TITLE 25.5. HEALTH CARE POLICY AND FINANCING COLORADO MEDICAL ASSISTANCE ACT ARTICLE 6. COLORADO MEDICAL ASSISTANCE ACT - LONG-TERM CARE PART 11. CONSUMER-DIRECTED CARE

Submitted by Anonymous on July 25, 2012 - 8:46am

COLORADO REVISED STATUTES


TITLE 25.5. HEALTH CARE POLICY AND FINANCING
COLORADO MEDICAL ASSISTANCE ACT
ARTICLE 6. COLORADO MEDICAL ASSISTANCE ACT - LONG-TERM CARE
PART 11. CONSUMER-DIRECTED CARE


C.R.S. 25.5-6-1101 (2011)


25.5-6-1101. Definitions

As used in this part 11, unless the context otherwise requires:

(1) "Attendant support" means any action to assist an eligible person in accomplishing activities of daily living, instrumental activities of daily living, and habilitative and health-related tasks. Such activities include, but are not limited to, personal care services, household services, cognitive services, mobility services, and health-related tasks.


(2) "Authorized representative" means an individual designated by the eligible person, by the parent of a minor, or by the legal guardian of the eligible person if the eligible person cannot demonstrate sound judgment to his or her primary care physician, who has the judgment and ability to assist the eligible person in acquiring and utilizing services under this part 11. The extent of the authorized representative's involvement shall be determined upon designation.

(3) "Consumer-directed" means that an eligible person receives a direct payment through a voucher and employs, trains, and in other ways manages the person who provides his or her attendant support. The direct payment through a voucher that is received by an eligible person to pay for attendant support shall not be counted as income for purposes of determining eligibility for medicaid and other state programs that use income to determine eligibility.
 

(4) "Eligible person" means a person who is eligible to receive services under parts 3 to 12 of this article or any other home- and community-based service waiver for which the state department has federal waiver authority.

 

(reference of notation of parts 3 – 12: not part of statute language)

·  PART 3. HOME- AND COMMUNITY-BASED SERVICES FOR THE ELDERLY, BLIND, AND DISABLED

· PART 4. HOME- AND COMMUNITY-BASED SERVICES FOR PERSONS WITH DEVELOPMENTAL DISABILITIES

·  PART 5. HOME- AND COMMUNITY-BASED SERVICES FOR PERSONS WITH HEALTH COMPLEXES RELATED TO ACQUIRED IMMUNE DEFICIENCY             

· PART 6. HOME- AND COMMUNITY-BASED SERVICES FOR PERSONS WITH MAJOR MENTAL ILLNESSES

· PART 7. HOME- AND COMMUNITY-BASED SERVICES FOR PERSONS WITH BRAIN INJURY

· PART 8. HOME- AND COMMUNITY-BASED SERVICES FOR CHILDREN WITH AUTISM

· PART 9. HOME- AND COMMUNITY-BASED SERVICE PROGRAMS FOR CHILDREN

· PART 10. CONSUMER-DIRECTED ATTENDANT SUPPORT FOR PERSONS WITH DISABILITIES

· PART 11. CONSUMER-DIRECTED CARE

· PART 12. IN-HOME SUPPORT SERVICES


(5) "Primary care physician" means a physician who is the primary provider of physician services to the eligible person or who is familiar with the eligible person's needs and capabilities.

(6) "Qualified services" means services provided under the eligible person's applicable waiver program and attendant support.


HISTORY: Source: L. 2006: Entire article added with relocations, p. 1967, § 7, effective July 1.
Cross references: For the legislative declaration contained in the 1993 act enacting this title, see section 1 of chapter 230, Session Laws of Colorado 1993.
Editor's note: This article was added with relocations in 2006 containing provisions of some sections formerly located in article 4 of title 26. Former C.R.S. section numbers are shown in editor's notes following those sections that were relocated. For a detailed comparison of this article, see the comparative tables located in the back of the index.
Cross references: For definitions applicable to this article, see
§ 25.5-4-103.
Law reviews: For article, "Colorado Medicaid Home and Community-Based Services and Least-Restrictive Environment", see 39 Colo. Law. 35 (May 2010).
Editor's note: This section is similar to former § 26-4-1301 as it existed prior to 2006.

 

25.5-6-1102. Service model - consumer-directed care   
(1) The state department shall implement a consumer-directed care service model that allows eligible persons to receive a direct payment through a voucher to purchase qualified services. The state department is authorized to seek any federal waivers or waiver amendments that may be necessary to implement this part 11. The state department shall design and implement the consumer-directed care service model with input from consumers of home- and community-based services or their authorized representatives. An eligible person shall not be required to disenroll from the person's waiver program in order to receive qualified services through the consumer-directed care service model.

(2) In order to qualify and to remain eligible for the consumer-directed care service model authorized by this section, a person shall: 

                (a) Be eligible for home- and community-based services under parts 3 to 12 of this article or any other home-    and community-based service waiver for which the state department has federal waiver authority;
                (b) Be willing to participate;
                (c) Obtain a statement from his or her primary care physician or advanced practice nurse indicating that the                 person has sound judgment and the ability to direct his or her care or has an authorized representative;
                (d) Demonstrate the ability to handle the financial aspects of self-directed care or has an authorized                 representative who is able to handle the financial aspects of the eligible person's care; and
                (e) Meet any other qualifications established by the state board by rule.

(3) The voucher issued to the eligible person under this part 11 shall be based on the eligible person's historical utilization of home- and community-based services under parts 3 to 12 of this article, the single entry point agency's care plan, or any approved resource allocation process as determined by the state department and the department of human services for the eligible person. 


(4) While an eligible person is participating in the consumer-directed care service model established in this part 11, that person shall be ineligible to receive a home care allowance as provided in
section 26-2-122.3 (1) (b), C.R.S.

(5) The state department shall develop the accountability requirements necessary to safeguard the use of public dollars, to promote effective and efficient delivery of services, and to monitor the safety and welfare of eligible persons under this part 11. 

 

(6) The state board shall adopt rules as necessary for the implementation and administration of the consumer-directed care service model authorized by this part 11. Such rules shall include a provision allowing an eligible person to designate a family member or authorized representative to be responsible for managing the financial matters associated with the consumer-directed care or to direct the eligible person's care. The designee shall not receive reimbursement for managing the financial matters associated with the eligible person's care or for directing the eligible person's care


(7)
Sections 12-38-103 (8), 12-38-103 (11), 12-38-123 (1) (a), 12-38.1-102 (5), and 12-38.1-117 (1) (b), C.R.S., shall not apply to a person who is directly employed by an individual participating in the consumer-directed care service model pursuant to this section and who is acting within the scope and course of such employment. However, such person may not represent himself or herself to the public as a licensed nurse, a certified nurse aide, a licensed practical or professional nurse, a registered nurse, or a registered professional nurse. This exclusion shall not apply to any person who has had his or her license as a nurse or certification as a nurse aide suspended or revoked or his or her application for such license or certification denied. 

 

(reference of notation of section 12-38: not part of statute language)

 

(8) "Practical nurse", "trained practical nurse", "licensed vocational nurse", or "licensed practical nurse" means a person who holds a license to practice pursuant to the provisions of this article as a licensed practical nurse in this state or is licensed in another state and is practicing in this state pursuant to section 24-60-3202, C.R.S., with the right to use the title "licensed practical nurse" and its abbreviation, "L.P.N.".


(11) "Registered nurse" or "registered professional nurse" means a professional nurse, and only a person who holds a license to practice professional nursing in this state pursuant to the provisions of this article or who holds a license in another state and is practicing in this state pursuant to
section 24-60-3202, C.R.S., shall have the right to use the title "registered nurse" and its abbreviation, "R.N.".

12-38-123. Unauthorized practice - penalties


123 (1) It is unlawful for any person:
(a) To practice as a practical or professional nurse unless licensed therefor.

 

38.1-102

(5) "Practice of a nurse aide" or "nursing aide practice" means the performance of services requiring the education, training, and skills specified in this article for certification as a nurse aide. Such services are performed under the supervision of a dentist, physician, podiatrist, professional nurse, licensed practical nurse, or other licensed or certified health care professional acting within the scope of his license or certificate.

 

38.1-117

              (1) This article shall not be construed to affect or apply to:
              (b) A person for hire who does not represent himself or herself as or hold himself or herself out to the public as a certified               nurse aide. However, no person for hire who is not a nurse aide certified under this article shall perform the duties of or hold               himself or herself out as being able to perform the full duties of a certified nurse aide.


(8)
Section 25.5-6-310 does not apply to a family member of an eligible person who provides consumer-directed care services to the eligible person pursuant to this part 11.  .

      

          (reference of notation of 6-310: not part of statute language)

                25.5-6-310. Special provisions - personal care services provided by a family
              (1) A member of an eligible person's family, other than the person's spouse, may be employed to provide               personal care services to such person.
              (2) The maximum reimbursement for the services provided by a member of the person's family per year for               each client shall not exceed the equivalent of four hundred forty-four service units per year for a member of the               eligible person's family


(9) A person who has been designated as an authorized representative under this part 11 shall submit an affidavit, which shall become part of the eligible person's file, stating that: 
              (a) He or she is at least eighteen years of age;
              (b) He or she has known the eligible person for at least two years;
              (c) He or she has not been convicted of any crime involving exploitation, abuse, or assault on another person; and
              (d) He or she does not have a mental, emotional, or physical condition that could result in harm to the eligible               person.

HISTORY: Source:. L. 2006: Entire article added with relocations, p. 1968, § 7, effective July 1.L. 2008: (2)(c) amended, p. 134, § 24, effective January 1, 2009.

Editor's note: This section is similar to former § 26-4-1302 as it existed prior to 2006.

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25.5-6-1103. Reporting  

(1) The state department shall provide a report to the joint budget committee of the general assembly and the health and human services committees of the house of representatives and the senate, or any successor committees, by October 1, 2006, that includes, but is not limited to, the following:
                (a) The number of elderly persons participating in the consumer-directed care program;
                (b) The cost-effectiveness of the consumer-directed care program;
                (c) Feedback from consumers and the state department concerning the progress and success of the consumer-                directed care program; and
                (d) Any changes to the health status or health outcomes of the program participants.

HISTORY: Source: L. 2006: Entire article added with relocations, p. 1969, § 7, effective July 1.

Editor's note: This section is similar to former § 26-4-1303 as it existed prior to 2006.

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