9 CCR 2503-5-3.570 - HOME CARE ALLOWANCE AND BURIAL
3.570.1
HOME CARE ALLOWANCE
3.570.11
PURPOSE OF PROGRAM
A. Home Care Allowance
(HCA) is a special cash payment made to a client, five (5) years of age or
older for the purpose of securing in-home, personal care services.
1. HCA is a non-entitlement
program;
2. Clients must be
evaluated for Home and Community Based Services through Health First Colorado
(Medicaid) before the HCA program can be considered.
a. At application, if the client is
functionally eligible for Home and Community Based Services (HCBS) through
Health First Colorado (Medicaid), the client is not eligible for HCA.
b. At reassessment on or after 05/01/2022,
clients must be evaluated for Home and Community Based Services through Health
First Colorado (Medicaid) and if functionally eligible, the clients are no
longer eligible for the HCA program. Clients who are determined eligible for
HCBS through Health First Colorado at reassessment may remain on HCA for up to
three (3) months while they transition to HCBS if the delay in transition is
not within the client's control.
c.
HCA cannot be received while receiving Home and Community Based Services;
and,
3. HCA is designed
to serve clients with the lowest functional abilities and the greatest need for
paid care.
B. Effective
September 1, 2018, the HCA grant standard maximums are as follows:
1. Tier 1 - $330.00
2. Tier 2 - $472.00
3. Tier 3 - $605.00
C. The tier grant standard maximums shall be
lower for certain clients with special circumstances, as defined in Section
3.570.13, D.
D. The HCA grant is
not taxable income to the client. The payment made to the care provider using
the HCA grant received by the client is income to the care provider and subject
to taxation under State and Federal laws.
E. The HCA grant standards shall be adjusted
to stay within available appropriations. Appeals shall not be granted for these
adjustments.
F. In addition to the
regular monthly HCA grant payments, supplemental payments necessary to comply
with the Federal Maintenance of Effort (MOE) requirements, as incorporated in
Section 3.531.D, may be provided. These payments are supplements to regular
grant payments, are not entitlements, and do not affect grant standards.
Appeals shall not be allowed for MOE payment adjustments.
3.570.12
DEFINITIONS
"Activities of daily living" (ADL) mean physical transfers, bladder care, bowel care, mobility, dressing, bathing, hygiene, and eating.
"Authorized representative" means an individual or organization designated by the client, or by the parent or guardian of the client, if appropriate, to assist in acquiring or utilizing Home Care Allowance (HCA). The extent of the authorized representative's involvement shall be determined upon designation.
"Care planning" means identifying client goals and choices for the care needed, services needed, appropriate service providers, and knowledge of the client and of community resources. The care plan shall be documented on the State Department prescribed care plan tool.
"Case management" means the assessment of a client's long-term care needs, development and implementation of a care plan, coordination and monitoring of the long-term care service delivery, evaluation of service effectiveness, and periodic reassessment of client needs.
"Functional assessment" means the comprehensive evaluation of the client's ability to manage his or her activities of daily living and to determine the level of assistance the client requires to complete his or her activities of daily living.
"Home" means a non-facility residence. A home cannot include a homeless shelter or other temporary setting.
"Intake/screening/referral" means the initial contact with clients by the Single Entry Point (SEP) and shall include, but not be limited to, a preliminary screening of: the client's need for long term care services, the client's need for referral to other programs or services, eligibility for financial and program assistance, and the need for a comprehensive assessment.
"Medical leave" means the absence of the client from their home for more than twenty-four (24) hours due to admittance to a hospital or other facility, upon physician's order with the presumption on the part of the physician that the client will be returning to their home. Medical leave may be planned or unplanned.
"Non-medical leave" means the absence of the client from their home for more than twenty-four (24) hours for non-medical reasons that are not part of a client's care plan. Non-medical leave may be planned or unplanned.
"Non-skilled care" means care provided by licensed and unlicensed non-medical personnel, including caregivers who assist or help the individual with daily tasks such as bathing, eating, cleaning the home, and preparing meals.
"Ongoing case management" means the evaluation of the effectiveness and appropriateness of services, on an ongoing basis, through contacts with the client, appropriate collateral contacts, and service providers.
"Reassessment" means a comprehensive re-evaluation by the case manager with the client and appropriate collaterals (such as family members, friends and/or caregivers) to determine the client's level of functioning, service needs, available resources, potential funding resources, and necessity for paid care. The reassessment of functional need shall be documented on the State Department prescribed assessment tool.
"Single Entry Point ("SEP") agency" means the agency selected by HCPF to provide case management functions for persons in need of long term care services within specific demographic areas, pursuant to Section 25.5-6-106, C.R.S.
"Skilled personal care" means some exceptions to personal care for activities of daily living that, because of the severe or complex nature of the client's need, requires a person with specialized training and skill to complete the task. Skilled personal care is not a paid service of the Home Care Allowance (HCA) program. See Section 8.489.30 (10 C.C.R. 2505-10) of the HCPF rules for the definitions of personal care and the skilled exceptions to personal care.
3.570.13
ELIGIBILITY
A. Eligibility for
HCA shall be based on both financial need and the client's functional needs.
The client shall meet eligibility for both financial and functional
requirements to be approved for an HCA payment.
B. To be financially eligible, the client
shall:
1. Be approved for Supplemental
Security Income (SSI) benefits; or,
2. Meet all eligibility criteria required for
Aid to the Needy Disabled - State Only (AND-SO) program; or,
3. Have been receiving both Old Age Pension
(OAP) grant payments and HCA as of December 31, 2013 and remain continuously
eligible for both benefits.
C. To be functionally eligible, the client
shall have an HCA eligible functional assessment score. The functional
assessment score is calculated by determining the client's functional capacity
score and need for paid care score, as follows:
1. Functional Capacity: determined by
assessing the client's ability to complete all activities of daily living
(ADLs) and applying a score to his or her ability to complete the ADLs using
the functional impairment scale; and,
2. Need for Paid Care: determined by
identifying the unmet need for paid care and applying a score to the unmet need
using the need for paid care scale, as outlined in Section 3.570.14;
and,
3. Combining the functional
capacity score and the need for paid care score to determine whether the client
meets the minimum scores for eligibility and, if eligible, the tier of grant
payments to be approved, as follows:
|
Tier |
Capacity Score |
Need for Paid Care Score |
|
1 |
21 or Higher |
1 to 23 |
|
2 |
21 or Higher |
24 to 37 |
|
3 |
21 or Higher |
38 to 51 |
D. The SEP shall not approve the maximum
authorized HCA amount for the tier if:
1. The
client's needs can be fully or partially met through other paid or unpaid
sources (excluding family and friends); or,
2. The HCA provider is able to provide the
authorized services for less than the maximum authorized amount; or,
3. The client is unwilling or unable to use
the maximum authorized amount.
E. Each client who meets the minimum
functional assessment scoring requirements for the HCA program shall be
functionally eligible for an HCA grant.
1. The
authorization by the SEP shall be forwarded to the county department to
determine financial eligibility.
2.
Clients shall not be approved for HCA if financially ineligible, even if the
client is functionally eligible.
3.
Clients shall not be approved for HCA if functionally ineligible, even if the
client is financially eligible.
F. If financially and functionally eligible
for HCA, the HCA grant payment shall begin on the first day of the month
following the month in which the HCA is approved or the payment effective date
from the State approved form completed by the SEP, whichever date is later.
There shall be no retroactive HCA payments.
G. If a client is assessed and does not meet
the functional assessment scoring requirements, the county department and SEP
shall refer the client to other agencies or services available in the
community, such as Area Agencies on Aging (AAA), Aging and Disability Resources
for Colorado (ADRC), Centers for Independent Living, and/or other local
community resources to help with any identified needs.
3.570.14
FUNCTIONAL ASSESSMENT
SCORING
A. The need for skilled
personal care shall not be included in the scoring of the need for paid
care.
B. In order to be eligible
for the Home Care Allowance program, each client shall score a minimum of
twenty one (21) points when assessed for the ability to complete the ADL using
the following functional impairment scale:
1.
Independent: score zero (0) if the client is physically able to perform all
essential components of the ADL, with or without an assistive device.
2. Low: score one (1) if the client requires
occasional or intermittent supervision or stand-by assistance in a limited
number of the components of the activity such as he or she is able to perform
all essential components of the function, but impairment of function exists
even with an assistive device.
a. Occasional
or intermittent means the client does not need assistance daily, but may need
assistance a few times a month or up to two (2) times per week.
b. Supervision means verbal prompting,
cueing, and reminders to help the client if he or she needs assistance up to
two (2) times per week.
c. Stand-by
assistance means assistance or monitoring to help the client if he or she needs
physical assistance up to two (2) times per week.
3. Moderate: score two (2) if the client is
unable to perform the majority of the essential components of the function even
with an assistive device, and the client requires hands-on and frequent
assistance to accomplish the activity.
a.
Frequent means the client needs assistance at least three (3) times per week
and up to daily.
b. Hands-on
assistance means the care provider must physically assist the client in
completing the task.
4.
Severe: score three (3) if the client is totally unable to perform the function
and requires someone to perform the task, or the client requires constant
supervision for the task.
C. The need for paid care score shall be
based on the frequency of the client's unmet need for paid care and shall be
modified by the following factors:
1. Need for
paid care shall be scored as zero (0) when those services are provided through
another program, agency, or individual.
2. For clients living with others, the need
for paid care shall be scored only on the client's needs that are greater than
and differentiated from typical household routine and the typical expectation
of assistance by family members living in the home.
D. For children age five (5) through eighteen
(18) years, functional capacity and need for paid care shall be scored
according to age appropriate criteria. Children under the age of 5 shall not be
scored and are not eligible to receive Home Care Allowance.
E. The need for paid care scale is as
follows:
|
Score |
Frequency |
Definition Of Frequency |
|
0 |
None |
Client's needs are met. No need for paid care. |
|
1 |
Weekly |
Client needs paid care up to and including once a week. |
|
2 |
Daily |
Client needs paid care more than once a week and up to once a day, seven days a week. |
|
3 |
Twice Daily |
Client needs paid care two or more times per day at least five days per week. |
F.
The functional assessment shall be scored on the State Department prescribed
form, which shall list each activity of daily living, the functional capacity
score and the need for paid care score for each ADL.
3.570.15
ACTIVITIES OF DAILY
LIVING
A. Activities of daily living
(ADL) shall be scored using the functional capacity impairment scale and the
need for paid care scale.
B. The
activities of daily living are:
1. Critical
ADL
a. Transfers: the ability to move between
surfaces, such as getting in and out of bed; transferring from a bed to a
chair, wheelchair, or walker; moving from a chair or wheelchair to a walker or
to a standing position; and the ability to use assistive devices, including
prosthetics.
b. Bladder care: the
extent to which the client has control of his OR her bladder functions and the
ability of the client to accomplish the tasks of toileting, including
catheterizing, getting on and off the toilet, changing incontinence products,
and cleaning him/herself.
c. Bowel
care: the extent to which the client has control of his OR her bowel functions
and the ability of the client to accomplish the tasks of toileting, including
getting on and off the toilet, changing incontinence products, and cleaning
him/herself.
2. Basic
ADL
a. Mobility: the ability of the client to
ambulate around the home and around essential places outside the home, with or
without assistive devices.
b.
Dressing: the ability of the client to accomplish all phases of the activities
of dressing and undressing, including getting, putting on, fastening, and
taking off all items of clothing, braces, and artificial limbs.
c. Bathing: the ability of the client to
safely accomplish the task of washing body parts including getting into bathing
waters, with or without assistive devices or whether the client requires stand
by or hands-on assistance from another person.
d. Hygiene: the ability of the client to
maintain personal hygiene other than bathing, including combing hair, brushing
teeth, and clipping nails.
e.
Eating: the ability to cut food into manageable size pieces, chew, and swallow
food, with or without assistive devices.
3. Instrumental ADL
a. Meals: the ability to safely prepare food
to meet the basic nutritional requirements of the client, including cutting
food, transferring food to cooking vessels and/or dishes, utilizing utensils,
using a stove or microwave, and implementing special dietary needs. A child age
5 to 18 years shall not be scored for meals.
b. Housekeeping: the ability to maintain the
interior of the client's residence for the purpose of health and safety, such
as wiping surfaces, cleaning floors, making a bed, and cleaning dishes. A child
age 5 to 18 years shall not be scored for housekeeping.
c. Laundry: the ability to gather and wash
soiled clothing and linens; use washing machines and dryers; hang, fold, and
put away clean clothing and linens. A child age 5 to 18 years shall not be
scored for laundry.
d. Shopping:
the ability to purchase goods that are necessary for health and safety.
Activities include the ability to make needs known, to make a list, reach for
the needed items at the store, ability to estimate or determine the cost of the
item, and to move items into the home and put them away. A child age 5 to 18
years shall not be scored for shopping.
4. Supportive ADL
a. Medicine: the ability to manage
medications, including knowing the name of the medication, knowing the amount,
frequency, and how to take the medicine, understanding the reason for taking
it, and understanding possible side effects. A child age 5 to 14 years shall
not be scored for medicine.
b.
Appointment: the ability to schedule or make an appointment for essential
activities, such as doctor visits, meetings with caseworkers, and
transportation. A child age 5 to 18 years shall not be scored for
appointments.
c. Money: the ability
to manage money, such as balancing a check book, writing checks or paying a
bill electronically, and ability to understand financial decisions. A child age
5 to 18 years shall not be scored for money.
d. Access: the ability to access resources or
services in the community, such as locating the resource/service and completing
the process necessary to receive the resource or service. A child age 5 to 18
years shall not be scored for access.
e. Telephone: the ability to use the
telephone to communicate essential needs, such as answering the phone in a
reasonable time, speaking clearly and loudly enough to be understood, dialing
the phone, initiating a conversation, hearing the caller, and placing a call in
an emergency. A child age 5 to 12 years shall not be scored for
telephone.
3.570.16
CARE PLANNING AND CASE
MANAGEMENT
A. Home Care Allowance may
be used to purchase:
1. Non-skilled assistance
with activities of daily living, as defined in Section 3.570.15; and;
2. Electronic monitoring, such as an
emergency alert button; and,
3.
One-time deep cleaning if a referral is initiated by Adult Protective Services
and determined necessary by the SEP.
B. The SEP shall develop a care plan on the
State Department prescribed form within ten (10) working days after program
eligibility has been determined and prior to the arrangement for services.
1. The care plan shall be:
a. Signed by the client, SEP, and the service
provider; and,
b. Reviewed and
updated at least once every twelve months; and,
c. Reviewed sooner if there is a change in
the client's needs; and,
d.
Provided to all parties.
2. Care planning shall include, but not be
limited to, the following tasks:
a.
Identifying and documenting care plan goals and client choices.
b. Identifying and documenting services,
including type, duration and frequency.
c. Arranging for services through a service
provider, family member, or other provider of the client's choosing.
1) Providers shall be at least eighteen (18)
years of age or older and have the ability to provide appropriate
services.
2) The SEP shall
negotiate with the client and care provider to arrive at the total number of
paid care hours to be provided monthly.
3) The HCA payments shall be made directly to
the client or authorized representative who shall pay the provider the agreed
upon, authorized amount monthly.
4)
No portion of the authorized HCA amount shall be withheld by the client for
personal use. The entire HCA authorized amount shall be spent for HCA allowable
services.
d.
Coordinating service delivery, negotiating with the service provider and the
client regarding service provision, and formalizing the provider
agreement.
e. Completing program
requirements for the authorization of services.
f. Referring the client to community
resources, as needed, and attempting to develop resources for the client if a
resource is not available within the client's community.
g. Explaining the complaint procedures to the
client, as listed on the care plan document.
h. Explaining the client's right to appeal
any decision.
3. The SEP
shall meet the client's needs, with consideration of the client's choices,
using the most cost effective methods available.
a. When services are available to the client
at no cost from family, friends, volunteers, or others, these services shall be
utilized before the purchase of services, providing these services adequately
meet the client's needs.
b. When
public dollars must be used to purchase services, the SEP shall assist the
client in comparing the cost of services.
c. The SEP shall ensure there is no
duplication in services provided by any other public or privately funded
services.
d. The SEP shall discuss
with the client if other waivers and/or services are more appropriate or
beneficial to the client and assess as needed.
C. The SEP shall provide ongoing case
management, as follows:
1. Monitoring the
quality of care provided to the client.
2. Contacting service providers concerning
service coordination, effectiveness, and appropriateness.
3. Reviewing the client's assessment, care
plan, and service agreements to include changes in client functioning, service
effectiveness, appropriateness, and cost-effectiveness that may require a
reassessment or a change in the care plan.
4. Making changes in care plans as
appropriate to client needs and/or referring the client to community resources,
if appropriate.
5. Providing
conflict resolution and/or crisis intervention, as needed.
6. Identifying and contacting appropriate
individuals, and resolving any problems or complaints raised by the client or
others regarding service delivery.
7. Notifying the appropriate law enforcement
and/or child/Adult Protective Services agency of suspected abuse, neglect or
exploitation, as required by Sections 18-6.5 108,
19-3-304 and
26-3.1-102, C.R.S.
D. The SEP shall complete a review
of the client's current assessment or reassessment and the care plan with the
client six months following the assessment or reassessment.
1. The review shall be conducted by
telephone, at the client's place of residence, at the place of service, or
other appropriate setting as determined by the client's needs.
2. An in-person home visit shall be completed
when significant changes in the client's condition are identified.
E. The SEP shall complete an
in-person functional reassessment within twelve (12) months of the initial
functional assessment and every twelve months thereafter. A reassessment shall
be completed sooner if the client's condition changes.
F. Reassessment shall include the following
tasks:
1. Reviewing the care plan, service
agreement, and provider contract or agreement.
2. Evaluating service effectiveness, quality
of care, and appropriateness of services.
3. Verifying continuing financial and program
eligibility.
4. Annually, or more
often if indicated, completing a new care plan and service agreement.
5. Referring the client to community
resources, as needed; and
6.
Discussing with the client if a HCPF waiver and/or service is more appropriate
or beneficial and assess as needed.
G. The SEP shall update the information
provided at the previous assessment or reassessment, utilizing the State
Department prescribed form and the HCPF prescribed system. When a new
functional assessment is completed a copy shall be sent to the county
department within ten (10) working days of the
reassessment.
3.570.17
DENIALS, DISCONTINUATIONS, AND CASE TRANSFERS
A. The responsibility of the SEP is to
determine the functional eligibility of the client. The SEP shall deny or
discontinue the client from the HCA program if he or she is determined
functionally ineligible and provide timely or adequate notice as required by
Section 3.554 .
1. The client shall be
informed of his or her appeal rights as outlined in Section 3.587.
2. The client shall be provided appropriate
referrals to other community resources within one (1) working day of
discontinuation or denial.
3. If
the discontinuation or denial is due to functional eligibility, the SEP shall
notify the client that he or she must notify the providers on the care plan
within one (1) working day of receiving notice from the county
department.
4. If the
discontinuation or denial is due to financial eligibility, the SEP shall notify
the client that he or she must notify all providers on the care plan within one
(1) working day of receiving notice from the county department.
5. The SEP shall notify the county department
within FIVE (5) working days of discontinuation.
6. The SEP shall prepare for and defend at
the state level fair hearing any appeal related to functional denial or
discontinuation. The SEP may request assistance and/or testimony from the
county department.
B.
The responsibility of the county department is to determine the financial
eligibility of the client. The county department shall deny or discontinue the
client from the HCA program if he or she is determined financially ineligible
and provide timely or adequate notice as required by Section 3.554.
1. The client shall be informed of his or her
appeal rights as outlined in Section 3.587.
2. The client shall be provided appropriate
referrals to other community resources within one (1) working day of
discontinuation or denial.
3. The
county department shall notify the SEP within FIVE (5) working days of
discontinuation.
4. The county
department shall prepare for and defend at the state level fair hearing any
appeal related to financial denial or discontinuation. The county department
may request assistance and/or testimony from the SEP.
C. Following the notice procedures outlined
in Section 3.554, denial and/or discontinuation from the HCA program shall
occur for the following reasons:
1. Financial
and Functional Eligibility: The SEP or county department shall deny or
discontinue a client if the client is not financially eligible and/or is not
functionally eligible for HCA.
2.
Level of Care: The SEP shall deny or discontinue when the client:
a. Does not meet functional capacity score
minimum requirements; or,
b. Does
not meet need for paid care score criteria.
3. Receipt of Services: The SEP or county
department shall deny or discontinue when the client:
a. Has not received services for one
month;
b. Has twice refused to
schedule an appointment for an initial assessment, six (6)-month review, or
reassessment within a thirty (30) consecutive DAY period;
c. Has failed to keep three (3) scheduled
appointments within a thirty (30) consecutive day period;
d. Has refused to schedule an appointment for
a required visit after the client's case has been transferred to a new SEP or
county department;
e. Refuses to
use the HCA payment to pay for services or uses the payment for services not
identified in the service agreement;
f. Refuses to sign the intake form, care
plan, or other documents and forms required to receive services.
4. Facility Status: The SEP or
county department shall deny or discontinue when the client:
a. Is a resident of a nursing facility,
hospital, or any other long-term care facility; or,
b. Enters a hospital or other long-term care
facility for treatment, hospitalization, or rehabilitation that continues for
thirty (30) calendar days or more.
5. Service Limitations Related to Safety: The
SEP or county department shall deny or discontinue when the client cannot be
safely served given the type and/or amount of services available. Evidence of
safety concerns include, but are not limited to:
a. The results of an Adult Protective
Services assessment that substantiates ongoing risk.
b. A statement from the client's physician
attesting to diminished cognitive capacity, debilitating mental health
concerns, or ongoing risk.
c. Lack
of available and/or appropriate service providers.
d. A functional assessment score indicating a
level of need for services in excess of those available under the HCA
program.
e. Other available
information or evidence that will support the determination that the client's
safety is at risk.
6.
Service Limitations Related to Cost Effectiveness: The SEP or county department
shall deny or discontinue when other more cost effective alternatives are
available to meet the client's needs.
7. Living Arrangements: The SEP or county
department shall deny or discontinue when the client is residing anywhere other
than his OR her home.
a. The SEP may continue
to authorize services while a resident is on medical or non-medical
leave.
b. Combined leave shall not
exceed a total of forty-two (42) days in a twelve (12) month period beginning
with the date the client was approved for the HCA program.
8. Move Out of State: The SEP or county
department shall deny or discontinue when the client has moved out of state.
a. Discontinuation shall be effective the day
after the date of the move.
b.
Clients who leave the State on a temporary basis with the intent to return to
Colorado within thirty (30) calendar days shall not be discontinued. If the
client fails to return to Colorado the client shall be discontinued on day
thirty one (31).
9.
Voluntary Withdrawal from the Program: The SEP or county shall deny or
discontinue when the client requests withdrawal from the HCA program.
10. Death: The SEP or county shall
discontinue the HCA program effective the day after the client's date of death.
No notice of discontinuation shall be sent.
D. The SEP shall complete the following
procedures to transfer an HCA client to a new county department:
1. The SEP shall notify the county department
of the client's plans to relocate to another county and the date of
transfer.
2. If the client's
current service providers do not provide services in the area where the client
is relocating, the SEP shall make arrangements, in consultation with the
client, for new service providers.
E. The SEP shall complete the following
procedures to transfer an HCA client to a new SEP:
1. The transferring SEP shall contact the
receiving SEP by telephone or email to give notification that the client is
planning to transfer, to negotiate a transfer date, and to provide
information.
2. The transferring
SEP shall forward copies of the client's case records, including forms required
for the HCA program, to the receiving SEP prior to the relocation, if possible,
but in no case later than five (5) working days after the client's
relocation.
3. The receiving SEP
shall complete an in-person meeting with the client and an assessment and case
summary update within ten (10) working days after notification of the client's
relocation.
4. The receiving SEP
shall review the care plan and the assessment tool, revise as necessary, and
coordinate services and providers.
3.570.18
COUNTY DEPARTMENT AND SINGLE
ENTRY POINT (SEP) REQUIREMENTS AND RESPONSIBILITIES
A. The county department shall:
1. Ensure all requirements of the county
department are implemented, as appropriate for the HCA program, related to:
a. General requirements, as outlined in
Section 3.520; and,
b. Old Age
Pension, as outlined in Section 3.530; and,
c. Aid to the Needy Disabled State Only and
Colorado Supplement, as outlined in Section 3.540 and 3.546; and,
d. Financial redetermination, as outlined in
Section 3.550.
2.
Determine financial eligibility for HCA in the statewide automated system and
update any changes in the case record.
3. Notify the SEP in writing:
a. Within five (5) working days of
determining HCA eligibility.
b.
Within five (5) working days after the eligibility worker determines that the
client is no longer financially eligible for HCA.
c. Within one (1) working day when the client
has filed a written appeal with the county department.
d. Within one (1) working day when the client
has withdrawn the appeal or a final agency decision has been entered.
4. Respond to requests for
information from the SEP within ten (10) working days.
B. The SEP shall:
1. Provide intake, screening, and referral
activities, as follows:
a. Determine the
appropriateness of a referral for a client assessment.
1) If appropriate, complete intake activities
within two (2) working days of the referral.
2) Obtain the client's or client's authorized
representative's signature on the intake form.
3) Complete the HCA functional assessment
within thirty (30) calendar days of referral.
b. Provide the client information and
referral to other agencies, as needed.
2. Identify potential payment source(s),
including the availability of private funding:
a. Refer the client to the county department
to complete an application; or,
b.
Refer the client to another community resource that can assist in completing
the application; or,
c. Verify the
client's ability to private pay for services.
3. Complete a functional assessment when the
county department provides written notification that the client has requested
HCA and is receiving or has submitted an application for Old Age Pension (OAP),
Aid to the Needy Disabled Colorado Supplement (AND-CS), Aid to the Needy
Disabled State Only (AND-SO), or the client is receiving Supplemental Security
Income (SSI).
a. If the client is being
discharged from a hospital or nursing facility, the SEP shall complete the
functional assessment regardless of whether an application date for State
assistance or Medicaid has been provided by the county department.
b. The SEP shall complete the functional
assessment within two (2) working days after notification when a client is
being transferred from a hospital to the HCA program.
c. The SEP shall complete the functional
assessment within five (5) working days after notification when a client is
being transferred from a nursing facility to the HCA program.
d. The SEP shall complete the functional
assessment within ten (10) working days after notification for all other
clients. However, the SEP shall have a procedure for prioritizing urgent
referrals.
4. Document
all case information.
a. Documentation of
contacts and case management activities shall be entered into the HCPF
prescribed system within five (5) working days of the contact or
activity.
b. All information
related to intake, assessment, and care planning shall be thoroughly documented
within ten (10) working days of the intake, assessment or care planning using
State Department prescribed forms and the HCPF prescribed system.
c. Additional documentation that cannot be
entered into the HCPF prescribed system shall be maintained in the case
file.
5. Notify clients
of their program status using the State Department prescribed form at the time
of initial eligibility, when there is a significant change in the client's
payment or services, when an adverse action is taken, or at the time of
discontinuation.
6. Notify the
county department in writing:
a. Within five
(5) working days of determining HCA functional eligibility.
b. Within five (5) working days after the SEP
determines that the client is no longer functionally eligible for
HCA.
c. Within one (1) working day
when the client has filed a written appeal with the SEP.
d. Within one (1) working day when the client
has withdrawn the appeal or a final agency decision has been entered.
7. Respond to requests
for information from the county department within ten (10) working
days.
8. Notify the client, at the
time of his or her application and at the time of reassessment or
discontinuation of the right to request a state level fair hearing before an
Administrative Law Judge as outlined in Section 3.587, and to appeal adverse
actions of the SEP or county department.
9. Inform the client's Adult Protective
Services caseworker, if applicable, of the client's status. The case manager
shall participate in mutual staffing of the client's case.
10. Immediately report to the Colorado
Department of Public Health and Environment any congregate facility, with three
(3) or more residents, that is not licensed.
11. Immediately report to the county
department any information that indicates an overpayment, incorrect payment, or
misuse of any HCA benefit, and shall cooperate with the county department in
any subsequent recovery process.
12. Be subject to routine quality control,
program monitoring, and contract management to minimally include:
a. Targeted review of the HCPF prescribed
system documentation;
b. Case file
review;
c. Targeted program review
conducted via phone, email, or survey;
d. Onsite program review;
e. A performance improvement plan to correct
areas of identified non-compliance; and,
f. Contract sanctions when the SEP fails to
implement a performance improvement plan.
3.570.4
BURIAL
ASSISTANCE PROGRAM
3.570.41
PURPOSE OF PROGRAM
Burial benefits are available to eligible clients to cover reasonable and necessary costs for burial services.
3.570.42
DEFINITIONS
"Burial benefit" means the State Department program to pay all or a portion of the cost of funeral, burial, or cremation services for certain deceased clients.
"Burial funds" means the funds authorized by the county department under the burial benefit.
"Burial plot" means the client's final resting place, whether a cemetery plot, vault, or crematorium niche.
"Burial services" means those services provided as part of funeral, burial, or cremation services, including:
A. Transportation of the body from the place
of death to a funeral home or other storage facility, and/or from the funeral
home to the funeral/memorial site, and/or to the burial plot;
B. Storage of the body prior to final
disposition and/or storage of the cremated remains for no more than one hundred
twenty (120) days, in those cases where the remains are not buried and are not
claimed by the client's family or friends;
C. Embalming, where necessary for
preservation of the body and/or preparation of the body for the casket or for
cremation;
D. Purchase of a casket
or of an urn or other receptacle for the cremated remains;
E. Purchase of a gravesite, vault, vault
liner, or crematorium niche;
F.
Purchase and placement of the grave marker and/or of perpetual care of the
gravesite, vault, or crematorium niche;
G. Funeral or memorial service;
H. Cremation of the body;
I. Burial or internment of the body or
cremated remains in a burial plot, vault, or crematorium niche;
J. Any other items that are incidental to
burial services.
"Contributions" means any monetary payment or donation made directly to the service provider(s) by a non-responsible person to defray the expenses of a deceased public assistance or medical assistance recipient's funeral, cremation, or burial, or any combination thereof.
"Legally responsible person(s)" means a person who is the decedent's spouse or the decedent's parent if the decedent is an unemancipated minor who is under the age of eighteen; and bears legal responsibility for the charges associated with the decedent's funeral, cremation, or burial expenses.
"Nonresponsible person" means one of the following who makes a contribution to the charges for burial services:
A. A relative of the decedent who is not a
legally responsible person; or,
B.
Any other person or party.
3.570.43
ELIGIBILITY AND DETERMINATION
FOR BURIAL ASSISTANCE
A. A burial
benefit shall be available to cover all or part of reasonable and necessary
costs for burial services when:
1. A deceased
client was receiving Old Age Pension (OAP), Aid to the Needy Disabled (AND-SO
OR AND-CS), Home Care Allowance, and/or Colorado Medicaid assistance at the
time of death; and,
2. The deceased
client's estate is insufficient to pay all or part of the burial services;
and,
3. The resources of the
legally responsible person(s) for the support of the deceased client are
insufficient, even with contributions from the client's estate, to enable the
legally responsible person(s) to pay all or part of such expenses;
and,
4. The total cost for all
burial services does not total more than two thousand five hundred dollars
($2,500), except that the cost of a burial plot shall not be included in the
$2,500 maximum cost limit when:
a. The client
has a prepaid burial plot valued at two thousand dollars ($2,000) or less at
the time of purchase; or,
b. A
burial plot was purchased by someone other than the deceased client and donated
to the deceased client; and,
B. The total burial benefit shall not exceed
the current burial benefit rate.
1. Effective
March 1, 2020, the burial benefit shall not exceed one thousand five hundred
dollars ($1,500).
2. The
reimbursement rate shall be adjusted by the State Department as needed to stay
within the available appropriations. There shall be no appeal granted for this
adjustment.
C. When
assistance for funeral, burial, or cremation services is requested within
thirty (30) days from the date of death on behalf of a deceased client as
described in Section 3.570.43.A, by any interested party; an application
requesting a burial benefit shall be completed and submitted to the county
department for eligibility determination. Requests made after 30 days shall be
evaluated by the county department and an extension may be given if good cause
exists, not to exceed one (1) year from the date of death. Good cause shall
exist for any application filed within one year of the date of death of the
client, if the client's date of death preceded the effective date of this rule.
The client's family or friends, or the county department when there are no
known family or friends, shall make arrangements for disposition of the
client's body in a reasonable, dignified manner which approximates the wishes
and the religious and cultural preferences of the client or family, to the
extent possible within the burial benefit rules and burial grant payment funds.
1. The county department shall ensure that a
choice of disposition by the client is made in writing. The choice of
disposition may be made on the client's most recent application for benefits,
in the client's will, or by any other document which the county department
deems credible. If there are conflicting documents expressing the client's
choice of disposition, the county department shall utilize the most recent
document containing the client's choice. If the client has not expressed a
choice of disposition, the client's disposition shall be determined
respectively by the client's spouse, adult children, parents, or
siblings.
2. The county department
shall coordinate with the client's family or interested parties to explain the
burial benefit rules, including:
a. Options in
the event the client's or family's burial preferences cannot be met within the
limitations of the burial rules or burial grant payment maximum; and,
b. If the family's burial preference is in
opposition to the client's preference, as noted on the client's most recent
application for benefits or other documentation, the burial grant payment shall
be used to meet the client's preference, unless all options for meeting that
preference have been exhausted within the limitations of the burial grant
payment; and,
c. The legally
responsible person's responsibility to pay the cost of burial services that
exceed the approved burial grant payment; and,
d. That voluntary contributions from family,
friends, or other interested parties, may be used to cover some or all of the
legally responsible person's costs that exceed the approved burial grant
payment up to the maximum cost limit.
3. The county department shall use the
following procedures when the deceased client's burial preferences are unknown
and a family member cannot be located:
a. If a
family member has not been located within twenty-four hours after the client
dies, the county department shall have the body refrigerated or
embalmed.
b. If a family member has
not been located within seven (7) days, the county department shall make the
determination to bury or cremate the body based on the best option
available.
c. The county department
shall complete and send written authorization to the appropriate funeral home
or crematorium.
D. The county department shall reduce the
burial grant payment by applying the following monies toward the full burial
costs in the order listed:
1. First, subtract
monies due from any insurance policy of the deceased client to a legally
responsible person or any other person who makes a contribution to burial
services and is named as beneficiary or a joint beneficiary; then if costs
remain,
2. Subtract the value of
the deceased client's estate as of the date of death that are available,
including any cash or property of any kind which the deceased client owned or
proportionate share of resources held in joint ownership at the time of death;
then if costs remain,
3. Subtract
monies from the legally responsible person(s) for the client, as follows:
a. Social Security lump sum death benefits
payable to a legally responsible person shall be exempt.
b. If the legally responsible person(s) has
resources below the SSI resource limit of $2,000 for an individual or $3,000
for a couple any resources would not be used to reduce the burial grant
payment. These limits are consistent with the provisions of Federal Regulations
found at 20 CFR
416.1205 (2019), which are herein
incorporated by reference. This rule does not contain any later amendments or
editions. These regulations are available for no cost at
https://www.ecfr.gov/. These
regulations are also available for public inspection and copying at the
Colorado Department of Human Services, Director of the Employment and Benefits
Division, 1575 Sherman Street, Denver, Colorado, 80203, or at any State
publications library during regular business hours.
1) If the legally responsible person is the
widow(er), the individual resource limit shall apply.
2) The legally responsible person(s) may
voluntarily contribute monies toward the cost of the burial services.
c. If the legally responsible
person(s) has resources over the SSI limit, the amount of resources over the
limit shall be used to reduce the burial grant payment; then if costs
remain,
4. The county
department shall issue a written authorization for the amount of the burial
grant payment, up to the burial grant payment limit, as set forth in Section
3.570.43.B.1.
E. Once
the application and choice of burial services is determined, the family or
county department shall contact the appropriate provider(s) to obtain a written
estimate of the provider's proposed charges for burial services. If more than
one provider is involved, a separate written estimate from each provider shall
be obtained.
F. Once the
proposal(s) from the provider(s) is received, the county department shall
determine if a burial grant payment is appropriate.
1. If the combined charges from the
provider(s) exceed two thousand five hundred dollars ($2,500), no burial grant
payment shall be paid.
2. The
county department shall allow the provider(s) to resubmit a written estimate
within ten (10) calendar days of notification that the charges exceeded the
burial grant payment maximum.
G. All payments from a decedent's estate,
payments from legally responsible persons, and contributions from any other
person persons who make a contribution to burial services shall be paid
directly to the provider(s) of services. After the provision of all services,
the providers shall bill the county department directly for reimbursement for
appropriate costs that have not been covered by the resources from or
contributions made by the decedent's estate, legally responsible persons, or
any other person persons who make a contribution to burial services. The county
department shall reimburse the appropriate providers directly, based upon the
statement of agreement.
H. The
county department of residence of the deceased client shall authorize the
approved burial grant payment through the statewide automated system. The
burial grant payment shall be paid directly to the provider(s). The burial
application must be processed as soon as possible but no later than thirty (30)
days from submission.
I. The county
department shall have a statement of agreement between the providers, which
ensures that the distribution of burial grant payment is proportional to burial
services provided or as the providers otherwise determine. The agreement shall
be signed by all provider(s) and shall be approved and signed by the county
department before the burial grant payment is authorized in the statewide
automated system.
J. The county
department will seek recovery of resources if:
1. The resource was reported to the funeral
director after the deadline date, and the funeral director does not collect
from them.
2. The resource becomes
available only after the county department has paid for burial
services.
3.570.5
SUPPORTIVE PAYMENTS (Effective
7/1/2022)
3.570.51
PURPOSE
A. The purpose of the disaster assistance
payment is to provide disaster assistance to eligible clients to mitigate needs
and/or expenses due to a county, Governor, or federally declared disaster. The
payment shall not exceed two thousand dollars ($2,000) per client, per
disaster.
B. The disaster
assistance payment period begins when :
1. A
county, and/or;
2. Governor,
and/or;
3. Federal government
declares a disaster.
C.
The disaster assistance payment period ends when there is no longer:
1. A county, and/or;
2. Governor, and/or;
3. Federally declared disaster.
D. In cases where the effects of
the disaster appear after the disaster declaration has been rescinded, the
client may petition for disaster assistance which may be granted at the county
director's or director designee's discretion.
3.570.52
ELIGIBILITY
In order to be eligible for disaster assistance, the client must:
A. Be approved for or receiving
a grant payment during the time of the county, Governor, or federally declared
disaster.
B. Have an emergent need
related to the disaster that could include, but is not limited to: a threat to
health or safety, lack of food, clothing, shelter, transportation, personal
care or medical care, or other unmet expenses.
C. Request disaster assistance either
verbally or in writing to the county department. Counties have the option to
utilize a state prescribed form for a disaster assistance request.
D. Nothing precludes the county from making
additional payments to the client for the disaster through a general assistance
program or other resources. This payment shall also not preclude an individual
from accessing additional resources that are unrelated to the
disaster.
3.750.53
COUNTY DEPARTMENT RESPONSIBILITIES
When the county receives the disaster assistance request they shall:
A. Review the disaster
assistance request and determine what the client may potentially be eligible
for based on the request.
B. Only
request verification related to the client's request for disaster assistance if
the county considers the request questionable.
C. Assess the client's needs related to the
disaster assistance request and make additional referrals to the client and
inform them of other potential assistance that may be available.
D. Not request documentation to verify how
the client has used their disaster assistance payment.
E. Make a determination of eligibility for
disaster assistance the same day as the determination of eligibility for adult
financial grant payment if the client is pending for adult financial assistance
at the time of the request for disaster assistance.
F. Make a determination of disaster
assistance eligibility within five business days if already active on adult
financial assistance.
G. Notify the
client of approval or denial of disaster assistance in writing through the
statewide automated system.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.