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The Department of Health Care Policy & Financing (the Department) is working with Optumas to develop a Person-Centered Budget Algorithm (PCBA) for Health First Colorado Home and Community-Based Services (HCBS) waiver programs.
In collaboration with stakeholders, the Department has developed new processes for eligibility determinations, needs assessments, and support planning for all individuals seeking or receiving Long-Term Services and Supports (LTSS). As part of the new assessment and person-centered support planning process, the PCBA will help identify the right amount of support for members based on assessed need, and together with strengths and preferences identified during the assessment, contribute to a person-centered support plan. The PCBA is an important component of the assessment and support planning process to ensure a consistent method for assigning budgets for all members receiving HCBS.
The Department recognizes that transparency and stakeholder feedback are essential components of the process to develop a PCBA and this website will explain the steps taken in the process of creating the PCBA and will be updated regularly.
The Department and Optumas will be hosting a series of Statewide Meetings over the next year (virtually for now due to COVID-19). These meetings are intended to gather feedback on the development of the PCBA from a broad range of stakeholders. Morning and afternoon sessions will be held to accommodate as many stakeholders as possible. Both sessions will contain identical content. The Department and Optumas consider stakeholder feedback to be a critical part of the PCBA development and urge stakeholders to attend meetings when possible. Agendas, presentation materials, and summary notes from the Statewide Meetings will be uploaded here as they become available.
*Dates are tentative and subject to change
Reasonable accommodations will be provided upon request for persons with disabilities. Auxiliary aids and services for individuals with disabilities and language services for individuals whose first language is not English may be provided upon request. Please notify John Barry at (303) 866-3173 or John.R.Barry@state.co.us or the 504/ADA Coordinator email@example.com at least one week prior to the meeting to make arrangements.
The Department and Optumas are hosting smaller Technical Advisory Group (TAG) meetings to develop and review the statistical model of the PCBA. The information from the TAG meetings will also be presented at the Statewide Meetings to provide information to and gain additional feedback from a broader range of stakeholders.
Summary notes from the TAG meetings will be uploaded here as they become available.
No algorithmic tool can fully capture the resource needs of an individual or population. The PCBA is intended for use as one component of a larger person-centered planning process.
No, 31 states are currently using some form of an assessment-informed, prospective budget methodology.
No, the SIS will not be used in the development of the PCBA. Data from the new LTSS Assessment will be used.
Optumas will conduct a series of analyses that compare services utilized with services authorized at the member level. Assessment data will then be compared to estimated need in terms of services utilized and services authorized. This work also focuses on the impact of natural supports on member utilization. Information on members’ natural supports is available through the new LTSS Assessment and Support Plan.
Yes, Optumas has developed models like the PCBA in various states.
No, utilization data that have been influenced by the COVID-19 pandemic will not be used.
The Department and Optumas will carefully evaluate all items in the LTSS Assessment for appropriateness, consult published literature, conduct a detailed examination of existing assessment-informed, prospective budget methodologies, conduct a wide variety of statistical analyses, and seek feedback from stakeholders.
No, the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule prevents the Department and Optumas from sharing Protected Health Information (PHI). Appropriately deidentified and summarized data may be used. Sample data may also be shared.
The Department and Optumas are utilizing LTSS Assessment data as well as corresponding HCBS and State Plan claims from 2018-2019. New data available after implementation of the LTSS Assessment will be used in refining the PCBA.
The new LTSS Assessment and Support plan is available here: https://www.colorado.gov/hcpf/colorados-ltss-assessment-and-support-plan. Additional information surrounding the development of the new LTSS Assessment and Support Plan is also provided.
No, adults and children have markedly different needs and will not share identical drivers of resource need. As such, the Department and Optumas expect that the PCBA may utilize a different statistical structure as well as a different set of variables, distributions, and coefficients for adults and children.
Yes, the Department and Optumas intend to conduct statistical analyses in a manner that accounts for comorbidities. This may include variable transformation and/or the development of composite scales. All methodological processes of this nature will be shared with stakeholders during stakeholder meetings.
Yes, the Department and Optumas will be working with stakeholders to build an exceptions process with the understanding that no algorithmic tool can fully capture the resource needs of every individual.
No, a wide variety of Assessment items are being considered for inclusion in the PCBA.
Below are some acronyms that Optumas has used in presentation materials. This list will be updated as new acronyms are used.
A/SP: Assessment and Support Plan
ADRC: Aging and Disability Resource Center
CMS: Centers for Medicare & Medicaid Services
GLM: Generalized Linear Model
HCBS: Home and Community Based Services
HIPAA: Health Insurance Portability and Accountability Act
IDD: Intellectual and Developmental Disabilities
LOC: Level of Care
LTC: Long-Term Care
LTSS: Long-Term Services and Supports
PC: Person Centered
PCBA: Person Centered Budget Algorithm
PHI: Protected Health Information
PHR: Personal Health Record
QI: Quality Improvement
RA: Resource Allocation
RAE: Regional Accountable Entity
SB: Senate Bill
SEP: Single Entry Point
SIS: Supports Intensity Scale
SP: Support Plan
Contact Tasia Sinn for questions, comments or concerns at Tasia.Sinn@state.co.us.
To submit anonymous feedback about the development of Colorado's Person-Centered Budget Algorithm (PCBA), please fill out this form at https://forms.gle/Huuu7R1NnqzAhHbv5
LTSS Assessment and Support Plan Page
Other Long-Term Services and Supports Programs