Tracking #2013-xxxxx
Emergency 2/1/13, eff. 2/1/13

I:/12120501.rtf
(I:/12120501.doc) 

(9 CCR 2503-7)

[Note: Statement of Basis and Purpose has been incorporated with Tracking# 2012-01069 (#12-12-3-2).] 

***********************

[Instructions: replace lines 2325940 through 2325971.] 
3.720  HOME CARE ALLOWANCE [Rev. eff. 2/1/13] 
Home Care Allowance (HCA) is a special allowance for the purpose of securing services to an individual in his/her home, based on the case manager's assessment. Home Care Allowance is a non-entitlement program, which cannot be combined with other long-term care programs such as a Home and Community Based Services Medicaid waiver or adult foster care. The HCA program is designed to serve those recipients with the lowest functional abilities and the greatest need for paid care. Eligibility for, and authorized amounts of, the Home Care Allowance are subject to available appropriations. 
3.720.1  SINGLE ENTRY POINT AGENCIES [Rev. eff. 2/1/13] 
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.
3.720.2  ELIGIBILITY [Rev. eff. 2/1/13]
Eligibility for the Home Care Allowance program shall be based on both financial need and the applicant's or recipient's functional needs. The client shall meet eligibility for both financial and functional requirements to be approved for a Home Care Allowance payment. 
A.  To be financially eligible, the applicant or recipient shall: 
1.  Meet all eligibility criteria required for either the Old Age Pension (OAP) or Aid to the Needy Disabled/Aid to the Blind-State Only (AND/AB-SO) program; or,
2.  Be approved for Supplemental Security Income (SSI) benefits and be receiving at least a $1.00 SSI payment.
B.  To be functionally eligible, the applicant or recipient (client) shall have an HCA eligible functional assessment score as outlined in Section 3.720.3. 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 applicant’s or recipient’s ability to complete all Activities of Daily Living (ADLs) and applying a score to their ability to complete the ADLs using the functional impairment scale, as outlined in Section 3.720.3; 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 3.720.3; and, 
3.  Combining the functional capacity score, as referenced in Section 3.720, B, 1, and the need for paid care score, as referenced in Section 3.720, B, 2, to determine whether the client meets the minimum scores for eligibility and, if eligible, the tier of benefits to be approved, as follows: 

TIER	CAPACITY SCORE	CARE SCORE	
	
1	21 or Higher		1 to 23	
	
2	21 or Higher		24 to 37 	
	
3	21 or Higher		38 to 51 	

C.  The case manager shall not approve the maximum authorized HCA amount for the tier if the applicant's or recipient's needs can be fully or partially met through other paid or unpaid sources, if the HCA provider is able to provide the authorized services for less than the maximum authorized amount, or if the applicant or recipient is unwilling or unable to use the maximum authorized amount. In determining the authorized HCA amount, the case manager shall ensure that there is no duplication of services in accordance with Section 3.721.23, D, 4. 
3.720.3  FUNCTIONAL ASSESSMENT SCORING [Rev. eff. 2/1/13] 
A.  The need for skilled personal care shall not be included in the scoring of the functional capacity or need for paid care. Skilled personal care is not a paid service of the Home Care Allowance program (see HCPF rules, Section 8.489.30 (10 CCR 2505-10) for the definition of skilled personal care).
B.  In order to be eligible for the Home Care Allowance Program, each client (applicant or recipient) shall score a minimum of twenty one (21) points when assessed for the ability to complete the Activities of Daily Living (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 is able to perform all essential components of the function, but impairment of function exists even with an assistive device. The client requires occasional or intermittent supervision or physical assistance in a limited number of the components of the activity. 
a.  Occasional or intermittent means the client does not need assistance daily, but may need assistance a few times a month or up to one to two (1-2) times per week. 
b.  Supervision or assistance means verbal prompting, cueing, and reminders, and means stand-by assistance or monitoring to help the client if he/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 to four (3-4) 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. 
3.  For clients approved for Special Populations Home Care Allowance, as defined at Section 3.740, the need for paid care shall be scored only on the client’s needs that are greater than and differentiated from services received through the Medicaid Home and Community Based Services Supportive Living Services (HCBS-SLS) or Children’s Extensive Support (HCBS-CES) waiver.
4.  For children age zero (0) through five (5) years, functional capacity and need for paid care shall be scored according to the following age appropriate criteria: 
a.  Bladder and bowel care: a child age 0 to 36 months shall not be scored for bowel and bladder incontinence.
b.  Mobility: a child age 0 to 36 months shall not be scored for mobility, including positioning.
c.  Dressing: a child age 0 to 60 months shall not be scored for dressing.
d.  Bathing and hygiene: a child 0 to 60 months shall not be scored for bathing and hygiene.
e.  Eating: a child 0 to 48 months shall not be scored for eating.
f.  Transfers: a child 0 to 48 months shall not be scored for any transfers. A child 0 to 60 months shall not be scored for car seat, highchair, or crib transfers.
D.  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.	

E.  The functional assessment shall be scored on the State-prescribed form, which shall list each activity of daily living, the functional capacity score and the need for paid care score for each ADL. 
3.720.31  Activities of Daily Living [Rev. eff. 2/1/13] 
A.  Activities of Daily Living (ADLs) shall be scored using the functional capacity impairment scale outlined in Section 3.720.3, B, and the need for paid care scale outlined in Section 3.720.3, C and D. 
B.  The Activities of Daily Living are: 
1.  Critical ADLs: 
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/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/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 ADLs: 
a.  Mobility: the ability of the client to ambulate around the home and around essential places outside the home, and the ability to change positions while seated or laying down, 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, clipping nails, and shaving.
e.  Eating: the ability to cut food into manageable size pieces, chew, and swallow food, with or without assistive devices.
3.  Instrumental Activities of Daily Living (IADLs)
a.  Meals: the ability to safely prepare food to meet the basic nutritional requirements of the individual, including cutting food, transferring food to cooking vessels and/or dishes, utilizing utensils, using a stove or microwave, and implementing special dietary needs.
B.  Housekeeping: the ability to maintain the interior of the individual’s residence for the purpose of health and safety, such as wiping surfaces, cleaning floors, making a bed, and cleaning dishes.
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.
D.  Shopping: the ability to purchase goods that are necessary for health and safety. Activities include 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. 
4.  Supportive ADLs 
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.
b.  Appointment: the ability to schedule or make an appointment for essential activities, such as doctor visits, meetings with caseworkers, and transportation.
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.
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.
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. 
3.720.32  Home Care Allowance Authorized Payment Amount [Rev. eff. 2/1/13]
A.  The maximum HCA authorized grant amount for each tier is established by the Colorado Department of Human Services. 
1.  HCA payments shall be adjusted by the Colorado Department of Human Services to stay within available appropriations. 
2.  A county conference or state appeal shall not be granted when HCA payments have been adjusted to stay within available appropriations. 
B.  Each client (applicant or recipient), who meets the minimum scoring requirements for the HCA program and other program requirements as defined in Sections 3.720 or 3.740 shall be functionally eligible for a Home Care Allowance (HCA) or Special Populations Home Care Allowance (SP-HCA) grant. 
1.  The authorization by the Single Entry Point 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, as per Section 3.720.2.
3.  Clients shall not be approved for HCA if functionally ineligible, even if the client is financially eligible, as per Section 3.720.2. 
C.  If financially and functionally eligible for HCA, payment of the Home Care Allowance authorized grant will begin on the first day of the month following the month in which the HCA is approved.
D.  There shall be no retroactive Home Care Allowance payments. The hardship exceptions at Section 3.140.173 shall not apply to Home Care Allowance grant payments.
E.  The Home Care Allowance recipient's grant standard for OAP or AND/AB-SO will increase based on the authorized HCA amount per Section 3.360.44 of the Old Age Pension rules, and Section 3.460.13 of the State AND/AB rules.
F.  The HCA amount determined by the need for paid care score shall be authorized for an SSI recipient receiving at least a $1.00 payment. For persons approved for SSI but not receiving at least a $1.00 payment, the HCA grant standard for Aid to the Needy Disabled/Aid to the Blind-Colorado Supplement (AND/AB-CS) will be increased based upon the authorized HCA amount per Section 3.460.45 of the AND/AB-CS rules.

********************

[Instructions: replace lines 2326028 through 2326054.] 
3.721.22  SEP Functional Assessment Responsibilities [Rev. eff. 2/1/13]
A.  The Single Entry Point (SEP) case manager shall complete an assessment when the county department of social/human services provides written notification that the client has requested HCA or AFC and is receiving or has submitted an application for OAP, State AND/AB, AND/AB/SSI-CS, or the client is receiving SSI. If the client is being discharged from a hospital or nursing facility, the Single Entry Point case manager shall complete the assessment regardless of whether the Medicaid application date has been provided by the county department.
B.  The SEP case manager shall complete an assessment within the following time frames: 
1.  For a client who is being transferred from a hospital to the Home Care Allowance or Adult Foster Care program, the SEP case manager shall complete the evaluation within two (2) working days after notification.
2.  For a client who is being transferred from a nursing facility to the Home Care Allowance or Adult Foster Care program, the SEP case manager shall complete the evaluation within five (5) working days after notification.
3.  For an individual who is not being discharged from a hospital or a nursing facility, the client evaluation shall be completed within ten (10) working days.
C.  The SEP case manager shall conduct the following activities for a client assessment: 
1.  Determine the client's Functional Capacity assessment score during an evaluation, with observation of the client and family, if appropriate, in his or her residential setting on the State Department prescribed assessment tool, using the scoring system outlined in Section 3.720.3; 
2.  Determine the ability and appropriateness of the client's caregiver(s) who must be at least eighteen (18) years of age or older to provide the client assistance in activities of daily living;
3.  Determine the client's service needs, taking into consideration services available, or already being received, from all funding sources;
4.  If an out-of-home placement is required, review placement options based on the client's needs, the potential funding sources, and the availability of resources;
5.  Maintain appropriate documentation of the authorization for Home Care Allowance or Adult Foster Care program eligibility;
6.  Refer the client to alternative services, if the client does not meet the eligibility requirements for Home Care Allowance or Adult Foster Care programs administered by the Department;
7.  The State prescribed assessment form and the Appropriateness of Placement form shall be completed to determine eligibility for the Adult Foster Care program.
a.  The assessment shall indicate whether there is a minimal need for care. A specific functional or need for paid care score is not required.
b.  An applicant that meets one or more of the criteria on the Appropriateness of Placement form is ineligible for the AFC program, regardless of the need for care.
8.  Obtain diagnoses from the client's medical provider for Adult Foster Care program applicants.
9.  If found eligible for AFC, the recipient must be placed in an appropriate AFC facility within forty-five (45) calendar days. If the date of placement will not occur within the forty-five day period, the case manager must complete a new assessment, using the Appropriateness of Placement form.

********************

[Instructions: replace lines 2326393 through 2326429.] 
3.744  FUNCTIONAL ASSESSMENT, CARE PLAN, AND PROVIDER AGREEMENT [Rev. eff. 2/1/13]
A.  The Single Entry Point (SEP) agency shall complete a functional assessment for each client as follows:
1.  Upon referral by the State Department to determine initial eligibility for the SP-HCA program; or,
2.  Immediately whenever the SEP, during ordinary case management services and in his/her professional opinion, identifies a significant change in the client’s ability to perform activities of daily living; or,
3.  Immediately whenever the client or authorized representative reports a significant change in the client’s ability to perform activities of daily living; or,
4.  Annually, at a minimum, the annual functional assessment shall be completed no earlier than forty five (45) calendar days prior to and no later than the client’s reassessment due date. The assessment shall include, but may not be limited to:
a.  A new functional assessment during a face-to-face visit at the client's place of residence;
b.  Evaluation of the appropriateness of services, service effectiveness, and quality of care over the past year; and,
c.  Completion of an updated care plan and provider agreement.
B.  The functional assessment shall determine the client’s functional eligibility and shall be completed using the same process and scoring guidelines as for the Home Care Allowance program, as outlined in Section 3.720.2, B, Section 3.720.3, and Section 3.720.31, A through E. 
1.  The need for paid care shall be scored only for needs that are greater than and differentiated from: 
a.  Normal household routine and the normal expectation of assistance by family members living in the home; and, 
b.  Services received through the Home and Community Based Services Supportive Living Services (HCBS-SLS) or Children’s Extensive Support (HCBS-CES) waiver. 
2.  The grant standards shall equal the grant standards for the Home Care Allowance (HCA) program.
a.  The SP-HCA program shall be managed within available appropriations and the SP-HCA grant may be reduced below the HCA grant level if necessary to stay within the appropriation. No appeal shall be granted if grants are reduced to stay within available appropriations. 
b.  The SP-HCA grant is not taxable income to the client.
c.  The payment made to the care provider using the SP-HCA grant received by the client is income to the care provider and subject to taxation under State and Federal laws. 
=== 
******************