Case Management Redesign

Conflict Free Case Management (CFCM)/Case Management Redesign (CMRD)

Background Information

In 2014, a Federal Rule passed called the Home and Community Based Services (HCBS) Final Settings Rule that said an agency receiving Medicaid funding and providing both Case Management Services and Direct Services can no longer provide both services to the same person. The potential conflict is because Case Management authorizes services, there is the potential for Case Managers to only “authorize” or refer people/families to their own direct service programs. For Colorado to continue receiving Medicaid funding and to come into compliance with the Federal Rule, Colorado passed House Bill (HB) 21-1187.

Envision is a Community Centered Board/Case Management Agency (CMA) that is subject to Colorado House Bill 21-1187. This bill requires that all CMAs in the state be conflict-free, meaning that they cannot provide case management services to individuals who are also receiving services from the agency that employs them. Additionally, the agency who is going to be the CMA must be willing to provide Case Management Services to all 10 Medicaid Waiver programs. As a result, people receiving case management services from Envision will be transitioning to the new CMA for Weld County, The Area Agency on Aging (AAA), with Weld County Department of Human Services.

Envision will be the CMA through 2/29/2024. The Area Agency on Aging will be the CMA beginning 3/1/2024.

Envision will continue to be the Early Intervention Service Coordination Agency (birth-3 years old), and will also continue to provide and expand direct services: Residential, Family Care Giver, Day Program Services (including the Art Program), Competitive/Integrated Supported Employment, and the Summer Camp Respite Program.

Transition Plan

The CMA Change Management and Transition Template is designed to help you identify critical aspects of change your agency will need to navigate as part of the Colorado Case Management Redesign (CMRD).

View Transition Plan Template

Change Management Plan

The goals of this change management plan are to:

• Ensure a smooth transition for people and families receiving services from Envision to the AAA.
• Mitigate any disruption to services.
• Build trust and confidence with people and families receiving services.

The following key strategies will be used to achieve the goals of the change management plan:

• Communication: Envision and the AAA will communicate regularly with people and families receiving services to keep them informed about the transition. This communication will include information about the new case management agency, the services that will be provided, and how to contact the AAA. All written materials will be approved by Health Care Policy and Financing (HCPF) prior to distribution.
• Education: Envision and the AAA will provide education and training to people and families receiving services about the transition. This education will help people and families understand the changes that are taking place and how they will be affected.
• Support: Envision and the AAA will provide support to people and families receiving services during the transition. This support may include helping people and families find new case managers, connecting them with resources, and answering their questions.

The transition from Envision to the AAA will take place over a period of several months. The
following is a timeline of the key milestones:

July-August 2023

Envision and the AAA will develop a communication plan for people/families currently receiving case management services from Envision, PASAs, employees, and vendors
Envision and the AAA will work together to share policies, procedures, processes and provide training by Envision staff to AAA staff on our case management waiver and State General Fund programs. This information sharing and training will include but not be limited to:
▪Billing/payments/reimbursement
▪ OHCDS/Vendor payments
▪ PASAs contacts/connections
▪ RFP process
▪Intake/eligibility/determination
▪ CES/CHRP/DD Waiver/HCBS-SLS
▪ Family Support Services Program/Family Support Council
▪ State SLS/OBRA
▪ Human Rights Committee

August-October 2023:

Envision and the AAA will continue with any outstanding information sharing and training that Envision staff need to provide to the AAA staff
Envision and the AAA will begin communicating with people and families receiving services, PASA’s, and vendors about the transition. We will provide education and training, conduct in-person and virtual meetings and engagement, and conduct stakeholder surveys to obtain feedback and input on what’s working/what’s not working with current Case Management services, and other suggestions/comments.
Envision and the AAA will review questions, comments and feedback from the stakeholder engagement meetings and survey, and discuss changes that could improve the quality, efficiency and effectiveness of of case management services.
Envision and the AAA will develop which programs/caseloads/employees will transition at what timeframes
Envision will provide updates on CFCM/CMRD on their website, social media posts, and email list-serve

November 1 2023 – February 29, 2024

Envision and the AAA will meet weekly with HCPF to provide updates and discuss the transition
Envision will begin transferring people/families supported, case management staff, and case management files to the AAA
Envision will provide a “Transition Navigator” position to help address phone calls, emails and walk-ins of current on new people/families to ensure they know what is happening, and how to receive the services they needMarch 1, 2024 – June 30, 2024

Envision will continue to offer support and assistance to the AAA in any areas that assistance is needed
“Transition Navigator” will be available for any new people still contacting Envision for referrals and seeking services; this position will provide appropriate paperwork when needed, and connect them with the appropriate person at the AAA

The following resources will be used to support the change management plan:

• Transition checklists provided to case management agencies from HCPF
• Communication materials: Envision and the AAA will develop communication materials to keep people and families receiving services, PASAs and vendors informed about the transition. These materials will include fact sheets, brochures, and videos.
• Education and training materials: Envision and the AAA will develop education and training materials to help people and families understand the transition. These materials will include in-person and virtual presentations, workshops, and online resources
• Support services: Envision and the AAA will provide services and to people and families receiving services during the transition. These services will be provided by case managers, case management supervisors and the Transition Navigator Evaluation

The effectiveness of the change management plan will be evaluated by the following metrics:
• Number of people and families who are aware of the transition.
• Number of people and families who are satisfied with the transition.
• Number of disruptions to services.

Conclusion
This change management plan outlines the key strategies that will be used to ensure a smooth
transition for people and families receiving services from Envision to the AAA. The plan also includes a timeline of the key milestones and the resources that will be used to support the transition. The effectiveness of the plan will be evaluated by the metrics outlined above.

Communication Plan

Following adoption of the Federal Home and Community Based Services (HCBS) Final Settings Rule, an agency receiving Medicaid funding may not provide both Case Management and Direct services. For Colorado to come into compliance with the HCBS Final Settings Rule, Colorado House Bill 21-1187 passed in 2021, requiring the state to redesign its case management system for long-term services and supports. It requires an agency to choose between being a Case Management Agency (CMA) or a Direct Service Agency. Additionally, the entity who will be the CMA must be willing and able to provide case management to all ten (10) Medicaid Waiver programs, not just the four (4) currently provided by Envision. The new system must be implemented by July 1, 2024.

In August 2022, Envision’s Board of Directors made the decision that we would not respond to the CMA RFP based upon two primary factors. 1. The Weld County Commissioners had stated that they would be interested in being the CMA in Weld County and we thought it was better to collaborate with instead of compete against them. 2. Envision was established to serve people with developmental disabilities in the community; we felt that being required to serve other populations would compromise the integrity of why we were established. The CMA RFP opened in December 2022 and closed in February 2023. In June 2023 we received notice that the Weld County Department of Human Services, Area Agency on
Aging (AAA) would be the new CMA in Weld County.

Envision, as the outgoing CMA, is responsible for communicating this change to the following audiences:
•Envision employees;
•People receiving services from Envision;
• Families/guardians of people receiving services from Envision;
•Program Approved Service Agencies (PASAs) who currently work with Envision;
•OHCDS and general vendors working with Envision;
•County and Local Governments;
• Local advocacy agencies (The Arc of Weld County, Adeo, Connections for Independent Living);
•Key community partners (schools, vocational rehabilitation, early childhood programs, medical professionals, and local Medicaid); and
•The general community.

Communication Goals
Envision’s communication goals are to:
1. Inform all stakeholders about the changes to the case management system including that the new CMA is the Area Agency on Aging, and the timeframes of expected transition;
2. Seek feedback and input from all stakeholders about what’s working/what’s not working with current services and systems, and what changes they would like to recommend with
CFCM/CMRD;
3. Answer questions and address concerns related to CFCM/CMRD; and
4. Ensure all people/families successfully transition to the new CMA with no gaps in services, and receive CM support from a team of competent, knowledgeable and committed staff.

Communication Timeline (subject to change)
Implementation in the following phases:

Phase 1: 15, August 15, 2023 – October 31, 2023
- Envision will create a survey for all stakeholders to obtain input/feedback on what’s working/what’s not working with current services.
- Envision will modify the provided communication templates provided by Health Care Policy and Financing (HCPF) so they are applicable to the target audiences.
- Envision will distribute communication letters and surveys through a variety of means including email, postal mail, physical copies at Envision, Envision website, social media sites, and during regularly scheduled community meetings. The communication letter will include dates/times of upcoming engagement opportunities.
- Envision and the AAA will offer public meetings (in-person and virtually) to answer questions and address concerns. We have four of these scheduled towards the end of September; two in-person and one virtual for people/families receiving services, and one hybrid for PASAs/Providers and Vendors.
- Envision will develop a job description, recruit, hire and train a Transition Navigator to help people/families currently receiving services who for whatever reason are unaware, and new people/families seeking services, successfully connect with the appropriate person at AAA. This position will be available at Envision both during the transition as well as several months after the transition occurs.

Phase 2: November 1, 2023 – until transition is complete
- Envision will continue to distribute information about the new CMA and transition plan through its website, social media, emails, postal mailings, and other channels.
- Envision will continue working with AAA, PASAs, and Vendors to ensure that they are prepared for the transition to AAA.

Information to be shared with all stakeholders:

The purpose of the new CMA and CMRD
The benefits of CMRD
The timeline for the transition to the AAA
Opportunities for stakeholder input/feedback
How/where people/families can get help and information during the transition

Communication Strategies
The following communication strategies will be used to reach all stakeholders:

Website: Envision will create a dedicated tab on our website with information about CFCM/CMRD
Social media: Envision will use social media to share information about the new CMA and CMRD
Email: Envision will send email updates to stakeholders about the new system.
Phone calls: Envision will respond to phone calls from stakeholders to answer questions and address concerns.
Public meetings: Envision will hold public meetings (in-person and virtually) to answer questions
and address concerns.
Presentations at community meetings/events: Envision will ask service organizations, and other partners for an opportunity to present information on the changes at regularly scheduled meetings.

Evaluation
Envision will evaluate the effectiveness of its communication plan by monitoring the following metrics:

Number of responses to survey
Number of website visits
Number of social media followers
Number of email subscribers
Number of phone calls
Attendance at public meetings
Number of people/families successfully transitioned from Envision and receiving services from the new CMA

Conclusion
Envision is committed to communicating effectively with all stakeholders about the changes to the case
management system related to CFCM/CMRD. The communication plan outlined above will ensure that
everyone has the information they need to make a smooth transition to the new CMA for Weld County