1. Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing 1 CCT & MDS 3.0 Section Q Return to the Community Overview

2. Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing Improving health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources Our Mission: 2

3. Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing 3 INTRODUCTION TO CCT

4. Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing Overview  Colorado’s Money Follows the Person (MFP) initiative, CCT, facilitates transition of people from Long-Term Care (LTC) facilities to community living  $22M grant for 5 years from Centers for Medicare and Medicaid Services (CMS) 4

5. Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing 5 A LITTLE MFP HISTORY MFP born of Supreme Court’s landmark decision Olmstead v. L.C, 527 U.S. 581 in 1999 Authorized in Deficit Reduction Act of 2005Expanded through the Affordable Care Act

6. Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing 6 CMS GOALS FOR CCT Increase use of HCBS services Decrease use of institutionally-based services Eliminate barriers to client’s choices for community living Ensure continuous quality assurance

7. Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing 7 COLORADO’S GOALS FOR CCT Transition 490 people by 2016 Increase investments in HCBS Increase housing options Expand consumer direction Streamline access to LTSS Expand array of LTSS

8. Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing 8 FUNDING & REFORM For every $1 spent on CCT Waivers Colorado receives an increased federal match of $0.75 $0.25 of that federal match is set aside for a rebalancing fund and will be used to reform LTSS in Colorado

9. Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing CCT ELIGIBILITY REQUIREMENTS Must meet long-term care Medicaid eligibility requirements Currently residing in long-term care facility (for a minimum 90 consecutive days) Must move into qualified housing

10. Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing QUALIFIED HOUSING Home owned or leased by individual or individual's family member Residence in community-based setting with no more than four unrelated individuals Living, sleeping, bathing & cooking areas Lockable access and egress Services not condition of tenancy Living, sleeping, bathing & cooking areas Lockable access and egress Services not condition of tenancy Apartment with individual lease

11. Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing CCT DEMONSTRATION SERVICES Assistive Technology, Extended Caregiver Education Community Transition Services Dental Services Enhanced Nursing Home Delivered Meals Home Modifications, Extended Independent Living Skills Training Intensive Case Management Peer Mentorship Substance Abuse Counseling, Transitional Transitional Behavioral Health Supports Transitional Specialized Day Rehabilitation Vision Services

12. Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing Persons with brain injury Community mental health supports Persons who are elderly, blind, & disabled Supported living services Person with developmental disabilities QUALIFIED HCBS WAIVERS

13. Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing CCT ELIGIBILITY SPAN 365 days of CCT Services 365 days of CCT Services HCBS Waiver Services State Plan Benefits Client in facility; Medicaid begins Transition to community 365 days post transition

14. Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing I. Referral & Options Counseling II. 1 st TC Meeting with Client – Collaboration with Nursing Facility III. Development of Transition Assessment, Risk Mitigation & Emergency Back-Up IV. Transition Planning & Service Brokering V. Discharge Planning and Moving Day VI. Post Discharge 6 STEP TRANSITION PROCESS

15. Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing 15 REFERRALS Not all referrals will result in a transition Same procedure is followed for all types of referrals The resident Nursing Facility social worker Family and/or friends Minimum Data Set, Section Q (MDS Q) Ombudsmen The resident Nursing Facility social worker Family and/or friends Minimum Data Set, Section Q (MDS Q) Ombudsmen Referrals for transition services can come from any source:

16. Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing 16 LOCAL CONTACT AGENCIES Meet with resident Provide community options information Consult Nursing Facility staff Make referral to transition coordination agency

17. Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing STATE MEDICAID AGENCY (HCPF) RESPONSIBILITES 17 Communicate with Local Contact Agencies Monitor MDS referrals Track outcomes Develop protocols & procedures Provide technical assistance

18. Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing Contact Information Kathy Cebuhar, MA, LPC Colorado Choice Transitions Community Liaison Kathy.Cebuhar@state.co.us 303-866-4065 (FAX) 303-866-2786 18