for PACE.
Within five (5) Business Days after receiving a completed referral
from the nursing facility.
Within five (5) Business Days from the date of referral for
individuals residing in a nursing facility or ICF-IID.
Page 1212
o Within five (5) Business Days after receiving a completed
approval for the CLLI Waiver.
o Within two (2) Business Days after receiving a completed
referral from the hospital.
Annual Level of Care Screen Reassessment:
o WC CMA shall conduct an Annual Reassessment Level of Care
Screen no earlier than ninety (90) days prior to and no later
than thirty (30) days prior to the Level of Care Screen
certification end date.
Needs Assessment:
o WC CMA shall conduct a Needs Assessment (Initial) prior to
enrollment into an HCBS waiver, (Reassessment) and as needed
(off -cycle) within fifteen (15) Business Days after determination
of Level of Care and Financial eligibility for HCBS Waivers.
Supports Intensity Scale -A Assessment:
WC CMA shall conduct all initial SIS Assessments within sixty
(60) calendar days from the date of the Initial Level of Care
Screen.
WC CMA shall conduct all SIS reassessments within sixty (60)
calendar days from the date of approval from the Department.
WC CMA shall enter the SIS Assessment into SIS-A Online within
sixty-five (65) calendar days of completing the Level of Care
Screen
Support Need Level Assessment:
o WC CMA shall conduct an initial Support Need Level Assessment
within forty-five (45) calendar days from the date of the Initial
Level of Care Screen.
o WC CMA shall conduct all reassessments as necessary
individual's needs change.
Lastly, WC CMA will create a spreadsheet identifying every pre -enrollment
deliverable and its corresponding timeframe requirements. Deliverables will
be monitored and managed by the WC CMA Management Team.
Page 1213
By establishing and following these specific timeline practices, WC CMA will
be able to meet all the regulatory and contractual requirements related pre -
enrollment activities. Wed County CMA has been managing and adhering to
case management timelines for over twenty (20) years, and we will continue
to do so if awarded the contract for Weld County.
OFFEROR'S RESPONSE 6.g: Reimbursement for Missing Timelines
Detailed spreadsheet, specifically excluding PHI, indicating where
the Offeror did not meet required timelines for each function and
was responsible for reimbursement to a provider agency and/or a
governmental entity.
Over the past ten (10) years, WC CMA has had no instances of missing a
case management activity timeline that resulted in reimbursement to a
provider and/or a governmental entity. WC CMA staff have missed contract
required timelines for some functions, but none that have resulted in
reimbursement to an outside agency. For this section of the RFP, it includes
no reimbursements related to Intake, Screening and Referral services (RFP
3.10.1), Initial and Annual Level of Care Screen and Needs Assessments
(RFP 3.17), Appeals (RFP 3.17.3.1), and failures to discontinue services for
Members found ineligible for an HCBS waiver (RFP 3.17.3.2.4). Under our
existing SEP contract with the Department, WC CMA is not responsible for
the following functions in this section, and therefore is not subject to
reimbursements in these areas due to noncompliance: developmental
disability and delay determinations (RFP 3.12), wait list management (RFP
3.13), Program Enrollment from the Waitlist (RFP 3.14), compilation of
correction of waiting list data (RFP 3.15), authorization and reporting of
HCBS DD Enrollments (RFP 3.16), Supports Intensity Scale -A Assessment
(RFP 3.17.6), and support level assessments for HCBS-CHRP (RPF 3.17.7).
WC CMA Timeline Noncompliance Resulting in Payments to Others
Incident Type Resulting in Payment
2018
2019
2020
2021
2022
Number of incidents for assessments
0
0
0
0
0
Number of incidents for appeals
0
0
0
0
0
Number of incidents for service
discontinuation failures
0
0
0
0
0
Page 1214
Number of incidents for other timeline
non-compliance
0
0
0
0
0
OFFEROR'S RESPONSE 7: State General Fund Obligations
Please provide a detailed response on how the Offeror will meet
each obligation outlined in State General Fund Program Obligations.
The Offeror's response must address the following:
OFFEROR'S RESPONSE 7.a: Meeting FSSP and State SLS
Requirements
Provide details that demonstrate how the Offeror will meet all
program requirements related to FSSP and State SLS to include:
OFFEROR'S RESPONSE 7.a.i: Ensure services provided do not
supplant or duplicate third party funding sources available to
the individual including, but not limited to, public funding,
insurance, trust funds, Medicaid State Plan, HCBS Waiver or
EPSDT. 10 CCR 2505-10, Section 8.501.2.3.b. et. seq., 10 CCR
2505-10, Section 8.613.F.5 et. seq.
To ensure that services provided through the FSSP do not supplant or
duplicate third -party funding sources available to families, WC CMA will
implement several measures in accordance with relevant sections of the
Colorado Code of Regulations, including but not limited to 10 CCR 2505-10,
Section 8.613.
Family Support Services
After determining an individual's eligibility for the FSSP, based on specific
criteria such as the presence of an intellectual or developmental disability
(IDD) and living with family in Colorado, the case manager will conduct a
Needs Assessment with the family to ensure that families with the highest
assessed needs are prioritized for FSSP funding and in accordance with 10
CCR 2505-10, Section 8.613.E. The Needs Assessment completed by the
case manager gathers information about the Member and their family, such
as their support networks, geographical location (rural versus urban), access
to resources such as family income, insurance coverage, and other private
and public benefits.
Page 1215
After identifying the family's needs, as related to the individual's intellectual
or developmental disability, and assisting the family with accessing alternate
funding, the case manager will develop and implement an individualized
Family Support Plan (FSP) in accordance with 10 CCR 2505-10, Section
8.613.G. This FSP will be updated annually, and more often as needs and
available resources change. The FSP will outline specific FSSP services and
supports needed, the maximum amount of funds that can be spent for each,
the length of time these funds are available, and how payments for services
will be made. The Interdisciplinary Team process will be utilized to identify
needs and facilitate access to all HCBS and CMA-related programs and
services for which the individual may be eligible. When possible, the FSP will
also be integrated with other public or private Service Plans affecting the
family to ensure non -duplicative funding.
In an ongoing effort to ensure responsible and non -duplicative use of FSSP
funding, WC CMA will establish regular outreach and communication with
other funding sources and will develop and maintain a comprehensive
database of all third -party funding sources available to families with
individuals with IDD or Developmental Delays. This resource library will be
updated regularly. WC CMA will also establish a system of referral and
coordination efforts with other departments and community resources, such
as local housing authorities, county eligibility, Early and Periodic Screening,
Diagnostic, Screening, and Treatment (EPSDT) coordinators and RAEs.
Finally, in accordance with 10 CCR 2505-10, Section 8.613.K., the Annual
FSSP Program Evaluation, with input provided by families served, will assess
coordination efforts, utilization of funds and how FSSP services were
integrated with other community supports.
The above efforts, including ongoing training for WC CMA case managers on
all FSSP program requirements, procedures, internal policies, and available
funding sources in the community, will ensure that FSSP funds do not
duplicate or replace third (3rd) party resources and that families with
individuals with IDD or Developmental Delays can more effectively navigate
and access their community's network of supports.
State Supported Living Services
To ensure that services provided through State Supported Living Services
(State-SLS) do not supplant or duplicate third -party funding sources
available to the individual, WC CMA will put in place several measures in
accordance with State SLS rule 10 CCR 2505-10, Section 8.501.2.3.b. et.
seq.
Page 1216
The first measure to ensure non -duplicative funding sources will be to verify
eligibility for State-SLS, in accordance with 10 CCR 2505-10, Section
8.501.2.2., which includes the determination that the individual has an
intellectual or developmental disability, pursuant to the procedures set forth
in 10 CCR 2505-10, Section 8.607.2. Depending on the type of State-SLS
funds being requested, individuals must also meet additional eligibility
requirements for that type.
The second measure that will be implemented will be to conduct a
comprehensive assessment and support planning process, as required by 10
CCR 205-10, Section 8.501.4.E., which entails developing an Individualized
Support Plan (ISP). The ISP will identify needs that will be addressed by
supports and services and must demonstrate if and what other public or
community resources have been utilized and why State-SLS funds are being
authorized instead of or in combination with other resources. In the
development of the ISP, the case manager will ensure that individuals
enrolled in the State-SLS program access all benefits available under the
Medicaid State Plan, an HCBS Waiver or EPSDT, if available, prior to
accessing services under the State-SLS program, as required by 10 CCR
2505-10, Section 8.501.2.3.b. and will document all evidence of attempts to
utilize other benefits and resources, as per 10 CCR 2505-10, Section
8.501.2.3.c.
WC CMA will also undertake several additional measures to ensure non -
duplication of services, such as developing and maintaining a comprehensive
database of all the third -party funding sources available to families with
individuals with IDD or Developmental Delay. Regular communication,
referrals and coordination will be established with other funding sources to
stay abreast of service availability and ensure efficient access to benefits.
The WC CMA resource database will be updated regularly to ensure that
families are aware of and utilize all applicable funding options available to
them
Finally, all WC CMA case managers for State-SLS will receive focused and in-
depth training on all program requirements, steps and procedures, internal
policies, and alternate funding sources in the community. This will enable
case managers to effectively navigate, coordinate, authorize and monitor the
delivery of State-SLS support services to individuals with IDD or
Developmental Delay, in accordance with 10 CCR 2505-10, Section
8.501.5.B.
Page 1217
By following these measures and complying with the relevant regulations,
WC CMA will ensure that services provided through State Supported Living
Services (State-SLS) do not supplant or duplicate third -party funding
sources available to the individuals, in accordance with State SLS rule 10
CCR 2505-10, Section 8.501.2.3.b. et. seq.
OFFEROR'S RESPONSE 7.a.ii: Ensure all services are needed as
a result of the individual's Intellectual and/or Developmental
Disability (IDD) or Developmental Delay 1O CCR 25O5 -1O,
Section 8.613.F.2 et. seq.
WC CMA is committed to ensuring that services provided to individuals with
Intellectual and/or Developmental Disabilities (IDD) or Developmental Delay
are necessary, appropriate, and directly related to their condition. To
achieve this, WC CMA has developed a comprehensive plan.
First, the Case Manager will verify the individual's IDD/DD determination and
their eligibility for the FSSP, as outlined in 10 CCR 2505-10, Section
8.613.C.1. A record of this determination, including diagnoses, assessment
scores, and medical records, as appropriate, will be kept in the Department
Designated data system and will serve as a reference to correlate a need
with the disability.
Second, the Case Manager will conduct an initial and annual Needs
Assessment, as required by 10 CCR 2505-10, Section 8.613.E. This
comprehensive assessment will identify the individual's disability and related
conditions, their overall care and complexity of care needs, the frequency of,
and amount of direct assistance required for their care, and the types of
services needed that are above and beyond typical.
Third, based on the results of the Needs Assessment, the Case Manager will
develop an individualized Family Support Plan (FSP), in accordance with 10
CCR 2505-10, Section 8.613.G, which will thoroughly document and specify
the type of service or supports needed that correlate to the family's needs
related to the individual's disability or developmental delay, as required by
10 CCR 2505-10, Section 8.613.F.2.
WC CMA will also ensure access to State Supported Living Services (State-
SLS) is contingent upon meeting IDD determination and other eligibility
requirements, as outlined in 10 CCR 2505-10, Section 8.501.2.2. While
State-SLS services and supports, such as pest infestation abatement, may
not be directly related to the individual's IDD or Developmental Delay,
services authorized will be reviewed to ensure they meet all eligibility
Page 1218
requirements and are addressing an identified need that is not typical of the
individual's age group. All identified needs and corresponding services will be
thoroughly documented in the State-SLS Individual Support Plan (ISP), in
accordance with 10 CCR 2505-10, Section 8.501.4.E.6.
WC CMA Supervisors will conduct periodic reviews of State-SLS ISPs to
ensure all documentation requirements are met and that State-SLS services
are attributed to an identified and documented need that cannot be met
through other sources. By following these measures, WC CMA ensures that
services provided to individuals with IDD or developmental delay are
necessary, appropriate, and directly related to their condition, in accordance
with 10 CCR 2505-10, Section 8.613.F.2 et. Seq.
OFFEROR'S RESPONSE 7.a.iii: Ensure all services are provided
in the most cost-effective manner, meaning the least expensive
manner to meet the need. 10 CCR 2505-10, Section 8.613.F.3
et. seq.
WC CMA understands the importance of providing cost-effective services to
individuals with IDD or developmental delay, meaning services that meet
their needs in the least expensive manner possible. To achieve this goal, we
will implement a series of measures that prioritize the effective use of
resources.
First, the Case Manager will conduct an FSSP Needs Assessment to establish
funding priorities for families with the highest assessed needs, with the aim
of using third -party funding and resources first and making FSSP the last
resort. Once the Needs Assessment is complete, the Case Manager will
develop and annually review an individualized Family Support Plan (FSP), in
accordance with 10 CCR 2505-10, Section 8.613.G, that documents the
cost-effectiveness of services or supports, including quotes, bids, or product
comparisons, and clearly states the reasoning behind any less cost-effective
services indicated.
Before authorizing FSSP services, we will specify the length of time funds are
available, the maximum amount of funds that can be spent for each service
without amending the FSP, and document all expenses incurred by the
family and CMA in accordance with 10 CCR 2505-10, Section 8.613.J.
For the responsible and cost-effective use of State-SLS funds, we will ensure
that State-SLS is the payor of last resort, adhere to State-SLS service
reimbursement rates established in the Department published fee schedule,
and follow the service limitations outlined in 10 CCR 2505-10, Section
Page 1219
8.500., 10 CCR 2505-10, Section 8.501.4.B.2., 10 CCR 2505-10, Section
8.501.4.C.4., and 10 CCR 2505-10, Section 8.501.4.D.3.
We will also train all State-SLS and FSSP case managers on program
requirements, including cost-effectiveness, in accordance with 10 CCR 2505-
10 8.501.2 et. seq. and 10 CCR 2505-10 8.613 et. seq., and incorporate
program management requirements into ongoing quality assurance reviews.
OFFEROR'S RESPONSE 7.a.iv.: The Offeror must provide an
attestation that it has read, acknowledged, and fully
understands that direct services shall not be approved if the
need is a typical age -related need as outlined in 10 CCR 2505-
10, Section 8.613.F.2 et. seq.
WC CMA attests and confirms that we have read, acknowledged, and fully
understand the requirement outlined in 10 CCR 2505-10, Section 8.613.F.2
that direct services shall not be approved if the need is a typical age -related
need. We understand that services and supports available under the FSSP
may be purchased from a variety of providers who are able to meet the
individual needs of the family, and that all services must be needed as a
result of the individual's Intellectual and Developmental Disability (IDD) or
Developmental Delay. We will ensure that the correlation between the need
and the disability is documented in the Family Support Plan (FSP) before
approving any services.
OFFEROR'S RESPONSE 7.a.v: The Offeror must provide an
attestation that it has read, acknowledged, and fully
understands the State SLS monitoring requirements as outlined
in 10 CCR 2505-10, Section 8.501.5.B.1 et. seq.
WC CMA attests and confirms that we have read, acknowledged, and fully
understand the State Supported Living Services (SLS) monitoring
requirements as outlined in 10 CCR 2505-10, Section 8.501.5.B.1. We
understand that the case manager is responsible for coordinating,
authorizing, and monitoring services based on the approved State-SLS
Individual Support Plan and that the case manager shall have, based on the
client's preference, a face to face or telephone contact once per quarter with
the client. We acknowledge that the Case Manager shall assist clients to gain
access to other resources for which they are eligible and to ensure clients
Page 1220
secure long-term support as efficiently as possible and shall provide all
State-SLS documentation upon request from the Department.
OFFEROR'S RESPONSE 7.b: Family Support Council
Provide a detailed plan that demonstrates how the Offeror will
recruit, retain, and train a Family Support Council as required in 10
CCR 2505-10, Section 8.613.B. et. seq.
WC CMA is committed to establishing and maintaining a Family Support
Council (FSC) as required by 10 CCR 2505-10, Section 8.613.B. et seq. The
FSC will play a critical role in providing direction and assistance to the CMA
in the development of a family support plan for the designated service area,
as well as monitoring the implementation of the supports and services
provided through the Family Support Services Program. The establishment
of a strong and effective FSC will promote meaningful connections and
involvement with the individuals we serve and their families, contributing to
the successful implementation of services.
To add continuity and expertise to the new FSC, WC CMA will, upon being
awarded the contract, meet with our local CCB, Envision, and the FSC to
assess the interest of the current FSC members in transitioning to the new
FSC managed by WC CMA. This will help provide a solid foundation of
knowledgeable individuals who can bring valuable perspectives and insights
to the council. In addition, if there is an opportunity for new members, WC
CMA will actively seek out individuals from our served community to join the
FSC, taking advantage of our agency's established positive relationships
with individuals and families. We understand that at least five (5) members
are required for the council.
Ensuring that the FSC is representative of the community it serves, the
council will consist of professionals, interested citizens, family members of
persons with an intellectual and developmental disability, and persons with
an intellectual and developmental disability, with a majority of the council
being made up of family members. New members will be approved by the
CMA Administrator or other party designated by the Department, and all
members will receive written notice of their appointment and the criteria for
tenure.
Page 1221
WC CMA will provide orientation and training to all members regarding their
duties and responsibilities to ensure the effective implementation of the FSC.
The training will cover the details of the FSC's role in providing direction and
assistance in the development and implementation of the FSSP, the
development of the annual FSSP report, prioritization of families for funding,
establishment of an emergency fund, recommendations on "other" service
categories, and information on any other policies and procedures outlined by
the Department. The training will be consistent with any Department
required universal documents for the Family Support Council, ensuring that
all members are well-informed and equipped to fulfill their responsibilities.
WC CMA will create a roster of FSC members, including names, type of
membership, and chairperson. This roster will be available to the department
and the public upon request. Training and orientation will be documented,
and records will be kept on the date of training, trainer, topic, and
attendees.
The FSC will establish criteria for tenure of members, selection of new
members, and a process for addressing disputes or disagreements with WC
CMA. This process will be documented in writing and may include a request
for mediation assistance from the department.
To maintain accountability and transparency, WC CMA will submit a list of
FSC members to the Department annually and notify the Department in
writing of any changes within ten (10) business days. The agency will also
submit FSC meeting minutes monthly by the 15th of each month and by
June 30th, providing regular updates on the council's activities and progress.
Additionally, WC CMA, in conjunction with the FSC, will conduct an annual
evaluation of the effectiveness of the FSSP, submitting the report to the
Department by June 1st.
OFFEROR'S RESPONSE 7.c: Subcontractor Agreements
Provide a detailed plan that demonstrates how the Offeror will
identify and develop subcontractor agreements with local providers
to provide direct services to members enrolled in State SLS as
required in 10 CCR 2505-10, Section 8.501.2.3.f. et. seq.
Page 1222
To ensure the provision of quality services to State Supported Living
Services (SLS) program participants, WC CMA will engage local service
providers through subcontractor arrangements, in accordance with the
regulations outlined in 10 CCR 2505-10 Section 8.501.2.3.f. et. seq. We will
leverage existing relationships and resources to identify potential and
current subcontractors, and then engage our Contracts Department to
formalize agreements with interested service provider agencies to serve our
community.
We will start the process by partnering with Envision, the CCB for Weld
County, to identify local Program Approved Provider Agencies (PASAs)
currently providing services for the SLS Waiver, as well as current PASAs
delivering direct services to Members via the State SLS program. The
resulting data will be added to a State SLS subcontractor spreadsheet, and
we will then contact current and potential providers to discuss their interest
in continuing as a subcontractor or signing on to be a subcontractor for State
SLS under the new CMA. We will also schedule meetings, if necessary, to
address concerns and questions about forthcoming changes and
agreements. Through this collaborative process, we aim to foster positive
relationships and increase State SLS resources in our area.
We will also utilize our vast network of providers to inform them of potential
opportunities related to the expanded population we will be serving.
Additionally, we will monitor the Healthfirst Colorado "Find A Doctor" website
for new providers who may be potential candidates for providing service in
our area.
After compiling a list of interested providers, WC CMA's Contracts
Department will draft a contract or Memorandum of Understanding (MOU) to
formalize the relationship with providers. The contract or MOU will clearly
specify expectations and requirements for partnering with Weld County,
including adherence to the regulations outlined in 10 CCR 2505-10, Section
8.501.2. et. seq., as well as the provisions of the contract or MOU.
We will establish and maintain a system to distribute Requests for Provider
(RFP) to clients seeking a Program Approved Provider Agency (PASA) and
refer clients to approved providers who respond to the RFP. We are also
exploring the possibility of adding a provider section to our website to
provide relevant information and documents for the CMA/PASA relationship.
OFFEROR'S RESPONSE 74: Ensuring Sufficient Documentation
Page 1223
Provide a detailed plan that demonstrates how the Offeror will
ensure sufficient documentation is maintained to demonstrate
services were provided or received by the member and
reimbursement can be substantiated as required in 10 CCR 2505-10,
Section 8.501.3 and 10 CCR 2505-10, Section 8.613.J. et. seq.
WC CMA recognizes the crucial importance of comprehensive and easily
accessible documentation in the effective and responsible administration of
the FSSP and the State Funded Supported Living Services (State-SLS)
program. In line with our commitment to ensure adherence to the
regulations and guidelines specified by the Department of Health Care Policy
and Financing (HCPF), we shall maintain all necessary documentation to
demonstrate that the services were provided or received by the member,
and reimbursement can be substantiated in accordance with the FSSP and
State Plan-SLS regulations. We will accomplish this goal through the
following several general and program specific practices.
Documentation Practices - General
To ensure proper record -keeping, WC CMA shall document all activities
related to the FSSP and Supported Living Services (State-SLS) in the
Department prescribed information management systems (IMS).
Furthermore, we will store all relevant paper and/or electronic records,
including receipts, invoices, and other documentation that substantiates the
receipt of services and reimbursements, in our internal electronic records
management system, OnBase.
WC CMA will comply with all record -keeping requirements stated in 10 CCR
2505-10 8.130.2, which includes maintaining complete and accurate records
that are legible and created at the time the goods or services are provided.
The types of records that WC CMA will maintain include billings, prior
authorization requests, medical records, service reports, records of goods
prescribed, ordered for, or furnished to members, unaltered copies of
original invoices, records of payments received from the Medical Assistance
Program, and records required by Section 8.000 et seq. The retention period
for these records is seven (7) years, unless an individual Provider
participation agreement or Section 8.000 et seq. specifies a different
retention period.
WC CMA will also retain any other records related to the type and extent of
goods and/or services provided during regular business operations. All
records will be legible, verifiable, and shall comply with generally accepted
Page 1224
accounting principles, auditing standards, and applicable state and federal
laws, rules, and regulations.
Family Support Services Program Specific Documentation
WC CMA will maintain accurate and comprehensive documentation for the
FSSP in compliance with the regulations set forth by the Department of
Health Care Policy and Financing (HCPF). To achieve this goal, WC CMA will
develop and implement policies, procedures, and practices that align with
the reporting requirements established by 10 CCR 2505-10, Section
8.613.J.1. This includes documenting all FSSP activities in the Department -
prescribed information systems, and maintaining all records, such as
receipts and invoices, in our internal electronic records management system,
OnBase, as per 10 CCR 2505-10 8.130.2.
In accordance with 10 CCR 2505-10, Section 8.613.J.2, families receiving
FSSP shall maintain and provide receipts or invoices to their WC CMA case
manager. The case manager will maintain documentation that substantiates
all expenditures and reimbursements to providers and/or families.
When WC CMA purchases services or items directly for families, the case
manager will maintain receipts or invoices from the service provider, and
documentation demonstrating that the provider was paid (as per 10 CCR
2505-10, Section 8.613.J.2.a).
For FSSP reimbursements to families, WC CMA shall ensure that the family
provides receipts or invoices prior to reimbursement. WC CMA will maintain
receipts or invoices from the families and documentation demonstrating that
the family was reimbursed, in compliance with 10 CCR 2505-10, Section
8.613.J.2.b.
In cases where WC CMA provides funding to families for the purchase of
services or items in advance, the families will be notified that they are
required to submit receipts or invoices to WC CMA for all purchases made
prior to the close of the State Fiscal Year. WC CMA will collect and maintain
all receipts or invoices from the family, along with documentation
demonstrating that the family received funding (in accordance with 10 CCR
2505-10, Section 8.613.J.2.c).
As required by 10 CCR 2505-10, Section 8.613.J.3, WC CMA shall submit
information to the Department on individual family use of the FSSP in a form
and frequency designated by the Department.
Page 1225
Finally, in accordance with 10 CCR 2505-10, Section 8.613.3.4, WC CMA
shall report FSSP expenditure data only in the format and timeframe
specified by the Department.
State-SLS Specific Documentation
WC CMA recognizes the importance of accurate and thorough reporting and
documentation practices for the State-SLS program. To ensure adherence to
the regulations and guidelines established by the Department of Health Care
Policy and Financing (HCPF), WC CMA will incorporate reporting and
documentation practices in the service billing and payment policies and
procedures for the program.
In accordance with 10 CCR 2505-10, Section 8.501.4.E, WC CMA will
develop and implement the State-SLS Individual Support Plan (ISP) in the
format and timeframe established by the Department.
As per 10 CCR 2505-10, Section 8.501.3.1, Program Approved Service
Agency (PASA) must submit all claims, payment requests, and/or invoices to
WC CMA for payment within 30 days of the service date. WC CMA will
document receipt of all claim and payment requests from PASAs in the
relevant documentation systems, and we will ensure that all requests comply
with the required timeframes.
WC CMA shall also submit all claims, payment requests, and/or invoices in
the format and timeframe specified by the Department in accordance with
10 CCR 2505-10, Section 8.501.3.2.
To ensure that all claim, payment requests, or invoices are submitted
correctly, WC CMA understands that they must only be made when the
following conditions are met in accordance with 10 CCR 2505-10, Section
8.501.3.3.:
The services and supports are provided by a qualified PASA.
The services and supports are authorized and delivered in accordance
with the frequency, amount, scope, and duration of the service
identified in the client's State-SLS Individual Support Plan.
Required documentation of the specific service is maintained and
sufficient to support that the service is delivered as identified in the
State-SLS Individual Support Plan and in accordance with the service
definition.
All case management activities are documented and maintained by the
CMA.
Page 1226
WC CMA shall maintain records of all program -related activities in
accordance with 10 CCR 2505-10 8.130.2.
By implementing these practices, WC CMA will ensure that all services and
supports received through FSSP and State Plan-SLS have a comprehensive,
organized, and accessible trail of documentation to substantiate service
delivery and service reimbursement in accordance with 10 CCR 2505-10,
Section 8.501.3 and 10 CCR 2505-10, Section 8.613.J. et. seq.
OFFEROR'S RESPONSE 7.e: Advertising for FSSP
Provide a detailed plan that demonstrates how the Offeror will
engage in advertising the FSSP within the Defined Service Area as
required in 10 CCR 2505-10, Section 8.613.A.6. et. seq.
After being awarded the contract for Service Area 9, in accordance with 10
CCR 2505-10 8.613.A.6, in cooperation with the local Family Support
Council, WC CMA will ensure the FSSP is publicized by implementing the
following plan and strategies:
1. Utilize existing resources: Meet with the local CCB, Envision, and the
Family Support Council to evaluate their FSSP advertising strategies
(e.g., speaking at local schools, Children's Festival), resources, and
methods.
2. Develop a marketing plan: Develop a marketing plan that outlines the
target audience, budget, marketing channels, effective methods, and
objectives.
3. Utilize social and online media: Utilize WCDHS social and online media
platforms like Facebook, Twitter, Instagram, and Weld County DHS'
website to reach many people in a short period of time. WC CMA will
create a social media campaign to raise awareness about the FSSP and
its benefits.
4. Partner with local organizations: Partnering with local organizations
such as schools, the CCB, community centers, providers, county
departments and divisions, non -profits, and other agencies that are
part of our referral network that can help reach families who may need
FSSP services. These organizations can also help disseminate
information about the FSSP to their members or clients.
Page 1227
5. Create informational materials: Create multilingual informational
materials such as brochures and flyers to explain the FSSP, its
eligibility criteria, and the services it offers. These materials can be
distributed during annual home visits and intake assessments, at
community events, schools, county departments and divisions, and
other public spaces.
6. Participate in Community Events and Committees: Participate in
community events and committees such as information sessions, the
Community Advisory Committee, Weld DHS and Weld AAA events and
networking meetings, etc.
7. Collaborate with other county divisions: Collaboration with Child
Welfare and Adult Protection to ensure they are aware and can share
information with families as needed, make referrals, etc.
8. Monitor and evaluate the campaign: Monitor the progress of the FSSP
advertising campaign and evaluate its effectiveness. Use the data
collected to adjust the marketing plan as needed.
OFFEROR'S RESPONSE 7.f: State Funds Use Attestation
The Offeror must attest that it understands the requirements in 10
CCR 2505-10, Section 8.501.3.2. et. seq. related to the appropriate
use of state funds and that funds may be returned if not used
appropriately or on allowable services.
We, WC CMA, attest that we understand the requirements outlined in 10
CCR 2505-10, Section 8.501.3.2. et. seq. related to the appropriate use of
state funds and that funds may be returned if not used appropriately or on
allowable services. We understand the requirement for timely submission of
claims, payment requests, and invoices, and that reimbursement is subject
to review by the Department and dependent on meeting certain conditions.
We also understand the requirement to maintain records and comply with all
program integrity requirements. We will ensure that all PASA reimbursement
is made in accordance with the published fee schedule and the State-SLS
rates.
Page 1228
OFFEROR'S RESPONSE 8: Administrative Reporting
Provide acknowledgement that the Offeror understands the
requirements specified in Section 4.0 and shall comply with the
requirements if chosen to carry out the Work in this solicitation.
WC CMA understand the requirements specified in Section 4.0 of this
solicitation and shall comply with the requirements if chose to carry out the
Work in this solicitation.
OFFEROR'S RESPONSE 8.a: Member Engagement
The Department considers high quality work a key attribute to
successful Contractor performance. Provide a detailed explanation of
how the Offeror intends to implement and oversee member
engagement, communication, cultural responsiveness, language
assistance, and rights.
WC CMA is committed to providing quality care and services to its Long -
Term Services and Support (LTSS) members and their families. If awarded
the contract for Service Area 9, we will continue to implement and oversee
member engagement, communication, cultural responsiveness, language
assistance, and individual and member rights in a comprehensive and
person- and family -centered manner. A person- and family -centered
approach to case management and member and family interactions is deeply
embedded in our work culture through years of training and on the ground
implementation. It pervades all aspects of the work, to include the areas
addressed in this response.
Member Engagement, Cultural Responsiveness, and Communication
WC CMA staff will be trained on all aspects of person -centered approaches to
assessments, service planning, and other interactions and engagements with
members and families. Within the first one hundred twenty (120) days of
new hire start dates, employees will be trained in several key components
providing quality and perspective -based case management services. These
training topics include but are not limited to the importance of understanding
the client's perspective and feelings, and how to respond in nonjudgmental
and supportive ways, the importance of empathy, treating Members and
Page 1229
families with respect and dignity, regardless of their background or situation,
avoiding assumptions and stereotypes, recognizing unique strengths,
abilities, and goals. They will learn about empowerment, which includes
encouraging Member and families to make their own decisions and choices,
supporting their autonomy, and allowing Members and families to lead
conversations and choose the path that is right for them. They will learn
about collaboration, which includes working as a team with the Members and
families, involving them in the decision -making process and the planning
and implementation of their care plan. The value of open communication will
be emphasized, with a focus on fostering open and honest communication
while respecting rights to privacy and confidentiality. WC CMA staff will learn
about the delivery of services in a manner that reflects personal preferences
and ensuring health and welfare, and about the importance of identifying the
strengths, preferences, needs, and desired outcomes of the Member.
Additionally, WC CMA staff shall incorporate best practices in communication
and cultural responsiveness, such as:
Active listening: Paying attention to what the client is saying, both
verbally and non -verbally. Avoiding interruptions and asking clarifying
questions to convey understanding.
Cultural humility: Acknowledging their own cultural biases and
assumptions and seek to understand the client's cultural background
and experiences. Avoiding stereotypes, and respect the client's beliefs,
values, and practices.
Non -judgmental language: Using language that is inclusive and non-
judgmental, and the avoidance of making assumptions about the client
based on their background or situation.
Cultural competence: Taking the time to educate themselves about the
diverse cultures, beliefs, and practices of our Members. Seeking out
resources, attending training, and seeking feedback from clients and
colleagues to continually improve your cultural competence.
Communication accommodations: Making reasonable accommodations
to ensure that the client can understand and participate fully in the
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conversation. For example, provide written materials in the client's
preferred language, or use visual aids to explain complex information.
Member based written materials: providing written materials that are
culturally and linguistically appropriate, easy to understand,
consistent, proactive, and responsive, and in compliance with the
requirements of 45 C.F.R. Part 92, such as offering oral language
assistance (e.g., interpretation), written translation services, auxiliary
aids support (e.g., amplifiers, real-time computer aided transcription
services.
WC CMA shall provide and facilitate the delivery of services in a culturally
competent manner to all individuals and Members, and we will ensure all
electronic information and services comply with modern accessibility
standards, such as Section 508 of the Americans with Disabilities Act,
Section 504 of the Rehabilitation Act.
Language Assistance
In accordance with state and federal rules, contractual requirements, this
Solicitation, and the needs of its Members, WC CMA will make every effort to
facilitate barrier free communication with Members and their families. WC
CMA shall:
Provide language assistance services including bilingual staff and/or
interpreter services, at no cost to any individual or Member. Language
assistance shall be provided at all points of contact, in a timely manner
and during all hours of operation.
Make oral interpretation available in all languages and ensure the
competence of language assistance provided by interpreters and
bilingual staff.
Not use family and friends to provide interpretation services except by
request of the individual or Member.
Provide interpreter services for all interactions with individuals and
Members when there is no staff person available who speaks a
language understood by an individual or Member
Page 1231
Notify individuals and Members verbally about the individual's or
Member's right to receive the following language assistance services
and how to access them.
Provide oral interpretation for any language.
Ensure that language assistance services shall include, but are not
limited to, the use of auxiliary aids such as TTY/TDY and American
Sign Language
Ensure that customer service personnel can easily access interpreter
or bilingual services.
WC CMA commits to fulfilling the language assistance requirements
necessary to ensure equal access to services and support for all.
Additionally, if WC CMA is awarded the contract for this area, we will
continue to use our extensive resource pool of language assistance supports
and services.
To ensure the communication needs of our members are met, our case
management staff will conduct evaluations during intake and annual
assessments, and during other contact with the members, as needed. During
these evaluations, our staff will work to identify any communication barriers
and determine the individual's preferred method of communication. This
may include assessing the preferred language of the member and assigning
a bilingual staff member who speaks the same language, if available. Our
agency recognizes the importance of effective communication and is
equipped to address any communication needs through various methods and
technologies.
WC CMA also has strong relationships with community partners, including
the local Refugee and Asylee Program, to provide in -person interpretation
services when needed. In addition, we have access to interpretation services
through our agency, including Language Line Solutions, Voiance Language
Interpretation Services, and Voiance for Sign Language, which includes web -
based video. Our case managers can access these services in the office or
remotely through cell phones and laptops, ensuring that communication
support is always readily available.
Page 1232
WC CMA staff is and will continue to be familiar with various methods of
communication, including talk -to -text options for emails and text messages,
and are experienced working with clients who use teletypewriters or text
telephones (TTY) to communicate over the phone. Our staff is aware of how
to access and use telecommunication relay services (TRS) and are familiar
with Relay Colorado, a statewide service that connects standard voice
telephone users with those who use TTYs or voice carry-over (VCO) phones.
WC CMA staff are also knowledgeable about augmentative and alternative
communication (AAC) devices that are used to help individuals with
communication disorders express themselves. WC CMA uses the following
services to address communication needs: 711- Relay Colorado, TTY, Voice
Caller, Voice Carry Over, and Telebraille Relay Service. TTY is a device used
by individuals who are deaf, deafblind, hard of hearing, or have a speech
disability to communicate over the phone. Voice Caller is a standard
telephone service used by those with hearing loss or speech disabilities who
use TTYs or VCO phones. Voice Carry Over (VCO) allows a caller with
hearing loss to speak directly to a hearing person. Telebraille Relay Service
is a service used by individuals who are deafblind or have low vision to
communicate over the phone through a TTY or Telebraille device. English -to -
Spanish and Spanish -to -English translations are also available for Telebraille
Relay customers, ensuring that all members have access to effective
communication support, regardless of their language preferences.
The platform utilized by WC CMA for virtual meetings has closed captioning
available, and our staff may also use paper, pen, or whiteboards during in -
person visits as necessary. Our agency provides accessible and effective
communication for all members, and our experienced staff work to ensure all
communication needs are met.
WC CMA recognizes the importance of effective communication in serving its
members and is equipped with the resources and experience to address
communication needs professionally and informatively. If awarded the
contract associated with this solicitation, WC CMA will carry over our existing
experience, services, and practices, and will then further enhance our
communication tools and resources, as needed, and required, to be a fully
integrated CMA committed to serving all our members.
Page 1233
Member Rights
Weld County Case Management Agency (CMA) is committed to safeguarding
the rights of individuals and members. As a Case Management Agency, WC
CMA is obligated to abide by the provisions outlined in its contracts and to
establish written policies that guarantee the rights of everyone, including the
right to dignity, respect, and privacy.
In compliance with relevant regulations, Title XIX of the Social Security Act,
and other applicable federal and state laws, WC CMA will ensure that the
rights of individuals and members are protected. This includes, but is not
limited to, the right to be treated with respect, the right to participate in
decisions concerning their services, the right to be free from any form of
restraint or seclusion, the right to be fully informed of their rights and
responsibilities, the right to select service providers, the right to access a
uniform complaint system, the right to access a uniform appeal process, the
right to receive services, the right to choose a provider, the right to
confidentiality, and the right to be free from discrimination, the right to
request and receive a copy of their records, and the right to be free from
any form of restraint or seclusion used as a means of coercion, discipline,
convenience or retaliation.
To ensure that everyone is aware of their rights, WC CMA will provide
information about these rights to individuals, members, their families,
providers, case workers, and stakeholders, and will make sure that this
information is posted on our website and distributed at assessments, home
visits, and by mail and email, depending on Member preference.
Additionally, if awarded the contract associated with this solicitation, WC
CMA will establish a Human Rights Committee (HRC) to act as a safeguard
for the legal rights of persons receiving services on the HCBS-CES waiver,
HCBS-CHRP, HCBS-SLS, HCBS-DD, State SLS, OBRA-SS, and FSSP. The
HRC will be responsible for informed consent, monitoring the suspension of
rights, behavioral development programs, the use of psychotropic
medication, and reviewing mistreatment investigations.
Page 1234
All WC CMA staff will undergo training on member rights and how to inform
individuals, members, their families, providers, case workers, and
stakeholders of these rights in person, in writing, and virtually.
WC CMA is steadfast in its commitment to upholding these rights and to
ensuring that each individual and member is treated with the utmost dignity,
respect, and privacy.
OFFEROR'S RESPONSE 8.b: Close Out Experience
Provide a detailed explanation of the Offeror's experience
performing close out activities at the end of a Contract. If applicable,
this explanation must include but is not limited to:
i Transition of Members from one agency to another;
ii Communication with impacted parties; process for handling
capital and non -capital assets;
iii Process for closing out all financial records;
As the Single Entry Point for Weld County since 1993, WC CMA has not
closed any contracts, and therefore has no experience transitioning
members at the end of a contract, communicating with impacted parties,
handling capital and non -capital assets at the end of a contract, and no
experience closing out all the financial records associated with a contract
closure.
While lacking direct closeout experience, in accordance with Section 1.13.9
of our existing Single Entry Point Contract with the Department, WC CMA
has an FY23 Operations Guide that consists of a Department reviewed and
approved Communication Plan, Business Continuity Plan, and Closeout Plan.
The Closeout Plan requirements specified in our existing contract mirror the
Closeout Plan requirements and steps in this Solicitation. This includes the
required components of a closeout plan such as the transfer of clients and
members, documentation, records, services, and case management
services; designating a close out coordinator, communication and
notification protocols, and a detailed closeout period map that identifies all
the steps and milestones that take place over a three (3) month period.
Page 1235
On a micro -level, WC CMA has routine experience successfully transferring
members to other Case Management Agencies statewide in accordance with
Intercounty and Interdistrict rules at 10 CCR 2505-10 8.393.6 et. sec., to
include communicating with all parties (e.g., Members, providers, CMAs)
impacted by the transition, transitioning case records to other CMAs, and
closing out cases. WC CMA, along with the Finance Department, has decades
of experience closing out finances at the end of fiscal periods and
Department defined contract performance periods.
If WC CMA is not awarded the contract associated with this solicitation for
Service Area 9, we understand all the closeout requirements and timeframes
specified in RFP Sections 4.11.9 and 4.12, and those required to be a CMA at
10 CCR 2505-10 8.519.3.A.19. We have an existing plan in place to close
out the Single Entry Point Contract that aligns with these requirements, and
with support from various divisions and departments (e.g., WCDHS Finance
Department, Contracts Department, IT Department), are able to do so with
the utmost degree of competence and confidence, thus ensuring a successful
and seamless transition for our Members, WC CMA staff, the Department,
and any other parties involved and impacted by the change.
OFFEROR'S RESPONSE 8.c: Other Close Out and Startup Experience
Any other close-out or startup activities the Offeror has experience
with.
WC CMA has limited experience with close out and startup activities outside
of the SEP contract, but we have successfully participated in the startup
activities for two projects over the past ten years - Community Choice
Transitions (CCT) program and the Testing Experience and Functional Tools
grant (TEFT). For the CCT program, we completed the necessary steps,
timelines, and milestones to implement the program and provide intensive
case management services to Members in Weld County. Our staff received
extensive training, monitoring, supervision, and guidance to implement the
program successfully. For the TEFT grant, we applied, assigned staff to
complete the work, and had key personnel to oversee the implementation
and completion phases of the work. Although we do not have much
Page 1236
experience with starting and closing contracts, we have the administrative
capabilities to start new work, take on new employees, and projects.
OFFEROR'S RESPONSE 8.d: Internal Financial Controls
Provide a detailed explanation of the Offeror's internal financial
control systems and standards that apply to the operation of the
organization.
Internal financial control systems and standards are crucial to ensure the
proper management of an organization's finances, prevent financial fraud or
mismanagement, and provide transparency in financial operations. Weld
County Department of Human Services has established internal financial
control systems and standards to manage its financial resources efficiently
and effectively, while complying with all relevant laws and regulations.
The department requires adherence to the Weld County Code, which
establishes internal controls that have been audited annually and confirmed
to be adequate and appropriate. The controls provide necessary protections
to the department's financial resources, and they are designed to minimize
the risk of financial fraud or mismanagement. The department ensures
compliance with these controls to prevent unauthorized or unnecessary
expenses and ensure the proper use of financial resources.
All invoice payments and transactions processed through the Department's
Fiscal Office must be reviewed and approved by a supervisor or manager
who has first-hand knowledge of the appropriateness and necessity of each
associated purchase, as demonstrated by an authorizing signature. This
helps to ensure that purchases are made in compliance with the
department's financial policies and procedures, and that there is
accountability and transparency in the purchase process.
Once each invoice payment transaction has been entered into the County
Accounting system, it is reviewed for adherence to sound accounting
principles. The department ensures that proper accounting principles are
followed in each transaction and verifies the accuracy of financial records. If
appropriate, the invoice is approved for final payment. This helps to prevent
Page 1237
errors in financial transactions and ensures that the department's financial
records are accurate and reliable.
The department also has a Purchasing Policy that provides guidelines for the
procurement of goods and services. The policy outlines the process for
purchasing, including the approval of requisitions, competitive bidding, and
the selection of vendors. The policy ensures that purchases are made in the
most cost-effective manner, with consideration given to quality, delivery,
and other factors. The policy helps to control expenses and ensure that the
department operates within its means.
In addition to the specific policies mentioned above, the department also has
measures such as regular financial reporting, budgeting, and auditing.
Regular financial reporting allows the department to monitor its financial
performance and make informed decisions about future operations.
Budgeting helps to control expenses and ensure that the department
operates within its means. Auditing provides an independent review of the
department's financial records, identifying any weaknesses in the internal
control systems, and addressing them.
Overall, the internal financial control systems and standards established by
the Weld County Department of Human Services ensure the proper
management of financial resources, minimize the risk of financial fraud or
mismanagement, and provide transparency in financial operations. These
measures enable the department to operate efficiently and effectively, while
complying with all relevant laws and regulations.
Further information on internal controls and standard can be found at the
Charter and County Code, Weld County Municipal Library:
https://library.municode.com/co/weld county
OFFEROR'S RESPONSE 8.e: Long -Range Plan
Provide a description of the Offeror's Long -Range Plan and how the
Offeror intends to gather and incorporate input from the community
into their business operations impacting members in the Defined
Service Area.
Long -Range Plan (LRP) Status Summary
Page 1238
If awarded the contract for Service Area 9, WC CMA will actively pursue the
development and formalization of a Long -Range Plan in accordance with the
needs of our community, rules and regulations, and the contract. As the SEP
agency for Weld County, an LRP is currently not a component nor a
requirement of contract and rule. Per 10 CCR 2505-10 8.601.1.C., it is a
current Community Centered Board requirement. Although WC CMA does not
have a formal LRP, we do engage in several internal and external business
practices and activities that fit within the scope and intent of a LRP as
defined in this Solicitation. These activities include but are not limited to the
use of a Resource Development Committee to facilitate the development of
local resources to meet the LTSS needs of Clients and Members, the
establishment of Community Advisory Committee that provides public input
and guidance for WC CMA, methods for obtaining input from members and
the community, a staff recruitment and retention plan, and facilitating and
participating in community partner networks with agencies such as the RAE
and CCB for this area, CMAs, and other agencies within and without Weld
County OHS.
Long Range Plan Development Summary
If WC CMA is chosen to carry out the Work in this solicitation, the WC CMA
management team will facilitate several meetings to address each
component of the LRP, to include conducting an LRP based agency
evaluation to see what existing practices, partnerships, and activities fit into
the framework of the Long -Range Plan, what areas are lacking, and what
areas need attention, improvement and development. Based on the LRP
evaluation results, the team will proceed to address every component over a
series of meetings that may include additional staff from the CMA, staff from
other divisions (e.g., AAA) and programs (Adult Protective Services), Weld
DHS, the Resource Development Committee, the Community Advisory
Committee, and others. WC CMA will have a designated LRP Coordinator,
and this person will oversee scheduling meetings, providing structure and
organization, project management, and LRP monitoring and evaluation.
The outcome of the development and LRP contract deliverable process will
be a contract compliant, Department reviewed and approved LRP. In the
absence of a formalized and approved LRP, WC CMA offers the following
Page 1239
preliminary Long -Range Plan Summary as a starting point for the eventual
development and completion of an LRP should WC CMA be awarded the
contract for this area.
Long -Range Plan Description and Components
The WC CMA Long -Range Plan is a document that outlines the organization's
commitment to delivering exceptional case management services to its
defined service area. This plan is a comprehensive guide that details the
administrative and case management accomplishments, unmet needs, ways
of soliciting input from members and families, local area issues, policies that
may be barriers to a comprehensive case management system, recruitment
and retention of case management staff, recruitment of new and existing
providers, efforts towards equity, diversity, inclusion, and access, and
engagement with social networks and community partners.
The plan outlines the steps that WC CMA will take to assess, gather data and
feedback, develop strategies, implement modifications, and monitor
progress to ensure that the organization continues to deliver quality services
and make a positive impact in the lives of those it serves. The Long -Range
Plan is a living document that will be reviewed and updated regularly to
reflect the changing needs of the community and to ensure that WC CMA
remains at the forefront of delivering quality case management services.
RFP Section 4.13.1.1 Administrative and Case Management
Accomplishments
WC CMA will track and report on several functions and activities associated
with their work. These include tracking quality assurance review success
rates and year-to-year improvement patterns, measuring compliance with
timeline tracking and contract deliverable performance, and reviewing
progress on meeting the goals and objectives of the Long -Range Plan. The
agency will also track staff retention and hiring successes and the number of
professional development opportunities provided.
WC CMA will measure the impact of their work by reviewing positive
feedback from members, providers, the Department, and other agencies, as
well as measuring the level of engagement and satisfaction of stakeholders
Page 1240
through surveys, meetings, and dialogue. As a program under the Weld Area
Agency on Aging, we will also track program statistics and outcomes
throughout the year and make this information available to community
partners through our Annual Achievement Summary.
RFP Section 4.13.1.2 Unmet Needs
WC CMA is committed to identifying and addressing the unmet needs of
eligible persons in Weld County. To gather information on these needs, the
agency will reach out to community members and staff through surveys,
group discussions, meetings, and other means. In the fulfillment of the
resource development requirements of the contract, the Community
Advisory Committee will continue to meet at least twice a year to identify
and address gaps in services and unmet needs in the community.
Additionally, the WC CMA management team will facilitate discussions about
service gaps and potential solutions at monthly staff meetings, and case
managers will monitor for unmet needs through regular contact with
members and families. The agency will also review needs assessment data
completed by the Weld Area Agency on Aging, and members of various
committees and councils will have opportunities to bring needs gaps to the
attention of WC CMA.
Once unmet needs data is gathered, WC CMA will analyze it to identify
patterns and trends. The agency will then develop and implement strategies
to address these needs, with the involvement of community members,
organizations, and other government departments, divisions, and agencies.
RFP Section 4.13.1.3 Solicitation of Input from Members and
Families
WC CMA is committed to ensuring the quality of its case management
services. To solicit input from members and families, the agency will reach
out to them through various means, including surveys, routine case
management contacts, and other feedback mechanisms such as the
grievance/complaint process and our dedicated CMA input email account
(CMAinput@lweld.gov).
Page 1241
In addition, WC CMA will conduct annual surveys of a representative sample
of members to gather their feedback on the quality of case management
services, and we will also provide opportunities for members and families to
provide feedback through its division website and by participating in various
community events.
RFP Section 4.13.1.4 Local Area Issues
WC CMA is fully committed to addressing local area issues that impact or are
expected to impact its Defined Service Area. To accomplish this, the agency
has a proactive approach that involves continually considering and
evaluating the impact of local area issues and responding accordingly.
Awareness of local area issues will come from multiple sources, including
Weld County government at all levels, the Department, providers, members,
case managers, the RAE, the CCB, and others. In response, WC CMA will
evaluate the data and take action to address issues, as needed and able.
One of the ways WC CMA will respond is by leveraging its committees, board
participation, and community partners to work toward solutions and
resolutions.
In addition, WC CMA will participate in stakeholder meetings related to the
concern and will lobby the Board of County Commissioners and the Weld
DHS Director to help improve the situation. Lastly, WC CMA recognizes the
importance of collaboration and will work with the Department, providers,
case management agencies, and other agencies to address local issues, such
as the loss of housing in an area or the closing of an assisted living.
RFP Section 4.13.1.5 Policies as Barriers
WC CMA will assist in identifying and overcoming policy barriers that may
hinder the implementation of a comprehensive case management system in
our area. We will evaluate existing policies and gather feedback from
stakeholders, including members, case managers, community partners, and
other CMAs in the state, to understand the impact of the barriers on the case
management system. WC CMA will work with relevant departments,
including the Department of Health Care and Financing, to understand their
perspectives on the policies and their potential for modification.
Page 1242
The organization will involve CMA staff, organized committees (CAC, RDC,
etc.), and other entities in the process of evaluating and modifying the
policies. The division -level policies of WC CMA will be assessed on an
ongoing basis and adjustments will be recommended.
Based on the data and feedback collected, recommendations for
modifications to the policies that will overcome the barriers will be developed
and presented to relevant departments and community partners for review
and feedback.
WC CMA will leverage its committees, board participation, and community
partners to monitor issues within the region that may affect the individuals
they serve and proactively work to resolve any issues.
RFP Section 4.13.1.6 Recruitment and Retention of Case
Management Staff
WC CMA recognizes the importance of recruitment and retention of case
management staff, and the division that oversees the CMA, Weld AAA, has
created a retention policy that outlines how it recruits and retains staff. The
policy will be summarized in the Long -Range Plan and reviewed regularly to
ensure that it remains relevant.
RFP Section 4.13.1.7: Recruit New and Existing Providers
WC CMA will work to expand the services of existing provider agencies and
recruit new ones. To achieve this goal, the organization will meet twice a
year with the Community Advisory Committee to identify gaps in long-term
support services and their resolution and invite new and existing providers
to staff meetings to discuss possible areas of expansion and to address
provider issues.
In addition, WC CMA will work with community groups, including the local
CCB and Regional Accountable Entity to further develop natural support
systems for individuals. The organization will also work with the CCB to
determine the success of previous provider recruitment efforts and use
existing resources, such as Weld County AM and Weld County DHS, to
expand services within the region. The goal is to provide comprehensive and
accessible services to the individuals in their defined service area.
Page 1243
RFP Section 4.13.1.8: Equity, Diversity, Inclusion, and Access
WC CMA is committed to promoting equity, diversity, inclusion, and access
in its services, workplace culture, and for individuals and its members. To
achieve this, the organization plans to provide a range of training and
resources for its staff, including disability cultural competency training,
flexible scheduling options to accommodate the needs of Members, and
training opportunities for ongoing learning. The organization also plans to
develop outreach programs to educate community partners and improve
access to its services, as well as partner with local organizations serving
diverse communities.
In addition to these efforts, WC CMA aims to create a diverse and inclusive
workplace by promoting an inclusive culture through policies and practices.
The organization will offer interpretation and translation services for non-
English speaking clients, encourage open communication among staff, and
provide training materials to new hires to expose them to case management
with an equity, diversity, inclusion, and accessibility lens. To foster a non-
judgmental environment, the organization will lead by example,
demonstrating sensitivity and respect for diversity, equity, and inclusion in
interactions with clients and in workplace culture.
Finally, WC CMA is committed to delivering services in a culturally competent
manner to all individuals, regardless of their cultural or ethnic background,
disabilities, gender, sexual orientation, or gender identity. The organization
will provide and facilitate the delivery of services to individuals with limited
English proficiency and diverse cultural backgrounds, ensuring that all clients
have equal access to its services and support.
RFP Section 4.13.1.9 Engage and Facilitate Social Networks
WC CMA recognizes the importance of connecting and collaborating with a
variety of community entities and partners to better support its members.
To achieve this, WC CMA will engage in various activities including leading
and facilitating community engagement and coordination with other agencies
such as the RAE and CCB or Weld County, Weld County departments,
nursing facilities, and others. This coordination aims to optimize the ability of
individuals to access services and support.
Page 1244
Additionally, WC CMA will increase outreach in the community and invest in
maintaining and strengthening key partnerships by inviting community
partners to regularly scheduled team meetings. This will allow for open
discussion on the services they provide and how they can better support
members. WC CMA will also develop and disseminate marketing
communications to keep the community informed on program and resource
information, which can be accessed through our website and social media
platforms. Finally, WC CMA will conduct specific case consultation meetings
with RAE staff to address the barriers and needs of shared members.
RFP Section 4.13.1.10: The Use of State General Fund Programs
WC CMA will use State Supported Living Services (SSLS), Omnibus Budget
Reconciliation Act of 1987 Specialized Services (OBRA-SS), and FSSP
services and supports to help individuals, members, and families in Weld
County.
SSLS provides services and support to individuals with intellectual and
developmental disabilities living in the community. WC CMA will perform
case management duties, including intake and referral, determining program
eligibility, developing an individualized State SLS Support Plan, and
providing service authorization and coordination. WC CMA will approve direct
services provided under SSLS to include assistive technology, behavioral
consultation, dental services, job coaching, and more.
OBRA-SS is a program that provides specialized services to individuals with
intellectual and developmental disabilities living in nursing facilities. WC CMA
will help by enrolling eligible individuals into OBRA-SS, developing an OBRA-
SS Individual Support Plan (ISP), by providing ongoing case management,
and approving, as needed and justified, direct services such as assistive
technology, behavioral consultation, dental services, job coaching, and
more.
FSSP offers a range of services and support to individuals and families with
intellectual and developmental disabilities or delays. WC CMA will support
members by determining individual eligibility, conducting a needs
assessment, and developing an individualized Family Support Plan (FSP) for
each enrolled individual. The FSP outlines the services and support needed
Page 1245
by the individual with an IDD or Developmental Delay living in the family
home. WC CMA will provide ongoing case management, which includes
coordination of services, assessment of needs, monitoring the effective and
efficient provision of services, and program transition coordination. To
support members, in accordance with service authorization requirements,
WC CMA will use funding to approve assistive technology (equipment
necessary for communication and mobility), environmental engineering
(home/vehicle modification), medical and dental items prescribed by a
licensed medical professional, and other services such as recreational needs,
specialized services, parent and sibling support, professional services,
program expenses, respite, and transportation.
RFP Section 4.13.1.11: Voices of Underserved Populations
WC CMA is committed to incorporating the voices of historically underserved
and marginalized communities into its decision -making processes. To
achieve this, we will foster a culture of transparency and accountability by
openly sharing information and decision -making processes with clients and
the community. This will be supported by providing opportunities for clients
to share their experiences and perspectives through client satisfaction
surveys and other feedback mechanisms.
In addition, WC CMA will encourage participation in advisory committees and
boards, providing ongoing input and advice on decision -making practices.
The organization will incorporate input from underserved and marginalized
populations into its Community Advisory Committee meetings and respond
to and implement recommendations from the CAC. WC CMA will also recruit
board members from underserved and marginalized communities within its
region, ensuring that diverse perspectives are represented in its decision -
making processes.
RFP Section 4.13.1.12: Feedback from Community Members
WC CMA will obtain feedback from community members, members receiving
services, and individuals seeking services through surveys, routine case
management contacts, grievance/complaint process, random annual
surveys, and community events. Feedback will be incorporated into
strategies for delivering case management services.
Page 1246
We will gather feedback from community members, individuals receiving
services, and those seeking or waiting for services to improve the delivery of
case management services. The agency will use various methods to reach
out to members and gather their opinions and feedback, such as surveys,
routine case management contacts, and community events. Additionally, the
agency will post its grievance/complaint process and contact information,
including the email address CMAinput@weld.gov, to provide members with a
way to provide feedback.
The agency will also conduct random annual surveys from a sample of
members to gather feedback on the quality of case management services.
This information will be used to identify areas for improvement and develop
strategies to better deliver case management services within the defined
service area. The agency will also provide an opportunity for comments on
its division website to reach out to the community and gather additional
feedback.
Incorporating feedback into strategies for delivering case management
services is an important aspect of ensuring that the agency is meeting the
needs of the community.
Page 1247
ATTACHMENT A - Weld County Single Entry Point
Certification
a
COLORADO
Department of Health Care
Policy & financing
Thursday, May 19, 2022
Kelly Morrison
Weld County Department of Human Services
315 N. 11th Avenue, Bldg B
Greeley, CO 80632
Dear Ms Morrison:
Pursuant to Title 25.5-6-106, C.R.S. and 10 C.C.R. 2505-10 Section 8.391.4, the Single Entry Point
Agency shall be certified annually in accordance with quality assurance standards and requirements
set forth in the Department's rules. The evaluation of the agency has been reviewed for compliance
on quality of services, financial accountability and contractual performance.
The Department of Health Care Policy & Financing, Office of Community Living, has designated Weld
County Department of Human Services as a Single Entry Point Agency for the period of July 1, 2022
through June 30, 2023 for the following counties: Weld County.
Thank you for your continued efforts on behalf of Members receiving Long Term Services and Supports
in your service area. We look forward to a positive and productive working relationship during the
upcoming fiscal year.
Sincerely,
Yasmin Gardner, Division Director
Operations and Administration Division
CC: Amanda Lofgren, Director, Case Management and Quality Performance Division
Michelle Topkoff, Single Entry Point and Case Management Section Manager
Rhyann Lubitz, Quality Performance Section Manager
Page 1248
ATTACHMENT B - IT CISP Attestation
DEPARTMENT OF HUMAN SERVICES
PO Box A Greeley, CO 80632
Website: www.co.weld.co.us
February 3, 2023
Hi Kelly,
As we discussed on the phone, I attest that Weld County is in compliance
with the Colorado Information Security Protocols (CISP's). Please let me
know if you need anything else!
Kyle Drumm
Chief Information Security Officer
Weld County Government
1401 N 17th Avenue
Greeley, CO 80631
970-400-2519
Page 1249
ATTACHMENT C - FY18 - FY22 QIS Results and Corrective
Actions for Weld County SEP
WELD FY21-22 QIS Results and Corrective Actions
Waiver
Performance Measure
Compl
iance
CQIP
Actions
CQIP Action Details
EBD
CMHS
BI
CLLI
SCI
D.a.3 Number and percent of
waiver participants in a
representative sample whose
PCSPs address identified
health and safety risks
through a contingency plan
N: Number of waiver
participants in the sample
whose PCSPs address health
and safety risks through a
contingency plan D: Total
number of waiver participants
in the sample
83%
Monitor
Weld County will review 10
cases a month for 1 month.
Each contingency plan will be
reviewed and entered on the
contingency plan monitoring
tab: with member information,
certification span, case manager,
contingency plan and if CMA
would accept that contingency
plan. Spreadsheet will be
reviewed by Department Staff at
the start of the following month
and any discrepancies between
CMA and Department
acceptance will be discussed.
EBD
CMHS
BI
CLLI
SCI
D.d.6 Number and Percent of
waiver participants in a rep
sample whose frequency of
services are delivered as
specified in the person
centered service plan N: # of
waiver participants in a rep
sample whose frequency of
services are delivered as
specified in the service plan
75%
Train
Due to the PHE we understand
that there are continued barriers
with the utilization of services
for all Case Management
Agencies. Weld County will
provide updated guidance for
their Case Management staff as
reminder for staff to review
services at each Continued Stay
Review with member and to
remove or reduce services that
Page 1250
D: Total # of waiver
participants in the sample
the member is not currently
using or there is no provider for
in your area at this time. Please
upload a word document
outlining the guidance given to
your CMA SharePoint site.
Guidance can be completed with
staff at 1:1's, team meetings or
as an all staff email.
WELD FY2O-21 QIS Results and Corrective Actions
Waiver
Performance Measure
Compl
iance
CQIP
Actions
CQIP Action Details
EBD
CMHS
BI
CLLI
SCI
B.c.2 # and % of new waiver
participants in which the
Level of Care
(LOC)assessment and
determination was applied
appropriately according to
Dept regulations
80%
Monitor
& Train
We will review the individual
cases provided to us and look for
any patterns we see. We will
review the 100.2 scoring with
staff. We will continue
completing random full audits on
cases to make sure they are
scoring appropriately. As the
BUS scoring tool will be going
away this year this will not be a
big focus area for us.
EBD
CMHS
BI
CLLI
SCI
D.a.1 # and % of waiver
participants in a rep sample
whose Service Plans (SPs)
address the needs identified
in the Level of Care (LOC)
eval and determination,
through waiver & other non-
waiver services
26%
Monitor
& Train
This QIS measure has been
trained on since these reports
were pulled. We will also be
retraining at staff meeting.
Beyond that we are unsure how
the Inventory of Needs will
correlate to the new case
manager system, so we have no
Page 1251
planned actions for once the
BUS goes away.
EBD
CMHS
BI
CLLI
SCI
D.a.2. Number and percent of
waiver participants in a
representative sample whose
SPs address the waiver
personal participant's goals
83%
Monitor
& Train
We will discuss in more detail
the methodology and
requirements of this
performance measure. We will
be retraining at our next staff
meeting.
EBD
CMHS
BI
CLLI
SCI
D.a.3 Number and percent of
waiver participants in a
representative sample whose
SPs address identified health
and safety risks through a
contingency plan
70%
Monitor
& Train
We will retrain on this topic at a
staff meeting. We also have
made a template of probing
questions for case managers to
use to ask clients when
struggling to come up with a
contingency plan. This measure
will be checked by Sups on spot
checks and audits.
EBD
CMHS
BI
CLLI
SCI
D.d.2 Number and Percent of
waiver participants in a rep
sample whose type of
services are delivered as
specified in the service plan
74%
N/A
This QIS measure states that
only one of the PAR services was
billed during the cert period. No
action will be taken because we
actually passed this measure.
EBD
CMHS
BI
CLLI
SCI
D.d.3 Number and Percent of
waiver participants in a rep
sample whose scope of
services are delivered as
specified in the service plan
74%
N/A
same as D.d.2
Page 1252
EBD
CMHS
BI
CLLI
SCI
D.d.4 Number and Percent of
waiver participants in a rep
sample whose amount of
services are delivered as
specified in the service plan
37%
Monitor
In all these cases that were
marked down the case manager
did their diligence and log noted
why and even followed up with
providers. Most that we were
marked down on were because
we did not decrease units on the
PAR. This is not in regulation
that we have to reduce. We will
have our case managers
continue to monitoring services
at CSR and log note if and why
clients are not using their
services.
EBD
CMHS
BI
CLLI
SCI
D.d.6 Number and Percent of
waiver participants in a rep
sample whose frequency of
services are delivered as
specified in the service plan
79%
Monitor
In these cases we were marked
down the case manager log
noted and followed up. We
would not delete a line from the
PAR if a client did not use a
service. We will have our case
managers continue to
monitoring services at CSR and
log note if and why clients are
not using their services.
EBD
CMHS
BI
CLLI
SCI
G.d.3 Number and percent of
participants in a
representative sample whose
service plan addresses their
health needs
26%
same as D.a.1
WELD FY19-20 QIS Results and Corrective Actions
Waiver
s
Performance Measure
Compl
lance
CQIP
Actions
CQIP Action Details
Page 1253
Review
ed
EBD
CMHS
BI
CLLI
SCI
B.c.2 # and % of new waiver
participants in which the
Level of Care
(LOC)assessment and
determination was applied
appropriately according to
Dept regulations N: # of new
waiver participants in which
the LOC assessment and
determination was applied
appropriately according to
Department regulations D:
Total number of new waiver
participants
70%
Monitor
& Train
The specific area of this
performance measure we were
marked deficient in was with
scoring. However we did score
over a 90% in each individual
category. We will go over the
examples provided to us from
HCPF and review the HCPF 100.2
Train with staff. We complete
random full audits on cases for
case managers to make sure
they are scoring appropriately.
EBD
CMHS
BI
CLLI
SCI
Dressing scored accurately
(LOC Tool)
90%
Monitor
& Train
The specific area of this
performance measure we were
marked deficient in was with
scoring. However we did score
over a 90% in each individual
category. We will go over the
examples provided to us from
HCPF and review the HCPF 100.2
Train with staff. We complete
random full audits on cases for
case managers to make sure
they are scoring appropriately.
Page 1254
EBD
CMHS
BI
CLLI
SCI
Toileting scored accurately
(LOC Tool)
90%
Monitor
& Train
The specific area of this
performance measure we were
marked deficient in was with
scoring. However we did score
over a 90% in each individual
category. We will go over the
examples provided to us from
HCPF and review the HCPF 100.2
Train with staff. We complete
random full audits on cases for
case managers to make sure
they are scoring appropriately.
EBD
CMHS
BI
CLLI
SCI
Eating scored accurately
(LOC Tool)
90%
Monitor
& Train
The specific area of this
performance measure we were
marked deficient in was with
scoring. However we did score
over a 90% in each individual
category. We will go over the
examples provided to us from
HCPF and review the HCPF 100.2
Train with staff. We complete
random full audits on cases for
case managers to make sure
they are scoring appropriately.
EBD
CMHS
BI
CLLI
SCI
Supervision Memory scored
accurately (LOC
Tool)
90%
Monitor
& Train
The specific area of this
performance measure we were
marked deficient in was with
scoring. However we did score
over a 90% in each individual
category. We will go over the
examples provided to us from
HCPF and review the HCPF 100.2
Train with staff. We complete
random full audits on cases for
Page 1255
case managers to make sure
they are scoring appropriately.
EBD
CMHS
BI
CLLI
SCI
D.a.1 # and % of waiver
participants in a rep sample
whose Service Plans (SPs)
address the needs identified
in the Level of Care (LOC)
eval and determination,
through waiver & other non-
waiver services N: # of
participants in the sample
whose SPs address the needs
identified in the LOC eval and
determination, through
waiver & other non -waiver
services D: Total # of waiver
participants in sample
30%
Monitor
& Train
We will retrain staff on making
sure all the functional deficits
and care needs noted in the
100.2 and IADLs are noted in
the Inventory of Needs in the
Bridge. We will use the
examples provided to us from
HCPF. We will discuss in more
detail the methodology and
requirements of this
performance measure. Sups will
add this measure to their audit
and spot checking tool.
EBD
CMHS
BI
CLLI
SCI
D.a.2. Number and percent of
waiver participants in a
representative sample whose
SPs address the waiver
personal participant's goals
N: Number of waiver
participants in the sample
whose SPs address the
waiver participant's personal
goals D: Total number of
waiver participants in the
sample
70%
Monitor
& Train
We will discuss in more detail
the methodology and
requirements of this
performance measure and use
the examples provided from our
TA call with State to review.
Page 1256
EBD
CMHS
BI
CLLI
SCI
D.a.3 Number and percent of
waiver participants in a
representative sample whose
SPs address identified health
and safety risks through a
contingency plan N: Number
of waiver participants in the
sample whose SPs address
health and safety risks
through a contingency plan
D: Total number of waiver
participants in the sample
40
0/0
Monitor &
Train
We will retrain on this topic at a
staff meeting. We also have
made a template of probing
questions for case managers to
use to ask clients when
struggling to come up with a
contingency plan. We will also
use the examples provided to us
by HCPF. This measure will be
checked by Sups on spot checks
and audits.
EBD
CMHS
BI
CLLI
SCI
G.a.3 Number and percent of
all critical incidents requiring
follow-up completed within in
the required timeframe.
Numerator: number and
percent of all critical incidents
requiring follow-up completed
within the required
timeframe. Denominator:
Number of critical incidents
requiring follow-up
38%
Monitor
& Train
We will retrain with the power
point training on CIRs and this
performance measure. We are
also auditing case managers
monthly and are checking to
make sure a CIRs was
completed if needed. We will
also create a step by step guide
on how to properly enter follow
up into the BUS for CIRs.
EBD
CMHS
BI
CLLI
SCI
G.a.5 Number and percent of
unexplained deaths where
proper follow-up occurs N: #
of unexplained deaths where
proper follow-up occurs D: #
of unexplained deaths
75%
Monitor
& Train
We will retrain with the power
point training on CIRs and this
performance measure. We are
also auditing case managers
monthly and are checking to
make sure a CIRs was
completed if needed. We will
also create a step by step guide
on how to properly enter follow
up into the BUS for CIRs.
Page 1257
WELD FY18-19 QIS Results and Corrective Actions
Non-
Performance Measure from
Remedi
Action Details
Compli
ant
Waiver
ation
Action
Waiver
(s)
CLLI,
Number and percent of
CLLI
Monitor
We will create a power point
EBD
waiver participants for whom
67%
& Train
training on this performance
a Professional Medical
EBD
measure including screen shots
Information Page (PMIP) was
completed and signed by a
licensed medical professional
according to Dept. regulations
for initial determinations
Numerator: Number of waiver
participants in a
representative sample for
whom an initial PMIP was
completed as required
60%
of the Medical tabs in the BUS
and train on thoroughness of
data entry. We will also retrain
on the time frame requirements
for PMIP signature dates for CSR
and new cases. We are now
auditing case managers monthly
on their CSRs and checking
these sections of the Medical tab
for completeness.
Denominator: Total number
initial determinations in a rep.
sample certified to receive
waiver services
Page 1258
CLLI,
CMHS,
EBD
Number and percent of
participants in a
representative sample for
CLLI
0%
CMHS
Train
We will have our staff complete
the HCPF training/webinar -
ULTC 100.2 - Determining LOC,
whom the ULTC assessment
0%
time frames and scoring. The
tool was applied appropriately
EBD
methodology also overlaps with
for the initial assessment by a
60%
the previous performance
qualified
evaluator.
measure regarding PMIP dates,
so that will be covered with the
Numerator: Number of
participants in a rep. sample
for whom the ULTC
assessment tool was applied
appropriately for the initial
assessment during the review
period by a qualified
evaluator.
previous training listed above.
Denominator: Total number
of participants in a rep.
sample who received an
initial assessment during the
review period
Page 1259
CLLI,
CMHS,
EBD
Number and percent of
waiver participants in a
representative sample whose
Service Plans (SPs) address
the needs identified in the
ULTC assessment, through
waiver and other non -waiver
services.
Numerator: Number of waiver
participants in the sample
whose SPs addresses the
needs identified in the ULTC
assessment.
Denominator: Total number
of waiver participants in the
sample.
CLLI
0%
CMHS
0%
EBD
28%
Train
We will have staff attend the
recorded Person -Centered
Service Planning webinar
available on the HCPF website
and will discuss in more detail
the methodology and
requirements of this
performance measure.
CLLI
Number and percent of
waiver participants in a
representative sample whose
SPs adequately address the
waiver participant's goals.
Numerator: Number of waiver
participants in the sample
whose SPs adequately
addresses the waiver
participant's personal goals.
Denominator: Total number
of waiver participants in the
sample.
CLLI
67%
Train
We will have staff attend the
recorded Person -Centered
Service Planning webinar
available on the HCPF website
and will discuss in more detail
the methodology and
requirements of this
performance measure.
Page 1260
CLLI,
CMHS,
EBD
Number and percent of
waiver participants in a
representative sample whose
SP addresses identified health
and safety risks through a
contingency plan.
Numerator: Number of waiver
participants in the sample
whose contingency plan
adequately addresses
identified health and safety
risks.
Denominator: Total number
of waiver participants in the
sample.
CLLI
33%
CMHS
0%
EBD
72%
Train
We will have staff attend the
recorded Person -Centered
Service Planning webinar
available on the HCPF website
and will disuses in more detail
the methodology and
requirements of this
performance measure.
CMHS
Number and percent of
waiver participants with a
mental health provider in a
representative sample whose
BUS records indicate
coordination between the
CMA and the waiver
participants' mental health
provider
Numerator: Number of
participants in the sample for
whom BUS records indicate
the waiver participant's
mental health provider was
contacted every 180 days
Denominator: Total Number
of participants in the sample
CMHS
0%
Train
We will review and retrain staff
with a power point training on
this performance measure. We
will also look at adding this to
our master tracking and see if
there is a better way to monitor
a clients mental health provider
or lack there of.
Page 1261
CLLI,
EBD
Number and percent of
waiver services, by type, in a
representative sample of
waiver participants which
were delivered in accordance
with the service plan.
Numerator: Number of
waiver services in the sample
where the paid claims equal
those services authorized by
the service plan
Denominator: Total number
of waiver services in the
sample.
CLLI
0%
EBD
72%
Train
We will review and retrain staff
on how to authorize services by
using a PowerPoint and any
resources provided by HCPF.
EBD
Number and percent of ALL
EBD
Monitor
We will retrain with the power
critical incidents requiring
follow-up completed within
the required timeframe.
Numerator: Number of critical
incidents requiring follow-up
completed within the required
timeframe
42%
& Train
point training on CIRs and this
performance measure. We are
also auditing case managers
monthly and are checking to
make sure a CIRs was
completed if needed.
Denominator: Number of
critical incidents that required
follow-up
Page 1262
CLLI
Number and percent in a
CLLI
Monitor
We will create a power point
representative sample whose
Professional Medical
Information Page (PMIP) was
signed and completed by
licensed medical professional
attesting to long-term
disability and ability to
receive services in the
community.
Numerator: Number of
participants in the sample
whose PMIP was signed and
completed by a licensed
medical professional attesting
to a long-term disability and
ability to receive services in
the community
67%
& Train
training on this performance
measure including screen shots
of the Medical tabs in the BUS
and train on thoroughness of
data entry. Will also retrain on
the time frame requirements for
PMIP signature dates for CSR
and new cases. We are now
auditing case managers monthly
on their CSRs and checking
these sections of the Medical
tab.
Denominator: Total number
of participants in the sample.
(CLLI, SCI, SLS only)
AICPF
th
If
Page 1263
COLORADO
Department of Health Care
Policy & Financing
Weld County Area Agency on Aging
QIS Corrective Action Plan FY 2017-18
The Centers for Medicare and Medicaid Services (CMS) requires remediation
of any performance measure in which compliance is 85% or below. The
Department has identified the following performance measures from your
agency that fell at or below 85% compliance, thus requiring a Corrective
Action Plan (CAP). Individual remediation is only required if the performance
measure involves Mistreatment, Abuse, Neglect, and/or Exploitation (MANE).
Please follow the bulleted instructions below and return the completed CAP
to the Department no later than close of business on December 7, 2018.
Performance Measure and Compliance Percentage by Waiver has
been populated.
Actions to be Taken: The only options are as follows;
Train; requires an Agenda with date, time, topic, and a list of
training attendees. This will be reported to the Department on
a quarterly basis, as needed.
Monitor; requires a brief description of what actions you took,
what results you observed, were the results what you
expected [hoped for], and if not, what further actions were
taken. This will be reported to the Department on a quarterly
basis, as needed.
Other; requires a detailed explanation of what steps will be
taken to ensure that compliance with this PM improves? This
will be reported to the Department on a quarterly basis, as
needed.
Action Details: Please provide a narrative of the Actions to be Taken,
as chosen above.
Page 1264
Employee(s) Responsible for Implementing Actions: Who will ensure
that the Actions to be Taken will be implemented?
Implementation Time Frame/Date of Completion: The CAP
implementation will begin on December 7, 2018 and will commence
once all the Actions to be Taken have been completed, reported to
the Department, and approved by the Department. All CAP actions
must be completed by June 30, 2019.
Root Cause Analysis: What do you attribute to the deficiency? What
systemic issues do you see as obstacle(s) that contribute to the
deficiency
Appendix B - Level of Care
Performance
Measure
Number and percent of applicants with a level of
care (LOC) assessment indicating a need for
institutional level of care prior to receipt of services.
Numerator = Number of applicants who received a
Level of Care assessment indicating a need for
institutional level of care prior to the receipt of
waiver services.
Denominator = Total number of applicants.
Compliance % by
Waiver
BI = 66.67%
Actions to be Taken
X Train ❑ Monitor ❑ Other
Action Details
We will create a power point training to include
screen shots of the BUS for each of the areas
reviewed for this Performance Measure.
Employee(s)
Responsible for
Implementing Actions
Meghan Phillips and Sandra Hasch
Page 1265
Implementation Time
Frame/ Date of
Completion
This will be completed by June 30, 2019
Root Cause Analysis
Appears QIS is pulling BI transfer cases. With these
cases, the start date of the certification does not
change, so it will not be on or before the
Unscheduled transfer visit date because you keep
the same cert dates. Indiscernible since no actual
data could be received from QIS process. Also, it is
unclear to us how a cert start date would not be on
or before the first date of service or first claim date.
The PAR start date matches the 100.2 cert start
date, so no services would be able to be billed for
before this date. In all the new enrollee BI cases,
the Yes box is marked on the LOC cert screen and
the outcome is marked Approved, so not sure where
the deficiency is other than the cases are transfers
and it has to do with the visit date and cert start
date.
Performance
Number and percent of participants in a
Measure
representative sample for whom a Professional
Medical Information Page (PMIP) was completed and
signed by a licensed medical professional according
to Department regulations.
Numerator = Number of waiver participants, in a
representative sample for whom a PMIP was
completed as required.
Denominator = Total number of waiver participants
in a representative sample.
Compliance % by
BI = 35.29% CMHS = 30.77% EBD = 57.89%
Waiver
Page 1266
Actions to be Taken
X Train ❑ Monitor ❑ Other
Action Details
We will create a power point training on this
performance measure including screen shots of the
Medical tabs in the BUS and train on thoroughness of
data entry. Will also retrain on the time frame
requirements for PMIP signature dates for CSR and
new cases.
Employee(s)
Responsible for
Implementing Actions
Meghan Phillips and Sandra Hasch
Implementation Time
Frame/ Date of
Completion
This will be completed by June 30, 2019
Root Cause Analysis
In some cases, it appears case managers may not be
data entering all information from the PMIP into each
separate box in the Medical Provider Tab in the BUS
100.2 assessment. Indiscernible in data received
from QIS process. No uniformity of training from
either state or agency resources.
Performance
Measure
Number and percent of cases in a representative
sample in which the ULTC
100.2 Tool was applied appropriately.
Numerator = Number of cases in a representative
sample in which the ULTC
100.2 Tool was applied appropriately.
Denominator = Total number of clients reviewed in
sample.
Page 1267
Compliance % by
Waiver
BI = 41.18% CMHS = 7.69% EBD = 5.26%
Actions to be Taken
X Train ❑ Monitor ❑ Other
Action Details
We will have our staff complete the HCPF
training/webinar - ULTC 100.2 - Determining LOC.
The methodology also overlaps with the previous
performance measure regarding PMIP dates, so that
will be covered with the previous training listed
above.
Employee(s)
Responsible for
Implementing Actions
Meghan Phillips and Sandra Hasch
Implementation Time
Frame/ Date of
Completion
This will be completed by June 30, 2019
Root Cause Analysis
Indiscernible in data received from QIS process.
Perhaps due to no uniformity of training from either
state or agency resources; case manager experience
levels. Since this performance measure has so
many components, it is difficult to know exactly
where the deficiency lies or if there is a pattern to
pin point a cause.
Appendix D — Service Plan
Performance
Measure
Number and percent of waiver participants in a
representative sample whose
Service Plans (SPs) address the needs identified in
the ULTC assessment, through waiver and other
non -waiver services.
Page 1268
Numerator = Number of waiver participants in the
sample whose SPs address the needs identified in
the ULTC 100.2 assessment, through waiver and
other non -waiver services.
Denominator = Total number of waiver participants
in the sample.
Compliance % by
Waiver
BI = 76.47%
Actions to be Taken
X Train ❑ Monitor ❑ Other
Action Details
We will have staff attend the recorded Person -
Centered Service Planning webinar available on the
HCPF website and will discuss in more detail the
methodology and requirements of this performance
measure.
Employee(s)
Responsible for
Implementing Actions
Meghan Phillips and Sandra Hasch
Implementation Time
Frame/ Date of
Completion
This will be completed by June 30, 2019
Root Cause Analysis
Indiscernible in data received from QIS process.
Perhaps due to no uniformity of training from either
state or agency resources; case manager experience
levels.
Performance
Measure
Number and percent of waiver participants in a
representative sample whose SPs address identified
health and safety risks through a contingency plan.
Page 1269
Numerator = Number of waiver participants in the
sample whose SPs address health and safety risks
through a contingency plan.
Denominator = Total number of waiver participants
in the sample.
Compliance % by
Waiver
BI = CLLI = CMHS = EBD =
5.88% 0.00% 0.00% 0.00%
Actions to be Taken
X Train ❑ Monitor ❑ Other
Action Details
We will have staff attend the recorded Person -
Centered Service Planning webinar available on the
HCPF website and will disuses in more detail the
methodology and requirements of this performance
measure. This will overlap with the above
performance measure training.
Employee(s)
Responsible for
Implementing Actions
Meghan Phillips and Sandra Hasch
Implementation Time
Frame/ Date of
Completion
This will be completed by June 30, 2019
Root Cause Analysis
Case managers list a contingency plan within the
service plan. Indiscernible in data received from QIS
process. Perhaps due to lack of detail and no
uniformity of training from either state or agency
resources; when asked - HCPF refused to provide an
example of an acceptable contingency plan.
Performance
Measure
Number and percent of waiver participants in a
representative sample whose SPs adequately
Page 1270
address the waiver participant's desired goals as
identified in the Personal Goals.
Numerator = Number of waiver participants in the
sample whose SPs adequately address the waiver
participant's personal goals.
Denominator = Total number of waiver participants
in the sample.
Compliance % by
Waiver
BI = 29.41% CLLI = 0.00% CMHS = 61.54%
EBD = 63.16%
Actions to be Taken
X Train ❑ Monitor ❑ Other
Action Details
We will have staff attend the recorded Person -
Centered Service Planning webinar available on the
HCPF website and will discuss in more detail the
methodology and requirements of this performance
measure. This will overlap with the 2 above
performance measure trainings.
Employee(s)
Responsible for
Implementing Actions
Meghan Phillips and Sandra Hasch
Implementation Time
Frame/ Date of
Completion
This will be completed by June 30, 2019
Root Cause Analysis
Case managers list a client goal, if the client choses
to state one. Indiscernible in data received from QIS
process. Perhaps due to lack of detail and no
uniformity of training from either state or agency
resources.
Page 1271
Performance Measure
Number and percent of waiver services, by type, in a
representative sample of waiver participants which
were delivered in accordance with the service plan.
Numerator = Number of waiver services, by type,
in the sample where the
paid claims equal those services authorized by the
service plan.
Denominator = Total number of waiver services, by
type, in the sample.
Compliance % by
Waiver
CLLI = 22.55%
Actions to be Taken
X Train ❑ Monitor ❑ Other
Action Details
Review how to authorize services.
Employee(s)
Responsible for
Implementing Actions
Meghan Phillips and Sandra Hasch
Implementation Time
Frame/ Date of
Completion
This will be completed by June 30, 2019
Root Cause Analysis
Not being able to adjust units in the Bridge as well
as client choice and changes of need during their
cert period, hospitalization, etc. Has been and will
continue to be nearly impossible to authorize the
exact units needed so that total units authorized
equal claims processed. The Bridge system will need
to be changed to do so.
Performance Measure
Number and percent of waiver participants with a
mental health provider in a representative sample
whose BUS records indicate coordination between
Page 1272
the CMA and the waiver participants' mental health
provider.
Numerator = Number of participants in the sample
for whom BUS records indicate the waiver
participant's mental health provider was contacted
every 180 days.
Denominator = Total number of participants in the
sample.
Compliance % by
Waiver
CMHS = 0.00%
Actions to be Taken
X Train ❑ Monitor ❑ Other
Action Details
We will create a power point training on this
performance measure.
Employee(s)
Responsible for
Implementing Actions
Meghan Phillips and Sandra Hasch
Implementation Time
Frame/ Date of
Completion
This will be completed by June 30, 2019
Root Cause Analysis
Case managers not labeling log notes correctly.
Inability to get responses from Mental Health
entities. Indiscernible in data received from QIS
process. Perhaps due to no uniformity of training
from either state or agency resources.
Appendix G — Health and Welfare
Performance Measure
Number and percent of ANE critical incidents that
were reported by the CMA within required
timeframe as specified in the approved waiver.
Page 1273
Numerator = Number of ANE critical incidents
reported by the CMA timely.
Denominator = Number of ANE critical incidents.
Compliance % by
Waiver
EBD = 75.00%
Actions to be Taken
X Train ❑ Monitor ❑ Other
Action Details
We will have a power point training on CIRs and
this performance measure.
Employee(s)
Responsible for
Implementing Actions
Meghan Phillips and Sandra Hasch
Implementation Time
Frame/ Date of
Completion
This will be completed by June 30, 2019
Root Cause Analysis
Case managers have time off or may be out of the
office and may not get it entered within 24 hours.
24 hours is not enough time to report an incident
when case managers are frequently out in the field
visiting clients and our workloads are high.
Performance Measure
Number and percent of all critical incidents
requiring follow-up completed within the required
timeframe.
Numerator = Number of critical incidents requiring
follow-up completed within the required timeframe.
Denominator = Number of critical incidents that
required follow-up.
Compliance % by
CMHS = 0.00% EBD = 55.56%
Waiver
Page 1274
Additionally, please complete the CIRS Remediation
workbook
Actions to be Taken
X Train ❑ Monitor ❑ Other
Action Details
We will have a power point training on CIRs and
this performance measure. This will overlap with
the above training.
Employee(s)
Responsible for
Implementing Actions
Meghan Phillips and Sandra Hasch
Implementation Time
Frame/ Date of
Completion
This will be completed by June 30, 2019
Root Cause Analysis
Case managers have time off or may be out of the
office and may not get follow up reviewed or
entered within the required time frame. During this
QIS, no one else received the email that follow up
was required besides the CM, and if the CM was
out, then this is a very difficult time frame to meet.
At least now, a supervisor also receives notice of
follow up and can act on this if the CM is out of the
office for an extended time. At times, it is difficult
to meet these tight timelines due to sheer high
workload issues and other priorities with other
processes, such as PAR revisions, etc.
Page 1275
Statements of Attestation
HCPF Solicitation #: RFP UHAA 202300017
Case Management Agency (CMA) Activities and State General Fund Program Services
County of Weld
As per Solicitation RFP UHAA 2023000170, Section 2.1.1.6, Weld County has the financial
strength to maintain the contract if awarded.
As per Solicitation RFP UHAA 2023000170, Section 2.1.1.6, Weld County possesses the sound
financial health and level of financial risk, pertaining to its Liquidity, Solvency, and Operating
Efficiency necessary to maintain the contract if awarded.
As per Solicitation RFP UHAA 2023000170, Section 2.1.1.6, Weld County shall comply with all
obligations as a subrecipient identified in 2 CFR Part 200, and in alignment with 2 CFR Part
200.344 agrees that all subawards provided to the Offeror by way of the resulting Contract
must be spent only on allowable CMA activities in alignment with 2 CFR Part 200, state and
federal regulations, and the Contract.
As per Solicitation RFP UHAA 2023000170, Section 2.1.1.7, Weld County attests and agrees that
any unspent funding provided via the resulting Contract, for which there are not allowable
expenditures, must be returned to the Department following the end of the Contract Period of
Performance as this is required by law and will become a part of the final Contract resulting
from this solicitation.
As per Solicitation RFP UHAA 2023000170, Section 1.6.1, Weld County attests and agrees that
as the CMA for service area 9, WCDHS is a subrecipient of a federal award and as such is subject
to the requirements of the Office of Management and Budget Uniform Guidance, 2 CFR Part
200. As a subrecipient, the Contractor shall comply with all reporting, auditing, and other
requirements of 2 CFR Part 200).
As per Solicitation RFP UHAA 2023000170, Section 1.6.2, Weld County attests and agrees that
as the CMA for service area 9, WCDHS is required to follow all federal guidance for subawards
identified in 2 CFR Part 200. This includes but is not limited to § 200.344 (d) that states: "The
non —Federal entity must promptly refund any balances of unobligated cash that the Federal
awarding agency or passthrough entity paid in advance or paid and that are not authorized to
be retained by the non —Federal entity for use in other projects.
As per Solicitation RFP UHAA 2023000170, Section 1.6.3, Weld County attests and agrees that
as the CMA for service area 9, Section § 200.344 mandates that all subrecipients must return
Statements of Attestation
HCPF Solicitation tt: RFP UHAA 202300017
Case Management Agency (CMA) Activities and State General Fund Program Services
County of Weld
unused funds within the timeframe specified by the Department following the end of the
period of performance. Per Section 2.1.1.6.
Additionally, Weld County SEP has reviewed the draft Contract in Appendix B for this
solicitation, and has reviewed, understands, and agrees to comply with all subparts and
exhibits:
• Subpart D Post Federal Award Requirements
• Subpart E Cost Principles
• Subpart F Audit Requirements
• Exhibit F Federal Provisions
• Exhibit G Supplemental Provisions for Federal Awards
Signature Date
4
COLORADO
Department of Health Care
Policy £t Financing
HCPF Solicitation it:
RFP UHAA 2023000170
Case Management Agency (CMA) Activities and State General
Fund Program Services
Appendix E
Anti -Collusion Affidavit
Modification #1
ANTI -COLLUSION AFFIDAVIT
I hereby attest that I am the person responsible within my firm for the final decision as to the Request for
Proposal submission or, if not, that I have written authorization, enclosed herewith, from that person to make
the statements set out below on his or her behalf and on behalf of my firm.
I further attest that:
1. The responses to this solicitation/bid have been arrived at independently, without consultation,
communication, or agreement for the purpose or with the effect of restricting competition with
any other firm or person who is a bidder or potential prime bidder.
2. The responses contained within this solicitation/bid have not been disclosed to any other firm
or person who is a bidder or potential prime bidder on this project and will not be so disclosed
prior to bid opening.
3. The responses of the solicitation/bid of any other firm or person who is a bidder or potential
prime bidder on this project have not been disclosed to me or my firm.
4. No attempt has been made to solicit, cause, or induce any firm or person who is a bidder or
potential prime bidder to refrain from bidding on this Project.
5. No agreement has been promised or solicited for any other firm or person who is a bidder or
potential prime bidder on this Project.
6. The responses to this solicitation from my firm are made in good faith and not pursuant to any
consultation, communication, agreement, or discussion with, or inducement or solicitation by or
from any firm or person to submit any noncompetitive or other form of complementary bid.
7. My firm has not offered or entered into a subcontract or agreement regarding the purchase or
sale of materials or services from any firm or person, or offered, promised, or paid cash or
anything of value to any firm or person, whether in connection with this or any other project, in
consideration for an agreement or promise by any firm or person to refrain from bidding or to
submit any intentionally high, noncompetitive, or other form of complementary bid or agreeing
or promising to do so on this Project.
8. My firm has not accepted or been promised any subcontract or agreement regarding the sale of
materials or services to any firm or person and has not been promised or paid cash or anything
of value by any firm or person, whether in connection with this or any other project, in
consideration for my firm's submitting any intentionally high, noncompetitive or other form of
complementary bid, or agreeing or promising to do so, on this Project.
9. I have made a diligent inquiry of all members, officers, employees, and agents of my firm with
responsibilities relating to the preparation, approval, or submission of my firm's bid on this
Project and have been advised by each of them that he or she has not participated in any
communication, consultation, discussion, agreement, collusion, or other conduct inconsistent
with any of the statements and representations made in this Affidavit.
10.1 understand, and my firm understands that the Colorado Department of Healthcare Policy Et
Financing is entitled to rely on the statements made in this Affidavit and that any false
statements may be prosecuted under Colorado criminal statutes, the Colorado Antitrust Act,
and the Colorado False Claims Act. Any misstatement in this Affidavit is and shall also be
treated as a fraudulent concealment from the Colorado Department of Healthcare Policy &
Financing, of the true facts relating to submission of bids for this Contract.
I DECLARE UNDER PENALTY OF PERJURY UNDER LAW OF COLORADO THAT THE
FOREGOING IS TRUE AND CORRECT.
Executed on the
27th
at Weld County, Colorado
day of February, 2023
(date) (month) (year)
(city or other location, and state) or (country)
Mike Freeman, Chair, Board of
Weld County Commissioners
(printed name and title)
(signature)
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