ULTC 100.2

Another proposal includes $220,000 total funds and $110,000 General Fund to redesign the assessment tool for long-term care and better integrate the data collected from the assessment tool with claims information. The Department indicates that the current assessment tool focuses on how well a client can perform activities of daily living, but lacks some key information that impacts the cost of care, such as mental health status and the level of family support. Also, most of the responses on the assessment tool are not standardized entries but narrative responses that make comparisons difficult. The current lack of connection between the assessment tool and claims data is a barrier to the Department designing performance-based payments for long-term care, because the Department can't establish expected baseline expenditures for different levels of assessed needs.

It is the position of the Colorado Cross-Disability Coalition (CCDC), Family Voices of Colorado and at least one Single Entry Point Agency (we are waiting on the formal approval for the association) that there is NO NEED FOR THIS MONEY.

1. Original design of ULTC 100.2 was done by a collaborative of case managers, medical professionals, department staff and advocates.  The department cut off implementation partway through the process.  The group that did the work did so free of charge and are willing to continue it where it was left off without charge to the state.   We will recruit missing links for those who have moved on or retired.  One of the main authors of the tool now works for HCPF.
2. The tool is designed to integrate claims data and to create a care plan with the assessment which is best practice by all national standards.
3. The tool does address mental health
4. The way the department is going about addressing family or informal support is severely flawed and bad public policy, they are pushing family caregivers out cost shifting the burden to the state.  There are a number of serious public policy problems with the current management.
5. Original tool required SEP to reach out to collaterals, what is the need and what is the care plan, never implemented the care plan side of it, so that informal support could be appropriately implemented.
6. HCPF has refused to allow case managers to see claims and cost data.
7. IADL was never implemented
8. The state suddenly sprang an unrelated service plan on the SEPs with no SEP or client input.  The tool is designed to function as a service plan.

WE REQUEST THAT THE JBC DENY THIS REQUEST and ask that HCPF reconvene the group that developed this tool that has been cited by a national study as a model.  The tool was carefully crafted targeting markers of people in facilities.  We also think HPCF should be asked the following questions:  What studies or research did they do to determine these changes need to be made?  Who was interviewed, how many SEPs and how many clients?  What data are they using?

Before we reformed the tool, LTC was being used expensive homeless shelter for alcoholics and this stopped that process?  When the SEP agencies took over utilization review from the state managed contractor it was discovered that they were only reviewing 10%.  Moreover, much weight was being given to specific diagnosis and medications.  This is an expensive outdated model and the functional model is best practice.  HCPF staff have said in meetings that they want to return to medical model, despite directives by their director not to do so.

This is the 21st century –there are high needs people with significant medical needs living in the community.  HCPF staff are not experienced with LTC.  For example, they say there are quality of care concerns for those who are getting excellent care from loved ones, implement policies without data or understanding of how it affects overall care and do not understand how care in the home actually happens.

Revising the tool in the way described by HCPF at LTC meetings will be making the same mistakes and expecting different results.  The SEP model was developed to address these issues.  The first year the tool was implemented the JBC analyst estimated $17 million in cost avoidance.