Developmental Pathways Case Management Challenges
Hello providers,
Over the past several months DP has worked closely with the Colorado Department of Health Care Policy and Financing (HCPF) along with our neighboring case management agencies to plan and carry out the necessary steps associated with Case Management Redesign (CMRD).
As we have reached the scheduled November 1 transition date, we have identified pressure points or what we are calling “known issues” with the transition process, which are outside our local control.
As you may remember, CMRD includes dozens of inter-related projects that are owned and managed by our State partners at Health Care Policy and Financing (HCPF), which serves as our State Medicaid agency. These projects were often funded, at least in part, through nearly $530M in funds from the American Rescue Plan Act (ARPA) and are all intended to improve the long-term care (LTC) system for its members.
These projects encompass several ambitious and far-reaching goals that are intended to improve access to services.
- This includes implementing an entirely new case management database, called the Care and Case Management (CCM) System.
- The CCM system is a critical component of case management supports.
- Unfortunately, as is often the case with big technology shifts, there have been system glitches requiring complex solutioning, as managed by a third-party contractor with HCPF called AssureCare.
These ongoing issues with the CCM system have made it very challenging to access full, complete case management records, resulting in data disruptions that are out of our control as your case management agency.
These disruptions are occurring simultaneously with the unwind of the Public Health Emergency flexibilities and through the planned CMRD transitions, which are required to occur before July 1, 2024, for the State of Colorado to maintain its federal funding for long-term care services.
DP along with other Case Management Agencies (CMAs) have met with HCPF multiple times to troubleshoot the database issues and will continue doing so. Of particular importance is our ability to provide seamless case management transition & ongoing supports in a person-centered, timely manner.
Known Issues Include:
1) Access to case management data:
Case managers may not be able to immediately access or update member information in the designated state database. This means individuals, families, and/or providers may be asked to repeat some information that is “on file” but not immediately accessible to our teams.
When this occurs, we identify the issue & work with the state to resolve it.
2) Ability to create, update, or print service plans:
Sometimes case managers cannot create or update service plans. When this happens, we have to temporarily document supports in another way & work with the state to fix the issue.
This means that we may not have formal service plan information immediately available to share with individuals, families, and/or providers.
3) Ability to submit prior authorization requests (PARs) for providers to authorize supports.
Case managers have been having issues both creating & submitting support authorizations (called PARs) in the state’s system, which creates the authorizations that allow providers to bill & be paid for services.
If we can’t upload PARs, providers may struggle with payment.
We are working with the state and providers to ensure, whenever possible, that services are not disrupted but some providers may pause services until the issue(s) are resolved.
4) Disruption in Medicaid eligibility related to the Public Health Emergency (PHE):
Some people are experiencing disruptions to their Medicaid eligibility following the end of the COVID-19 public health emergency (PHE).
The best resource for information about this is found on this website: https://hcpf.colorado.gov/phe-end.
Individuals should contact their local county human services office and/or case managers immediately if they experience a disruption in Medicaid eligibility.
5) Disruption in provider billing:
Due to issues with submitting PARs (#3 above) and Medicaid eligibility disruptions (#4 above), some providers are not being paid for services they have provided.
This is extremely frustrating for all parties and we are working closely with our state partners to resolve billing issues as quickly as possible.
Resources From HCPF
Contact Information for DP
In closing,
We know transitions are hard and that complications like the ones listed above only make them feel harder. While the issues listed above are not being experienced unilaterally by all members or all providers, we are collectively working tirelessly to get meaningful solutions in place as quickly as possible.
Rest assured, both CMAs and HCPF remain committed to fixing these system glitches and improving our collective overall service experience as providers supporting some of Colorado’s most vulnerable citizens.
On behalf of our CMA partners at HCPF, we will continue to collaborate on shared solutions and will do all we can to support you and your provider agencies during this transitional time.
Thank you for your patience and understanding during these critical transitions,
Developmental Pathways |
