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The Department of Human Services and the Department of Health
Care Policy and Finance oversee Medicaid services for residents
with developmental disabilities. These agencies must ensure that
the waiver meets the needs and supports of those individuals
being served, and that the services comply with federal Medicaid
regulations.
During FY2003-04, the federal Centers for Medicare and Medicaid
Services (CMS) reviewed Colorado’s home and community based
services Medicaid waivers for persons with developmental
disabilities. The final report on the Comprehensive Waiver
program was issued in April 2004 and a renewal of the waiver was
approved September 24, 2004. The renewal was conditioned on
various changes, including (1) removal of certain program costs
from the Waiver program and their transition to the Medicaid
State Plan and (2) steps to increase financial oversight and
accountability for the program, including steps to “unbundled”
services and costs in the comprehensive waiver program.
In FY2004-05, Colorado unbundled the collection of service
encounter data and differentiated costs through Community
Centered Board (CCB) audits, but the billings were still
bundled. In addition, the CCBs continued to negotiate rates as
the Organized Health Care Delivery System (OHCDS). CMS has since
stated that: billings must be unbundled, all providers must have
the choice to bill directly or to use CCBs as the OHCDS, and
that there must be a uniform rate setting methodology.
The State is implementing several changes for July 2006 to
address these issues with the Comprehensive Services Waiver
including (1) detailed billings that unbundled services, (2)
notification of all providers of their option to become Medicaid
providers and to bill directly, and (3) a short-term plan for
uniform rates.
FY2006-07 will be a time of full transition to the adjustments
required. The transition will entail creation of a long-term
uniform rate setting methodology that relies, in part, on the
use of an intensity tool that will assist in identifying each
individual’s level of need for support. Extensive training will
be required for all system players in order for transitional
issues to be addressed and for changes in administrative
functions to be fully implemented.
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