Long-Term Services and Supports COVID-19 Response

A:  Providers suspending or reducing services due to COVID-19 are required to notify members and their case managers by phone or email within 24 hours of the decision to suspend or reduce services. Providers should provide the CMA with a list of members impacted. Review Operational Memo OM 20-069: Updated HCBS Provider Retainer Payments and Case Management Action Required for Closures Related to COVID-19.

A: SIS assessment interviews shall be conducted by alternative methods, such as video conference and telephone. If a case manager determines the member requires a Support Level Review based on an increased need due to COVID-19, the case manager may send in a Support Level Review request as normal.

A: Case managers should utilize electronic video (such as Apple FaceTime, Skype or Zoom) to complete routine monitoring unless the member only has the option to use a telephone. The case manager shall log a note in the Benefits Utilization System (BUS) indicating the communication method used to complete the monitoring. For non-routine contacts that may require face-to-face interaction, such as performing an investigation into a member’s health and welfare, the case management agency must follow COVID-19 Centers for Disease Control (CDC) guidelines for precautions and social distancing. Any monitoring that does not require face-to-face contact is required to be completed. For more detailed guidance, refer to Operational Memo OM 20-075: Updated Case Management Operational Changes in Response to COVID-19.

A: While components of a case management investigation may be able to be completed via telephone or other video conferencing, there may be activities that require an in-person presence as noted in the Operational Memo OM 20-075: Updated Case Management Operational Changes in Response to COVID-19.  Any in-person activities should follow COVID-19 Centers for Disease Control (CDC) guidelines for precautions and social distancing.

A: HRC meetings can be conducted by alternative methods, such as video conference and telephone. All requirements for HRC, including informed consent, remain.

A: There have been no changes to the emergency enrollment request process. Community Centered Boards (CCBs) may continue to submit requests to the Department for those individuals who are seeking enrollment into the HCBS-DD waiver.

A: Department communication regarding PASAs and approved providers about CMA core work changes due to COVID-19 will continue to be made available through the Department Memo Series and captured on the Department COVID-19 website. Changes to case management or provider requirements are combined into joint memos to both audiences whenever applicable. All changes are communicated utilizing the Memo Series.

A: Case managers do not need to complete a service plan revision for a change in service delivery location. Please refer to Operational Memo OM 20-046: Updated: Changes to Benefits and Services in Response to COVID-19 for more information pertaining to the temporary changes to waiver benefits.

A: Critical incidents involving COVID-19 must be identified through the documentation fields in the Benefits Utilization System (BUS). The Department released Operational Memo OM 20-080: Critical Incident Reporting for COVID-19 to provide guidance regarding Critical Incident reports when a member reports they have a presumptive or confirmed case of COVID-19. 

For the Family Support Services Program (FSSP), State Supported Living Services (SLS) and Omnibus Reconciliation Act (OBRA) program, case managers will enter COVID-19 in the Critical Incident Reporting System (CIRs) in the existing DDDWeb/CCMS system and send a notification email to hcpf_cirs@state.co.us. Please note there is not a drop-down option in this system for COVID-19; therefore, the case manager must enter COVID-19 into the text field.

A. Case managers can accept an electronic signature on forms requiring a member or legal guardian signature. Please refer to Operational Memo OM 20-027: Changes to Signature Requirements for Member Paperwork in Response to COVID-19 for Case Management Agencies.

A.  When processing a Continued Stay Review (CSR), the case manager does not need to wait for signed documents to proceed with the functional eligibility determination. The case manager can submit the level of care certification to the county and create the service plan and PAR. Services may begin prior to the receipt of signed required paperwork. Please refer to Operational Memo OM 20-049: Updated Case Management Additional Operational Changes in Response to COVID-19 for additional guidance on obtaining signatures and paperwork necessary to complete an enrollment. 

A.  An initial assessment or a Continued Stay Review (CSR)  for Home and Community Based Service waivers do not require a completed PMIP as outlined in Operational Memo OM 20-049: Eligibility and Notice of Action Changes in Response to COVID-19 for Case Management Agencies. The ULTC-100.2 and DSS1 should be finalized and sent to the county for processing.

A:  The Department issued guidelines for Providers and Case Management Agencies (CMAs) when there is a suspected or confirmed case of the COVID-19 illness in a residential setting. Those guidelines can be found in Operational Memo 20-072: Operational Information for HCBS Residential Services Pertaining to COVID-19 and the Protect Our Neighbors Order. As always, the Department advises all members and providers to refer to the Colorado Department of Public Health and Environment (CDPHE) and the Centers for Disease Control (CDC) for best practices when dealing with a COVID-19 case.

A:  Providers may transport three (3) members per 12 passenger van. Guidelines for hygiene, cleaning, screening, and social distancing shall apply to vehicles of all sizes per Operational Memo OM 20-063: Updated Operational Changes to the HCBS Non-Medical Transportation Benefit for COVID-19.

A:  The Department understands that not everyone may be able to wear a mask or face covering for the duration of day program. In these cases, day program providers are encouraged to work with the member individually, including in the member's own home, or outdoors in the community. The Executive Order does allow for exceptions to the mask order, therefore if a member is unable to wear a mask or face covering and wants to attend group or base site day program, they must have a note from a medical professional stating that the member is unable to wear a mask. If a member is unwilling to wear a mask or cloth face covering, but does not have a medical exemption, they pose a risk to other members and should not receive services that are provided in a small group or at the setting. Day Program providers are expected to enforce this requirement.

A:  Yes. Members who need assistance with daily living skills or mobility may return to their day program. Please see Operational Memo OM 20-070: Updated Information Pertaining to Day Program Services in Response to COVID-19 for details as to how Day Program can be provided under the Protect Our Neighbors phase.

A:  Yes. A provider must work with the participant, their family if applicable, and the participant’s case manager to determine if the participant is ready to return to services. The provider must provide information to the participant and their family about all risk factors including the risks other participants may introduce to the environment. The information must be documented by the provider in the participant’s file and the case manager in the state prescribed case management system. The provider may consider utilizing a readiness assessment with the participant and family to determine if the participant is ready and all parties feel the participant understands the risks. See Operational Memo OM 20-070: Updated Information Pertaining to Day Program Services in Response to COVID-19 for more information.

A:  Day Programs must comply with occupancy rules for the “limited healthcare settings” category and at whichever level their county is currently in. For example, if your county is at level orange, you may only have 25% of the posted occupancy limit, not to exceed 25 people per room. If your county is at level yellow, you may have 50% occupancy as long as you remain in compliance with Operational Memo 20-070. Please refer to the COVID-19 dial dashboard to determine your counties’ level.

A:  No; the same rules do not apply to activities held outdoors. If a setting is holding activities outdoors, they do not need to adhere to the same occupancy limits set forth by the counties. 

Due to the rising number of COVID-19 cases, the Department will be allowing Supported Community Connections (SCC) and Community Connector (CC), provided by either the Host-Home Provider (HHP) or the Legally Responsible Person, to be provided in the home, if the county in which the member resides in is a Level Orange, Red, or Purple on the COVID-19 County Dial Dashboard.  This will be allowed for SCC and CC that are currently authorized and part of the member's service plan only, and these services must remain at the current authorized levels.  No increases may be authorized for this change.  In these counties, goals for SCC or CC should be aimed at assisting the member to connect with their community in a way that everyone is having to adapt to, which is through virtual means and finding online resources to connect to others, such as though community-hosted online book clubs, virtual tours, online museums, cooking classes, etc. If the member resides in a county that is still considered Level Green, Blue, or Yellow on the COVID-19 County Dial Dashboard, then SCC and CC services must continue to be provided out in the community, apart from the member's home.  Service goals would still be aimed at assisting the member to safely get out of the house and interact with their community in a safe and reasonable manner, based on the current restrictions of the county.

A: Day programs, including Adult Day Services and Day Habilitation services are considered Limited Health Care Settings and should follow all guidance from CDPHE related to those types of settings. For capacity guidance based on County Level, please refer to the CDPHE Limited Health Care Settings website and the information listed under the heading "Worksites."

COVID-19 County Dial Dashboard

A:  In response to the COVID-19 pandemic, the Department of Health Care Policy & Financing (Department) worked expeditiously to garner authorization for retainer payments beginning March 13, 2020. Retainer payments were available for the following services:

• Adult Day Services 
• Day Habilitation 
• Day Treatment for the Brain Injury Waiver 
• Prevocational Services 
• Supported Employment (including Supported Employment-Group)

The Centers for Medicare & Medicaid Services (CMS) recently released information specifying a retroactive change in the length of time and requirements under which a state may authorize retainer payments. CMS specified that retainer payments may not exceed three (3) 30-day consecutive time frames.

Retainer payments must be stopped by the end of the 18-week period under the new CMS policy, which for Colorado is July 17, 2020.

No retainer payments will be paid after July 17, 2020. Providers are to resume billing for services rendered and stop using the T2034 code on their claim.

The Department is committed to continuing to work with stakeholders to evaluate program definition changes and service delivery flexibilities to mitigate the potential spread of the COVID-19 illness while also ensuring continuity of services for people with disabilities. Day services may continue to be provided remotely using a variety of telehealth methods as well as a variety of alternative locations including a member’s home, a park, or other location that works well for the member and provider.

See Operational Memo OM 20-069: Updated HCBS Provider Retainer Payments for the Department’s official announcement.  

A:  Yes. Member’s may leave the house or have visitors, if appropriate.  Providers, members, and family should have a conversation and work together to make that determination.

​Residential settings shall also continue to follow all issued guidance by the Colorado Department of Public Health & Environment (CDPHE) and comply with all local and state orders.

Protect Our Neighbors means that communities that meet certain criteria have less stringent restrictions than under the Stay-At-Home and Safer-At-Home orders. Different communities will be at different phases, based on local conditions and capabilities, and the state may change phases as well. All variances by county are updated on CDPHE’s website here. Please pay close attention to which phase the state and your community is in and follow guidelines.

During all phases, residential settings can continue to be vigilant in reducing the risk of exposure to members by:

• Following the Stay-at-Home recommendations for members that are considered part of the “Vulnerable Population”, which means only leaving home for medical care and essential activities. This population includes:
  • Individuals who are 65 years and older
  • Individuals with chronic lung disease or moderate to severe asthma
  • Individuals who have serious heart conditions
  • Individuals who are immunocompromised
  • Individuals who determined to be high risk by a licensed healthcare provider are considered vulnerable under Executive Order D 2020 127.
• Avoiding communal dining
• Performing active health screens for all residents
• Avoiding any congregating within the setting
• Limiting visitation to only necessary or essential visits as outlined in CDPHE’s latest Public Health Order. This can include end-of-life scenarios. Settings should make efforts to allow for safe visitation for residents in such necessary scenarios. For all other situations, the Department continues to encourage the use of technology to allow members to connect with their friends, families, guardians and/or natural supports, or community resources (i.e. Arc Advocate) via video chat (Apple FaceTime or Zoom).
• Completing required health screenings of all employees, contractors, and essential individuals prior to entering the premises
  • Screening documentation must be maintained until further notice and made available upon request to CDPHE. After screening, if an essential visitor is allowed into the setting, they must:
    • Limit their movement within the facility to the resident’s room
    • Limit surfaces touched
    • Use appropriate personal protective equipment (PPE) – gown, gloves and mask
    • Limit physical contact with resident
    • Only be two essential visitors per resident at a given time

See Operational Memo OM 20-072: Operational Information for HCBS Residential Services Pertaining to COVID-19 and the Protect Our Neighbors Order for more information.

A:  Members, providers and family members should follow the most recent Safer at Home and in the Vast, Great Outdoors order.  Within that Order, all Coloradans are encouraged to limit social interactions, take other common-sense precautions against spreading and contracting COVID-19 such as maintaining six (6) feet of Social Distancing from others not in their household, wearing non-medical face coverings that cover the nose and mouth while in public, and frequent hand washing.  Members who live in their own home or a Host Home and are considered “Vulnerable Individuals” may leave the house or have visitors, if appropriate.  Providers, members, and families should have a conversation and work together to make that determination.  If a member does leave the home, or has visitors, it is important to continue to practice vigilance and screening upon returning to the home.

A:  Yes.  If the facility limits this to provide day program services to one Group Home at a time, and adheres to all cleaning and disinfecting protocols in between groups, a provider could take all residents of a group home that would like to participate, to a day program setting.  The setting must be limited to those from one group home and no other outside members in attendance at the time.

A:  Yes, providers are encouraged to continue to utilize telephone or video conferencing methods to provide job coaching and job development services. Providers must use their best professional judgment to determine if a telephone or video conferencing visit would be beneficial and align with the member's employment needs and goals. Specifically, you can still use alternative service methods to provide and bill for Supported Employment (SE) Group if people are not working at their job site. Supported Employment services may be provided to assist with relevant training, job coaching and skill building ongoing.

Providers that determine telephone or video conferencing visits can meet the needs of the member must document the assessment and any concerns in the care plan. Providers then must inform case managers of care plan changes.

A: Throughout the COVID-19 pandemic, Health First Colorado (Colorado’s Medicaid program) is temporarily expanding its telemedicine policy to authorize the following:

• Expanding the definition of telemedicine services to include telephone only and live chat modalities.
• Authorizing Federally Qualified Health Centers (FQHCs), Rural Health Clinic (RHCs) and Indian Health Services to bill encounters for telemedicine visits.
• Adding specified Physical Therapy, Occupational Therapy, and Home Health, Hospice and Pediatric Behavioral Therapy services to the list of eligible telemedicine services.

Get additional guidance and visit our Telemedicine webpage for the most up-to-date guidance.

A:  Yes, therapeutic services may be conducted through virtual visits. To minimize physical contact between providers and members, the Department has issued an Operational Memo to provide alternative provision allowances. Please review Operational Memo OM 20-020 - COVID-19 Communication for HCBS Behavioral Therapy, HCBS-Bereavement Counseling, HCBS-Expressive Therapy, HCBS-Mental Health Counseling, HCBS-Movement Therapy, and HCBS-Therapeutic Life Limiting Illness Support Providers for further guidance for the following services: 

• HCBS Behavioral Therapy
• HCBS Bereavement Counseling
• HCBS Expressive Therapy
• HCBS Mental Health Counseling
• HCBS Movement Therapy
• HCBS Therapeutic Life-Limiting Illness Support

Providers conducting virtual visits must document services rendered in the virtual format within the care plan. Providers shall bill for services just as they currently do according to the Prior Authorization Request (PAR). Providers will not bill using telemedicine procedure codes, will not change the place of service on the claim to “Telemedicine”, nor do they need to modify their Medicaid enrollment. 

A: 

• Assistive Technology (available in the BI, CES, SLS waivers)
• Behavioral Management and Education (BI)
• Behavioral Therapies – Counseling, Assessment, and Consultation (DD, SLS)
• Behavioral Therapies – Line Staff (DD, SLS)
• Bereavement Counseling (CLLI)
• Wraparound and Intensive In-Home Support Services (CHRP)
• Expressive Therapy – Music Therapy and Art and Play Therapy (CLLI)
• Home Modification and Adaptations professional evaluations (BI, CES, CMHS, DD, EBD, SCI, SLS)
• Independent Living Skills Training (ILST – BI)
• Life Skills Training (CMHS, EBD, SCI, SLS)
• Mental Health Counseling (BI)
• Mentorship (SLS)
• Movement Therapy – Music Therapy and/or Dance Therapy (CES, CHRP, SLS)
• Peer Mentorship (SLS, DD, SCI, CMHS, BI, EBD)
• Substance Use Counseling (BI)
• Therapeutic Life-Limiting Support Illness Support (CLLI)

*Brain Injury Waiver (BI), Children’s Extensive Supports Waiver (CES), Children’s Habilitation Residential Program Waiver (CHRP), Children with Life-Limiting Illness Waiver (CLLI), Community Mental Health Supports Waiver (CMHS), Developmental Disabilities Waiver (DD), Elderly, Blind, and Disabled Waiver (EBD), Spinal Cord Injury Waiver (SCI), Supported Living Services Waiver (SLS)

Please refer to Operational Memo OM 20-046 for more information pertaining to the temporary changes to waiver benefits. 

A:  Providers who conduct virtual visits must clearly document services rendered in the virtual format within the care plan and notify the case manager of the change in service delivery.  Providers, utilizing virtual or Tele-delivery options should utilize “02” on submitted claims for “Place of Service.”  The Place of Service description for 02 is, “The location where health services and health related services are provided or received, through a telecommunication system.”

A:  The new waiver in Section 1135(b) of the Social Security Act explicitly allows the Secretary to authorize the use of telephones that have audio and video capabilities for the furnishing of Medicare telehealth services during the COVID-19 pandemic. In addition, effective immediately, the Health and Human Services Office for Civil Rights (OCR) will exercise enforcement discretion and waive penalties for HIPAA violations against health care providers who serve patients in good faith through everyday communications technologies, such as Apple FaceTime or Skype, during the COVID-19 nationwide public health emergency. For more information please reference: OCR announces notification of enforcement discretion for TELEHEALTH REMOTE COMMUNICATIONS during the COVID-19 nationwide public health emergency.   

A:  The Department is covering some home and community-based services (HCBS) when provided over the phone, as a virtual delivery method. The integrity of the service must be maintained when providing services over the telephone.  Please review Operational Memo OM 20-020 and Operational Memo OM 20-046 for further information. Not all HCBS waiver services may be appropriately delivered via telephone. Providers must use their professional judgment when determining if a service is appropriate for virtual service delivery.

For any questions related to telemedicine and State Plan services, including Physical Therapy, Occupational Therapy and Speech Therapy, please check the Department’s web page Telemedicine - Provider Information for updates.

A:  HCBS providers may only bill for the time and services rendered. The Department understands that many services are now being rendered via virtual or electronic means and these services may take less time to render than traditional face-to-face service delivery, or members do not have the technological means for virtual services, or members do not wish to receive virtual services for great lengths of time. However, regardless of the service delivery method, providers may only bill for services rendered, even if it is below the authorized amount in the Service Plan.