Tracking#2008-00722
FA/P 9/5/08, eff. 11/1/08

I:/08052701.rtf
[I:/08052701.doc]

(9 CCR 2503-1)

[Instructional note:  statement of basis and purpose was incorporated w/Tracking #2008-00725 (#08-7-1-2).]

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3.720.21  Single Entry Point Agencies [Rev. eff.  11/1/08] 
Single Entry Point (SEP) agencies shall utilize the State prescribed form to determine Home Care Allowance (HCA) eligibility and authorized amounts for all applicants and recipients. 

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3.720.42  Assessment [Rev. eff. 11/1/08] 
Refer to HCPF rules, Section 8.393.21 and 8.393.22 (10 CCR 2505-10), for SEP assessment procedures. The SEP case manager shall utilize the State approved form to complete an assessment. 
3.720.43  Care Planning [Rev. eff. 11/1/08]
If the applicant or recipient is found eligible for the Home Care Allowance program, the case manager shall work with the applicant or recipient or the designated representative to develop a care plan.   Eff  01/01/2007
A.  The applicant or recipient may select any person(s), 18 years of age or over, to provide services to be paid for with the Home Care Allowance. The case manager shall make a face-to-face assessment of each care provider's ability and willingness to provide the services, using the guidelines included in the Uniform Long Term Care Assessment   Instrument instructions.   Eff  01/01/2007
B.  The case manager shall negotiate with the applicant or recipient and care provider(s) to arrive at the total number of paid hours to be provided monthly. The applicant or recipient or designated representative and the provider shall sign the State prescribed provider agreement. Each shall receive a copy of the agreement. 
C.  In all cases, Home Care Allowance payments shall be made directly to the recipient or designated representative. The recipient or representative is responsible for paying the designated provider(s) the authorized amount on a regular monthly basis. No portion of the Home Care Allowance may be withheld for the recipient's personal use. The full HCA payment, including the recipient's contribution, if applicable, must be spent for HCA services each month.   Eff  01/01/2007
D.  The case manager shall explain that the recipient is responsible to pay each care provider on a monthly basis for the services provided.   Eff  01/01/2007
E.  With the recipient's agreement per the release of information form, a copy of the provider agreement shall be sent to each care provider specifying the services to be provided, total hours per month, and agreed upon monthly provider reimbursement.   Eff  01/01/2007
F.  After supervisory review and sign-off, the case manager shall send a signed copy of the assessment instrument to the county eligibility worker authorizing payment of the Home Care Allowance. 
3.720.44  Services for HCA Recipients [Rev. eff. 11/1/08] 
A.  Services include: 
1.  The areas listed in Section 3.720.31; 
2.  Electronic monitoring; and, 
3.  One-time deep cleaning if referral is initiated by Adult Protective Services and determined necessary by the Single Entry Point case manager. 
B.  Services shall be monitored in accordance with HCPF rules, Section 8.393.24 (10 CCR 2505-10); and, 
C.  Single Entry Point agency staff shall complete the reassessment in accordance with HCPF rules, Section 8.393.25 (10 CCR 2505-10). 
3.720.45  Notice of Action and Appeal Rights [Rev. eff. 11/1/08]
Home Care Allowance applicants and recipients shall be notified of their eligibility status including initial approval, denial, discontinuation, or changes to the authorized Home Care Allowance amount according to the procedures located in HCPF rules, Section 8.393.27 and 8.393.28 (10 CCR 2505-10).   Eff  01/01/2007
3.720.5  COUNTY RESPONSIBILITIES [Rev. eff. 11/1/08]
A.  The county department must retain a copy of the State prescribed assessment form in the physical case record. 
B.  The county department must review each State prescribed form for completion.   Eff  01/01/2007
C.  The county department must update any changes in the case record. These changes must be updated in the current computer system and documented in the physical case record.   Eff  01/01/2007
D.  The county shall have the case organized and available for State review.   Eff  01/01/2007
3.730  ADULT FOSTER CARE [Rev. eff. 11/1/08]
“Adult Foster Care (AFC)” means care provided on a 24-hour basis for no more than sixteen (16) residents in a non-medical facility. The facility is licensed by the Department of Public Health and Environment. This program serves the frail elderly, physically or emotionally disabled adults, 18 years of age and over, who do not require 24-hour medical care. 
3.730.1  DEFINITIONS [Rev. eff. 11/1/08]
A.  "Adult Foster Care Facility" means a licensed Assisted Living Residence (ALR) that meets all applicable federal, state, and local laws and regulations. AFC facilities shall provide the following: 
1.  Twenty-four hour residential care for no more than 16 residents;.   Eff  01/01/2007
2.  An environment which is sanitary and safe from physical harm;   Eff  01/01/2007
3.  Adequate sleeping and living areas; and,   Eff  01/01/2007
4.  Adequate recreational areas.   Eff  01/01/2007
B.  "Adult Foster Care Services" means those services which shall be provided by an AFC facility to each resident. These services shall include, but are not limited to: 
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3.730.21  Financial Eligibility  [Rev. eff. 11/1/08]
The county department eligibility worker in the recipient's county of residence shall determine financial eligibility for Adult Foster Care. In determining financial need, the applicant's or the recipient's total countable income is subtracted from the AFC grant amount to derive the net payment to the applicant or recipient. 
A.  In addition to the needs of the individual, an Adult Foster Care allowance shall be included in the grant of an AND/AB/SSI-CS or OAP recipient when:   Eff  01/01/2007
1.  The need for such care has been determined by the Single Entry Point agency;   Eff  01/01/2007
2.  The care is authorized by the Single Entry Point agency; and, Eff  01/01/2007
3.  The applicant or recipient is or will be residing in a currently licensed Adult Foster Care facility. 
B.  The maximum amount which can be allowed as Adult Foster Care is the difference between the AND/AB/SSI-CS or OAP standard and the State approved Adult Foster Care   rate plus $50 personal needs allowance.   Eff  01/01/2007
C.  The AFC payment to providers may be adjusted by the State Department to stay within available appropriations. 
3.730.22  County Responsibilities [Rev. eff. 11/1/08]
A.  The county department must retain a copy of the State prescribed assessment form in the physical case record. 
B.  The county department must review each State prescribed form.   Eff  01/01/2007
C.  The county department must update any changes in the case record. These changes must be updated in the current computer system and documented in the physical case record.   Eff  01/01/2007
D.  The county department shall have the case organized and available for State review.   Eff  01/01/2007
3.730.3  FUNCTIONAL ASSESSMENT [Rev. eff. 11/1/08]
A.  Single Entry Point agencies shall utilize the State prescribed assessment form developed by the State to determine functional capacity and need for paid care. Along with the State prescribed form, the functional eligibility of the applicant or recipient for AFC placement shall be determined using the Appropriateness of Placement form. 
B.  The State prescribed form and the Appropriateness of Placement criteria shall be completed on an annual basis or more frequently if there are changes in the recipient's circumstances. 
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3.730.42  Assessment [Rev. eff. 11/1/08]
Refer to HCPF rules, Section 8.393.21 and 8.393.22 (10 CCR 2505-10) for SEP assessment procedures.   Eff  01/01/2007
A.  After the State prescribed assessment form and the Appropriateness of Placement forms have been completed by the case manager, the information from these forms shall be used in determining if the applicant or recipient is functionally eligible for Adult Foster Care. 
B.  If determined functionally eligible, the recipient cannot be placed and the AFC payment cannot begin until an appropriate AFC facility is found.   Eff  01/01/2007
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3.730.5  CARE PLANNING [Rev. eff. 11/1/08]
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E.  Have a current provider agreement signed by the manager of the Adult Foster Care facility prior to placement. This agreement shall be renewed at least annually, contingent upon the facility having a license as an Assisted Living Residence. 
F.  After supervisory review and sign-off, the case manager shall send a signed copy of the State prescribed form to the county eligibility worker authorizing the Adult Foster Care payment. 
G.  In all cases, Adult Foster Care payments shall be made directly to the recipient or the recipient's designated representative. The recipient or representative is responsible for paying the AFC provider the agreed amount on a regular monthly basis.   Eff  01/01/2007
H.  The case manager shall explain that the recipient or recipient's designated representative is responsible to pay the AFC provider on a monthly basis.   Eff  01/01/2007
I.  An appropriateness of placement form must be completed when the recipient has been determined to be financially and functionally eligible for AFC. The Adult Foster Care payment effective date shall be the date that the applicant was admitted to the AFC facility or the date they are determined to be financially eligible, whichever is later. The date on the Appropriateness of Placement form shall not exceed a period longer than forty-five (45) calendar days prior to the recipient's placement in an AFC Facility. If the date is past the forty-five day period, the case manager must reassess the recipient, make needed changes on the form, enter the date of the new assessment, and re-sign the form. 
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3.736  PROVIDER AGREEMENT [Rev. eff. 11/1/08]
A.  Providers who are currently licensed by the Colorado Department of Public Health and Environment as an Assisted Living Residence may enter into a provider agreement with the Colorado Department of Human Services or its designee. 
B.  Facilities shall not accept Adult Foster Care payments from AFC recipients unless the facility is currently licensed as an Assisted Living Residence and has signed a provider agreement with the Colorado Department of Human Services or its designee. 
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3.738  REIMBURSEMENT METHOD FOR ADULT FOSTER CARE [Rev. eff. 11/1/08]
A.  AFC facilities shall negotiate a standard rate of payment per resident, per month with the agency designated by the State. 
B.  AFC facilities shall not submit bills or otherwise attempt to collect payments from recipients or recipients' estates for any services provided to the recipient which are benefits reimbursable under the program in accordance with the rules of the Colorado Department of Human Services.   Eff  01/01/2007
C.  AFC facilities shall charge private pay residents an amount at least equal to that charged to AFC residents.   Eff  01/01/2007
D.  Adult Foster Care payments shall not be made to residents in facilities that are not licensed by the Colorado Department of Public Health and Environment. 
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