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Long-Term Services and Supports - Benefits and Services Glossary

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A B C D E F G H I J K L M N O P Q R S T U V W X Y Z
 

Acupuncture

Acupuncture means the insertion of needles and/or manual, mechanical, thermal, electrical, and electromagnetic treatment to stimulate specific anatomical tissues for the promotion, maintenance, and restoration of health and prevention of disease both physiological and psychological. During an acupuncture treatment, dietary advice and therapeutic exercises may be recommended in support of the treatment. The utilization of acupuncture may typically begin at a higher frequency and is expected to decrease your progress. Authorization and payment for the acupuncture service are outlined at 10 CCR 2505-10 8.517.11.
 
Waiver(s) which include this service:
 

Adaptive Therapeutic Recreational Equipment and Fees

Adaptive Therapeutic Recreational Equipment and Fees services help a child have recreation in his or her community. Recreational equipment is adapted specifically to the child's disability. It does not include items a typical-age child would commonly need as a recreation item.

Recreational equipment examples include adaptive bicycles, adaptive strollers, adaptive toys, floatation collars for swimming, and balls with internal auditory devices. Services include admission fees for recreation centers only when the pass is needed to access professional services or to achieve or maintain a specific therapy goal as recommended and supervised by a doctor or therapist. Water safety trainings that are distinct from swimming lessons may be covered.

Waiver(s) which include this service:

 

Adult Day Services

Adult Day Services help you live independently in the community. Services are given in an Adult Day Center. Services include basic social and health services such as:

  • Social and recreational services
  • Help with daily activities like eating, dressing, and bathing
  • Emergency services
  • Nutrition services
  • Health monitoring services
  • Medication supervision
  • Special services for more complex needs
Waiver(s) which include this service:
HCBS Waiver for Persons with a Brain Injury
 

Alternative Care Facility (ACF)

Alternative Care Facilities (ACF) provide assistive living services so you can stay in the community. Residences are licensed and certified.
Services include:
  • 24-hour oversight
  • Medication Administration
  • Personal Care
  • Homemaker Services

You pay the full cost of room and board and may have to share the cost of the services.

 
Waiver(s) which include this service:

Assistive Devices

Assistive Devices include devices, controls, or appliances, required to help you increase your ability to function and perform activities or to perceive, control, or communicate with your environment to help gain greater independence in your home and community. 

This service includes items necessary for life support, ancillary supplies and equipment necessary for the proper functioning of such items, and durable/non-durable medical equipment not available under the Medicaid State Plan. 

 
Waiver(s) which include this service:

Assistive Technology

Assistive technology services include services, supports, or devices that help to increase, maintain or improve your ability to perform daily tasks. Services do not include ongoing subscription services. Services may include:

  • Evaluating needs
  • Choosing, buying, and using a device
  • Designing, fitting, customizing, adapting, applying, maintaining, repairing, and replacing devices
  • Training and technical assistance

There is a combined $10,000 maximum over the 5-year waiver period for the Assistive Technology, Home Accessibility Adaptations, and Vehicle Modifications benefits for the Children's Extensive Support (CES) and Supported Living Services (SLS) waivers. This amount may be exceeded with prior approval.

Waiver(s) which include this service:
 

Behavioral Management and Education

Behavioral Management and Education are services necessary for the treatment of a member's severe maladaptive behaviors when these services are not available under Medicaid State Plan benefits, other third-party liability coverage, or other federal or state-funded programs, services, or supports. Program includes a comprehensive assessment of behaviors, development of a structured behavioral intervention plan with specific treatment goals, working one-on-one with the member to implement the intervention plan and determine its feasibility, and training family and caregivers to reinforce behavioral programming methods and goals. Periodic reassessment of the individual plan is used to revise the plan, goals, and outcomes according to member needs.
 
Waiver(s) which include this service:
 

Behavioral Therapies

  • Intensive developmental behavioral therapies developed specific to the member's needs including conditioning, biofeedback, or reinforcement techniques.
     
  • Treatment goals that are consistent with building elementary verbal skills, teaching imitation, establishing appropriate toy play or interactive play with other children, teaching appropriate expression of emotions and behaviors, and where necessary, reducing self-stimulation and aggressive behaviors.
     
  • One-on-one behavior therapy is conducted with the member and Line Staff, following a specific protocol established by the Lead Therapist.
Training or modeling for parents or a guardian so that the behavioral therapies can continue in the home. Training or modeling shall be:
  • Directed towards instruction on therapies and use of equipment specified in the Care Plan.
  • Carried out in the presence of and for the direct benefit of the member.
  • Conducted by the Line Staff.
 
Waiver(s) which include this service:
 

Benefits Planning

Benefits Planning is the analysis and guidance provided to a member and their family/support network to improve their understanding of the potential impact of employment-related income on the member’s public benefits. Public benefits include, but are not limited to: Social Security, Medicaid, Medicare, food/nutrition programs, housing assistance, and other federal, state, and local benefits.  Benefits Planning gives the member an opportunity to make an informed choice regarding employment opportunities or career advancement.
 
Waiver(s) which include this service:
 

Bereavement Counseling

Bereavement counseling means counseling provided to the child and/or family members in order to guide and help them cope with the child's illness and the related stress that accompanies the continuous, daily care required for a child with a life-threatening condition. Bereavement activities offer the family a mechanism for expressing emotion, helping families manage stress, and asking questions about death and grieving in a safe environment.
 

Case Management

Case management is assistance provided by a case management agency on behalf of an eligible member, which includes referral of needed Health First Colorado (Colorado's Medicaid Program) services and supports that enable you to remain in your community-based setting.

A case manager is responsible for:

  • Assessing your long-term care needs,
  • Developing and implementing your care plan,
  • Coordinating and monitoring the delivery services and providers,
  • Evaluating the effectiveness of the services, and
  • Periodically re-assessing your needs.
 
 

Chiropractic

Chiropractic means the use of manual adjustments(manipulation or mobilization) of the spine or other parts of the body with the goal of correcting and/or improving alignment, neurological function, and other musculoskeletal problems. During chiropractic treatment, nutrition, exercise, and rehabilitative therapies may be recommended in support of the adjustment. The utilization of chiropractic care may typically begin at a higher frequency and is expected to decrease as you progress.
 
Waiver(s) which include this service:

HCBS Waiver for Complementary and Integrative Health

 

Community Connector Services

Community Connector Services helps children participate in typical childhood activities that build relationships and natural supports with others in the community where the child lives.

These services provide assistance to the child to enable them to integrate into their residential community and access naturally occurring resources. Community connector services:
  • Supports the abilities and skills necessary to enable the child to access typical activities and functions of community life.
  • Utilizes the community as a learning environment to assist the child to build relationships and natural supports in the child's residential community.
  • Are provided to a single child in a variety of settings in which children interact with individuals without disabilities.
Waiver(s) which include this service:
 

Consumer Directed Attendant Support Services (CDASS)

Consumer Directed Attendant Support Services allow you to independently manage your attendants for Personal Care Services, Homemaker Services, and Health Maintenance Services. You can hire, train, supervise, and fire your attendants. You manage the yearly budget for services. You decide the attendants' wages within a set range.
  • Personal Care services are available when they are not Health First Colorado benefits. Personal care services help you with daily tasks that you typically do for yourself but are unable to. Services may include skin, nail, hair, and mouth care, bathing, shaving, dressing, eating, walking, exercise, transferring, positioning, toileting, and respiratory care.

    Services may also include the attendant going grocery shopping with you, going with you to an appointment to help with Personal Care services, and Protective Oversight for certain supervision needs.
     
  • Homemaker services include help with general household activities that maintain a healthy and safe living environment. Activities may include housekeeping, preparing meals, doing laundry, light house cleaning, bed making, and shopping.
     
  • Health Maintenance Services may include helping you with health care tasks related to care for the skin, nails, or mouth, dressing, feeding, toileting, exercise, transferring, medical management, or respiratory care.

    Services must be pre-approved by your SEP/CCB Case Manager.
 
Waiver(s) which include this service:
 

Day Habilitation Services

Day Habilitation Services help you get, keep and improve self-help, socialization, and adaptive skills. These services take place away from your home unless there is a medical or safety need. Activities and environments are to help you gain skills, appropriate behavior, greater independence, and personal choice.
 
There are two types of services:
  1. Specialized Habilitation Services help you reach your highest skill level so you can be more self-sufficient. Services include help with self-feeding, toileting, self-care, sensory stimulation, and integration, self-sufficiency, maintenance skills, and supervision.

    Specialized Habilitation Services may be coordinated with physical, occupational, or speech therapy.
     
  2. Supported Community Connections Services support the abilities and skills needed for you to access typical activities of community life. These include community education or training, and retirement and volunteer activities.

    These services give opportunities to create and build relationships and natural supports in the community.
Waiver(s) which include this service:
 

Day Treatment

Day Treatment services are intensive and therapeutic services provided in a Day Treatment Center that develop your skills to live in the community.
 
Services may include social skills, sensory motor skills, positive coping behaviors, physical therapy, speech therapy, vocational counseling, nursing, social work, recreational therapy, case management, and neuropsychology.
 
Waiver(s) which include this service:

Expressive Therapy

Expressive Therapy means creative art, music, or play therapy which provides children the ability to creatively and kinesthetically express their medical situation for the purpose of allowing the child to express feelings of isolation, to improve communication skills, to decrease emotional suffering due to health status, and to develop coping skills. Services include creative art, music and play therapies.
 
Waiver(s) which include this service:

HCBS Waiver for Children with Life-Limiting Illness

 

Habilitation

Habilitation services are a twenty-four (24) hour residential program within the Children's Habilitation Residential Program waiver. It is distinct from the Residential Habilitation services in the adult waivers. Habilitation services can be provided to children and youth who require additional support to remain safely in their homes and community. Habilitation services include independent living training, self-advocacy training, cognitive services, emergency assistance, community access support, support for behavioral and therapeutic interventions, and medical supports.

Waiver(s) which include this service:

 

Health Maintenance

Routine and repetitive health-related tasks furnished to you in the community or in your home, which are necessary for health and normal bodily functioning that a person with a disability is unable to physically carry out. This service may include helping you with health care tasks related to care for the skin, nails, or mouth, dressing, feeding, toileting, exercise, transferring, medical management, or respiratory care.

This service is included in:

Consumer Directed Attendant Support Services (CDASS)
In-Home Support Services (IHSS)

Hippotherapy

Hippotherapy uses the movement of the horse to assist in the development or enhancement of skills including gross motor, sensory integration, attention, cognitive, social, behavior, and communication.

Waiver(s) which include this service:
 

Home Accessibility Adaptations

Home Accessibility Adaptations are specific modifications, adaptations, changes, or improvements in your existing home setting which, based on your specific needs, are necessary to ensure your health, welfare, and safety, and enable you to function with greater independence in the home or to prevent institutionalization. All modifications must be the most cost-effective means of meeting the need.
 
Home Accessibility Adaptations may include but are not limited to the following:
  • Installing or building ramps
  • Installing grab-bars and other Durable Medical Equipment (DME) as part of a larger Home Modification project
  • Widening doorways
  • Modifying bathrooms
  • Modifying kitchen facilities
  • Installing specialized electric and plumbing systems that are necessary to accommodate medically necessary equipment and supplies.
Regular homeowner maintenance and modifications that are not a direct benefit to you are not covered under the Home Accessibility Adaptations benefit. There is a combined $ 10,000 maximum over the 5-year waiver period for the Assistive Technology, Home Accessibility Adaptations, and Vehicle Modifications benefits for the Children's Extensive Support (CES) and Supported Living Services (SLS) waivers. This amount may be exceeded with prior approval.

Home Delivered Meals

Home Delivered Meals benefit includes nutritional counseling, planning, preparation, and delivery of meals. You must have a demonstrated need documented in your service plan for nutritional counseling, meal planning, meal preparation, dietary restrictions or specific nutritional needs, inability to prepare your own meals, limited assistance, and/or, inability to access and prepare nutritious meals.

To be eligible for Home Delivered Meals you must be:

  1. Transitioning from an institutional setting to a home and community-based setting,
  2. Transitioning from a more restrictive community setting to a less restrictive community setting, or
  3. Experiencing a change in life circumstance.

Home Delivered Meals may be used for up to 365 days following the first day the service is provided.

Waiver(s) which include this service:

Home Modification

Home Modifications are specific modifications, adaptations, changes, or improvements in your existing home setting which, based on your specific needs are necessary to ensure your health, welfare, and safety, and enable you to function with greater independence in the home, or to prevent institutionalization. All modifications must be the most cost-effective means of meeting the need.
 
Home Modifications, adaptations, or improvements may include but are not limited to the following:
 
  • Installing or building ramps
  • Installing grab-bars and other Durable Medical Equipment (DME) as part of a larger Home Modification project
  • Widening doorways
  • Modifying bathrooms
  • Modifying kitchen facilities
  • Installing specialized electric and plumbing systems that are necessary to accommodate medically necessary equipment and supplies.
 
Regular homeowner maintenance and modifications that are not a direct benefit to you are not covered under the Home Modification benefit. There is a $ 14,000-lifetime maximum for the Home Modification benefit.
 
 
Waiver(s) which include this service:

Homemaker Services

Homemaker Services are general household activities provided in the home of an eligible member to maintain a healthy and safe home environment for a member when the person ordinarily responsible for these activities is absent or unable to manage these tasks. Covered benefits shall be for the benefit of the member and not for the benefit of other persons living in the home or because a child's disability causes extra household tasks.
 
Services must increase the parent's or caregiver's ability to give the child needed care. Services may be hands-on help, performing a task for the child, or prompting the child to perform a task. Services shall be only in the permanent living space of the member.
 
Homemaking Services may include the following:
  • Routine light housecleaning, such as dusting, vacuuming, mopping, and cleaning bathroom and kitchen areas
  • Meal preparation
  • Dishwashing
  • Bed making
  • Laundry
  • Shopping
  • Teaching the skills listed above to you if you are capable of learning to do such tasks for yourself. Teaching shall result in a decrease in weekly units required within ninety days. If such savings in service units is not realized, teaching shall be deleted from the care plan.
 
Homemaking Services does not include:
  • Personal care services
  • Services you can perform independently
  • Services provided by family members
  • Homemakers Services provided in uncertified congregate facilities are not a benefit
 
Waiver(s) which include this service:
 
 
 

Hospital Back-Up

The Hospital Back Up (HBU) is a long-term care program that provides hospital-level care in skilled nursing facility settings. In accordance with 42 CFR 456.1, the HBU is a statewide program that safeguards against unnecessary or inappropriate use of Health First Colorado (Colorado's Medicaid Program)services in acute hospitals. Health First Colorado members who no longer need acute care in the hospital but require 24-hour monitoring for medically complex conditions or life-sustaining technology may apply to receive long-term care in an HBU-certified facility. Members who are discharged from the HBU program require skilled nursing supervision to remain stable and usually have chronic illnesses requiring ventilator assistance, tracheotomy care, or extensive wound management.
 
The acute hospital initiates the application for HBU placement. The hospital discharge planner shall submit an HBU application to the SURC for admission in an HBU facility on behalf of the Health First Colorado member.
 
The patient must be Health First Colorado certified or eligible. In order to apply for HBU services a Health First Colorado member shall:
  • Be hospitalized in an acute hospital and deemed clinically stable and ready for discharge,
  • Have no option for discharge home or in a class I. nursing facility due to level of care needs,
  • Meet long-term care eligibility as determined by the Single Entry Point (SEP) pursuant to 10 CCR 2505-10, Section 8.110.30.A,
  • Meet clinical criteria as outlined in 10 CCR 2505-10, Section 8.470 as determined by the State Utilization Review Contractor (SURC),
  • Be accepted by an HBU-certified skilled nursing facility
 
HBU members qualify for all nursing facility benefits and rights as outlined in 10 CCR 2505-10, Section 8.440 and 10 CCR 2505-10, Section 8.057
 
HBU care is individualized and patient-centered. The care plan is negotiated between the members/legal representative, the medical provider, and the clinical team. The care plan is adjusted as needed to meet the needs of the HBU member.
 

Independent Living Skills Training (ILST)

Independent Living Skills Training helps you stay in the community by helping you learn how to take care of yourself more independently. Training services may be given in the home or community.

Services may include:

  • Assessment, training, supervision, and help for self-care
  • Benefits Coordination
  • Communication skills
  • Household management
  • Interpersonal skills
  • Medication supervision and reminders
  • Money management
  • Recreation
  • Resource coordination
  • Safety awareness
  • Sensory/motor
  • Task completion
  • Time management

Waiver(s) or programs which include this service:

In-Home Support Services (IHSS)

In-Home Support Services allow you to choose your own agency-based attendants and direct your own care. You can hire, schedule, manage, supervise, train, and fire your attendant. Services include Personal Care, Homemaker Services, and Health Maintenance Services.

  • Personal Care services are available when they are not Health First Colorado benefits. Personal Care services help you with daily tasks that you typically do for yourself but are unable to. Services may include skin, nail, hair, and mouth care, bathing, shaving, dressing, eating, walking, exercise, transferring, positioning, toileting, and respiratory care.

    Services may also include the attendant going grocery shopping with you, going with you to an appointment to help with Personal Care services, and Protective Oversight for certain supervision needs.
     
  • Homemaker Services include help with general household activities that maintain a healthy and safe living environment. Activities may include housekeeping, preparing meals, doing laundry, light housecleaning, bed making, and shopping.
     
  • Health Maintenance Services may include helping you with health care tasks related to care for the skin, nails, or mouth, dressing, feeding, toileting, exercise, transferring, medical management, or respiratory care.
 
 
Waiver(s) which include this service:

Intensive Support Services

This service aligns strategies, interventions, and supports for your child and family to prevent the need for out-of-home placement. There are three distinct elements of this service: Wraparound Plan, Wraparound Monitoring, and Child and Youth Mentorship.

Wraparound planning should address steps to implement support strategies and prevent and/or manage a future crisis. The wraparound plan should incorporate all relevant strategies and other treatment plans into one comprehensive stabilization plan.

Wraparound monitoring and follow-up services include ongoing evaluations to ensure that triggers of crisis have been addressed to maintain stabilization and prevent a future crisis.

Child and Youth Mentorship should include implementation of therapeutic and/or behavioral support plans, building life skills, providing guidance to your child with self-care, learning self-advocacy, and protective oversight.

Includes: Identification of the strengths, abilities, preferences, desires, needs, expectations, and goals of your child/youth and family, maintaining stabilization, preventing crisis situations, de-escalation of a crisis, and follow-up services. All components of Intensive Support Services can be utilized together or as stand-only services.

Waiver(s) which include this service:

 

Life Skills Training

Life Skills Training services are individualized training, provided in your residence, the community, or group living situation, that is designed and directed with you to develop and maintain your ability to independently sustain yourself in the community.

To be eligible for Life Skills Training you must be:

  1. Transitioning from an institutional setting to a home and community-based setting,
  2. Transitioning from a more restrictive community setting to a less restrictive community setting, or
  3. Experiencing a change in life circumstance.

Life Skills Training may be used for up to 365 days following the first day the service is provided.

Long-Term Care - Home Health

Home Health Services are provided in a member's place of residence to prevent institutionalization and hospitalization. The services must be medically necessary, provided for treatment of illness, for disability, services must be reasonable in amount, duration, and frequency.

More Information about Long-Term Home Health

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Massage Therapy

Massage Therapy means the systematic manipulation of the soft tissues of the body, (including manual techniques of gliding, percussion, compression, vibration, and gentle stretching) for the purpose of bringing about beneficial physiologic, mechanical, and/or psychological changes. Massage is used to ease muscle contractures or spasms, increase extension and muscle relaxation, and decrease muscle tension. It also includes Watsu.

Services are limited based on your assessed need for services, physician's orders, and prior authorization by case managers up to the cost containment parameters.

Waiver(s) which include this service:
 
 

Medication Reminder

The devices, controls, or appliances which enable an individual to increase their abilities to perform activities of daily living, such as medication administration. Medication Reminders shall include devices or items that remind or signal the participant to take prescribed medications or other devices necessary for the proper functioning of such items, and durable and non-durable medical equipment not available as a State Plan benefit.
 

Mental Health Counseling (Individual, Family or Group)

Mental Health Counseling services help you and your support system better manage and overcome the difficulties and stresses faced by people with a brain injury. These services are in addition to the counseling services available through Health First Colorado basic services and do not replace those services. Services may be in the home, community, or provider's office.

Services include individual and group mental health counseling. They include services to family members who have a major role in supporting you or who live with or care for you. Services need pre-approval after 30 visits in individual, family, or group settings combined.

Waiver(s) which include this service:
 

Mentorship

Mentorship services help promote self-advocacy. Methods include instructing, giving experiences, modeling, and advising. This service helps you interview potential providers, understand complicated health and safety issues, and serve on private and public boards, advisory groups, and commissions.

This service may also include training in child and infant care for parents who have an intellectual or developmental disability.

 
Waiver(s) which include this service:

HCBS Supported Living Services Waiver

Movement Therapy

Movement therapy includes music and dance therapy for the habilitation, rehabilitation, and maintenance of behavioral, developmental, physical, social, communication, or gross motor skills. It also helps with pain management and cognition.

Waiver(s) which include this service:

HCBS Children's Extensive Support Waiver
HCBS Children's Habilitation Residential Program Waiver

 

Palliative/ Supportive Care

Palliative and Supportive Care services help lessen the child's symptoms, pain, and stress. They improve the child's quality of life. Services can be provided at the same time as curative treatment. Services include:

  • Care coordination: A care plan is developed. There are regular home visits to monitor the child's health and safety. Services are coordinated.
     
  • Pain and symptom management: A registered nurse manages the child's symptoms and pain in the home. This includes pain and symptom assessments and in-home visits.
 
Waiver(s) which include this service:

Parent Education

Parent Education services teach parents and other caregivers about a child's disabilities. Services may include consulting, training on a child's needs such as sign language, special resource materials, registration costs to attend conferences, educational workshops, membership costs for parent support, information organizations, and publications for parents of children with disabilities.
 
This benefit provides unique opportunities for parents or other caregivers to learn how to support the child's strengths within the context of the child's disability and enhances the parent's ability to meet the special needs of the child.
 
Waiver(s) which include this service:
 

Peer Mentorship

Services provided by peers to promote self-advocacy and encourage community living by instructing and advising on issues and topics related to community living, describing real-world experiences as examples, and modeling successful community living and problem-solving.

To be eligible for Peer Mentorship you must be:

  1. Transitioning from an institutional setting to a home and community-based setting,
  2. Transitioning from a more restrictive community setting to a less restrictive community setting, or
  3. Experiencing a change in life circumstance.

Peer Mentorship Services may be used for up to 365 days following the first day the service is provided.

Personal Care Services

Personal Care services are available when they are not Health First Colorado benefits. Personal Care services help you with daily tasks that you typically do for yourself but are unable to. Services may include skin, nail, hair, and mouth care, bathing, shaving, dressing, eating, walking, exercise, transferring, positioning, toileting, and respiratory care.

Services may also include the attendant going grocery shopping with you and going with you to an appointment to help with Personal Care services, and Protective Oversight for certain supervision needs.

Services may include Homemaker Services if given along with Personal Care services.

 
Waiver(s) which include this service:
 

Personal Emergency Response System

Personal Emergency Response System (PERS) allows you to live safely in your home and call for help in an emergency. You may get a PERS if you live alone for most or all of the day, or your companion is too impaired to help in an emergency. You may get a portable "help" button to wear so you can move around.

Personal Emergency Response System services shall be authorized only if you have the physical and mental capacity to utilize the particular system requested.
 
Waiver(s) which include this service:
 

Pre-Vocational Services

Pre-Vocational Services help you learn good work habits and skills to help you get paid work or unpaid community work within 5 years. Examples of good work habits and skills include following directions, good attendance, completing tasks, solving problems, and being safe.

Prevocational services encompass the following types of work-related activities:

  • teaching you such concepts as following directions, attending to tasks, task completion, communication, decision-making, and problem-solving,
  • training in the areas of safety, self-advocacy, and mobility,
  • intervention and training needed to benefit from Prevocational services which would allow common barriers to participation to be avoided, and,
  • travel training services may include providing, arranging, transporting, or accompanying you to Prevocational services and supports identified in the plan of care.
 
Waiver(s) which include this service:
 

Remote Supports

Remote Supports provides live 2-way communication for personal care and/or homemaker from an off-site location to help you complete on-demand daily tasks in your home that do not need hands-on assistance.  

Remote Supports can be used for personal care or homemaker tasks you and your care team decide would support safety, health, and independence. Services may include prompts for dressing, cooking support, overnight support, and fall detection.

Remote Supports Technology purchase and installation are available. 

More information about Remote Supports

Waiver(s) which include this service:
 

Residential Habilitation Services and Supports

Residential Habilitation Services and Supports help you stay safe and healthy and teach skills needed to live in the community. Services include assessment and evaluation, training materials, transportation, fees, and supplies. You can live in:

  • Individual Residential Services and Supports (IRSS) has up to 3 people living together
  • Group Residential Services and Supports (GRSS) has 4 to 8 people living together in a Residential Care Facility or Residential Community Home
  • A qualified family home

Services in both IRSS and GRSS may include training in self-advocacy, independent living, money management, decision-making, and emergency assistance. Services may include counseling, behavioral therapy, and other therapeutic interventions. They may also include medical and health care services to meet your daily needs. These include giving medications, community access services, travel services, and supervision to help you stay safe.

Waiver(s) which include this service:

HCBS Waiver for Persons with Developmental Disabilities

Respite

Respite is available for your caregiver on a short-term basis because of the absence or need for relief of those persons normally providing the care. Respite may be provided in the community, in the private residence of the respite provider, or in your home.
 
Waiver(s) which include this service:
 
 

Specialized Medical Equipment/Supplies

Specialized Medical Equipment and Supplies include devices, controls, or appliances that are required due to your disability and that enable you to increase your ability to perform activities of daily living or to safely remain in the home and community. Specialized Medical Equipment and Supplies include:
  • Kitchen equipment required for the preparation of special diets if this results in cost savings over prepared foods,
  • Specially designed clothing if the cost is over and above the costs generally incurred for regular clothing,
  • Maintenance and upkeep of specialized medical equipment purchased through the waivers.
 
Waiver(s) which include this service:
 

Substance Use Counseling

Substance Use Counseling services help you and your support system better manage and overcome substance use issues often faced by people with brain injuries. These services are in addition to counseling services available through Health First Colorado basic services. They are not intended to replace those services. Services may be in the home, community, or provider's office.

Services include individual and group mental health Substance Use counseling. They include services to family members who have a major role in supporting you or who live with you or care for you. Services need pre-approval after 30 visits in individual, family, or group settings combined.


Waiver(s) or programs which include this service:

HCBS Waiver for Persons with a Brain Injury

 

Supported Employment Services

Supported Employment offers work support services if you need intensive ongoing support in the work setting. Services include assessing and identifying interests and abilities, job placement and development, job coaching, and workplace assistance. If you get Supported Employment services, you must first use the services through the Division of Vocational Rehabilitation or speak with a CCB Case Manager.
 
Waiver(s) which include this service:

HCBS Waiver for Persons with Developmental Disabilities
HCBS Supported Living Services Waiver 

Supported Living Program (SLP)

The Supportive Living Program (SLP) is a specialized assisted living service for people with brain injuries. Residences are certified. Services include 24-hour oversight, assessment, training, and supervision of self-care, medication management, behavioral management, and cognitive supports. They also include interpersonal and social skills development.

You pay the full cost of room and board and may have to share the cost of the services.

 
Waiver(s) which include this service:
 

Transition Coordination

Transition Coordination is a Health First Colorado (Colorado's Medicaid Program) State Plan benefit under Targeted Case Management and is provided to members 18 years and older.

Transition Coordination are activities essential to move a member from a nursing facility, Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID), or Regional Center and establish a community-based residence. Services are provided by a Transition Coordination Agency (TCA).

These case management services facilitate a process to complete a community needs assessment for Health First Colorado State Plan services and non-Health First Colorado supports and services to support the members' return to the community from placement in a qualified facility and to aid the member in attaining their transition and independent living goals.

Waiver(s) or programs which include this service:

Available through Targeted Case Management Services, a State Plan benefit, for members 18 years or older.

See Transition Services

Transition Set-Up Services

Transition Set-up Services are the coordination and coverage of a one-time, non-recurring expense to establish a basic household upon transition from a nursing facility, Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID), or Regional Center to a community living setting.

To be eligible for Transitions Setup you must be transitioning from an institutional setting to a home and community-based setting.

Setup Services are not available when transitioning into a provider-owned setting, such as Alternative Care Facility, Host Home, Group Home, or Supportive Living Program. Setup services are not available in a community-to-community transition.

 
Waiver(s) which include this service:
 

Transition Support Services

This service aligns strategies and supports for your child and family when a child transitions to the family home from out-of-home placement or to lower levels of care while in out-of-home placement. There are three distinct elements of this service: Wraparound Plan, Wraparound Monitoring, and Child and Youth Mentorship.

Wraparound planning should address steps to implement support strategies and prevent and/or manage a future crisis. The wraparound plan should incorporate all relevant strategies and other treatment plans into one comprehensive stabilization plan.

Wraparound monitoring and follow-up services include ongoing evaluations to ensure that triggers of crisis have been addressed to maintain stabilization and prevent a future crisis.

Children and Youth Mentorship should include the implementation of therapeutic and/or behavioral support plans, building life skills, providing guidance to your child with self-care, learning self-advocacy, and protective oversight.

Includes: Identification of the strengths, abilities, preferences, desires, needs, expectations, and goals of your child and family, maintaining stabilization, preventing crisis situations, de-escalation of a crisis, and follow-up services. All components of Intensive Support Services can be utilized together or as stand-only services.

Waiver(s) which include these services:

HCBS Children's Habilitation Residential Program Waiver

 

Transitional Living Program (TLP)

The Transitional Living Program (TLP) offers you intensive services in an assisted living setting if you were recently injured for people with recent brain injuries. Services are to help you transition back home. The services are given only within 18 months of a first brain injury or 3 months of a second brain injury with a hospital stay. Services are generally limited to 6 months.

Services may include assessment, training, and supervision of self-care, medication management, communication skills, interpersonal skills, socialization, sensory/motor skills, money management, household management, physical therapy, occupational therapy, or speech therapy.

You pay the full cost of room and board and may have to share the cost of the services.

 
Waiver(s) which include these services:
 
 

Therapeutic Life-Limiting Illness Support

Therapeutic Life-Limiting Illness Support services offer your child and family counseling for grief, loss, and anticipatory grief. These services are to decrease emotional suffering, lessen feelings of isolation, and help you cope with your child's diagnosis.
 
Support available to your child, their siblings, and family may include counseling, attending doctor visits, giving emotional support, and connecting the family to community resources.
 
Waiver(s) which include these services:
 

Vehicle Modifications

Vehicle Modifications are adaptations or alterations to a car, truck, or van that is your primary vehicle to accommodate your special needs. These changes must be needed to enable you to integrate more fully into the community, and to ensure your health and safety. Services include changes to the vehicle, and upkeep and maintenance of the changes made to the vehicle. All modifications must be the most cost-effective means of meeting the need.

Services do not include regular vehicle upkeep and maintenance, vehicle purchase or lease, or modifications that are not a direct benefit to the member. There is a combined $10,000 maximum over the 5-year waiver period for the Assistive Technology, Home Accessibility Adaptations, and Vehicle Modifications benefits for the Children's Extensive Support (CES) and Supported Living Services (SLS) waivers. This amount may be exceeded with prior approval.

Waiver(s) which include this service:
 

Vision Services

These services are provided only when the services are not available through the Health First Colorado (Colorado's Medicaid Program)vision benefits.

Eye exams, diagnosis, glasses, contacts, and other services must be medically necessary.

Lasik and similar procedures must be medically appropriate and pre-approved by your CCB.

 
Vision Services are provided by a licensed Optometrist or Physician and include:
  • Eye exams and diagnosis
  • Glasses, except after surgery
  • Contacts
  • Other medically necessary methods used to improve specific dysfunctions of the vision systems.
  • Lasik and other similar types of procedures are only prior approved and allowable when the procedure is necessary due to documented specific behavioral complexities (i.e. constant destruction of eyeglasses) that make other more traditional remedies impractical.
 
Waiver(s) and programs that include this service:

Wellness Education Benefit (WEB)

The Wellness Education Benefit (WEB) is a mailed monthly benefit designed to reduce the need for a higher level of care by offering educational materials that provide members and their families with actionable tools that can be used to prevent the progression of a disability, increase community engagement, combat isolation, and improve awareness of Medicaid services. 
 
The WEB helps members and their unpaid caregivers to obtain, process, and understand information that assists with managing health-related issues, promoting community living, and achieving goals identified in their person-centered service plans. The WEB includes varied topics such as engaging in community activities, nutrition, adaptive exercise, balance training and fall prevention, money management, and developing social networks.
 
Waiver(s) and programs that include this service effective May 2024:
 

Youth Day

Youth Day Services provides care and supervision to children 12 - 17 years old while the primary caregiver works (paid or unpaid), volunteers, or seeks employment. Children with Intellectual and developmental disabilities in this age range typically require care and supervision while the primary caregiver is absent from the home. Youth Day Service may be provided on an individual or group basis and may be provided in the residence of the child or Youth Day service provider or in the community.
 
Waiver(s) which include these services: