The Vital Importance of Advocacy in Colorado

by Bryce Rafferty, CDASS Participant

While I wasn’t born in the state of Colorado nor did I grow up here, I am beyond thankful for this state, it’s people, and the public healthcare that makes life in Colorado that much better for persons with disabilities. Most people know Colorado for its mountains, but most don’t know that Colorado State Medicaid is one of the best in the union. Speaking with another quadriplegic like myself from Iowa, I heard about how Medicaid in his home state falls far short of the coverage and quality of care that I enjoy on a daily basis. However, being on federal health insurance anywhere has its fair share of challenges, and it is the responsibility of the people to hold the government accountable and maintain the positives when they are threatened by changes or pitfalls in policy. Continue reading “The Vital Importance of Advocacy in Colorado”

2019 Legislative Session Wrap Up

This was a busy session as is typical whenever there is a new administration and many new legislators.  Despite some unfortunate partisanship that caused delays,  the reading out loud of 2000 page bills, hearings that occurred during a blizzard, and overnight sessions some great work did get done that will benefit the people of Colorado including people with disabilities.

Before talking about the bills, I want to call out the amazing CCDC team that worked at the Capitol this year.

• CCDC Board Co-Chair Josh Winkler showed his typical leadership working some bills very hard, following the budget, and mentoring some of our newer volunteer lobbyists. Other board members that participated in the process were Scott Markham and Dr. Kimberley Jackson.
• Our volunteer lobbying team consisted of Francesca Maes, Michael Neil, Jennifer Roberts, Haven Rohnert, and Linn Oliver with help from Jennifer Remington, Auralea Moore, and Tim Postlewaite.
• Valerie Schlecht did a fantastic job as our contract lobbyist for mental health issues and stepped up on several other issues as a volunteer. Dawn Howard our community organizer, AKA Cat Herder in Chief did a great job making sure everyone knew what was happening, where people were needed, etc.

CCDC wants to thank our many partners, in particular the Arc of Colorado, Arc of Aurora, Arc of Adams, the Colorado Center on Law and Policy, the Colorado Children’s Campaign, 9-5 Colorado, ACLU of Colorado, Colorado Senior Lobby, Disability Law Colorado, Colorado Common Cause, PASCO, and Accent on Independence Homecare amongst others.  We also want to thank Colorado Capitol Watch for a great product that made tracking the bills easier.

Because this was a year with many new legislators and many groups rushing to push through bills that had struggled in years past, many of which were bills we were going to support, CCDC made a deliberate decision to NOT run our own proactive bills this year but to focus on our coalition work, and building relationships with the many new Senators and Representatives.   We laid groundwork for policies we want to promote over the next few years while focusing on the many coalition bills and responding to bills that affected our community.    We followed 139 bills.  This report shares the highlights-not every bill that we worked on during the session.

Housing:

This is being dubbed the year of the renter.    There were many bills that helped renters, along with some that will fund affordable housing.

• HB 19-1085 Increases the property tax/heat/rent rebate program both the amount of the grant and the income limits for people eligible for this grant through July 2021.
• HB 19-1106 Limits rental application fees to actual costs
• HB 19-1118: Requires landlords to expand the notice before eviction from three to 10 days, hopefully giving people a way to either find a new place to live or cure the problem that led to the eviction
• HB 19-1135 Clarifies that income tax credits for retrofitting a home for accessibility are available when one retrofits a home for a dependent.
• HB 19-1170 Improves warranty of habitability in housing to make it work for tenants.
• HB 19-1285 and HB 1332 Affordable housing funding
• HB 19-1309 Creates mobile home park dispute resolution and enforcement program, also increasing time to move if there is sale or eviction.
• HB 19-1328 Responsibilities of landlords & tenants to address bed bug infestations.
• SB 19-180 Creates an eviction defense fund to help low-income people

Health Care:

• HB 19-1044 Allows for an advanced directives for behavioral/mental health.
• HB 19-1120 Multiple approaches to address and prevent youth suicide
• HB 19-1151 Revisions to the Traumatic Brain Injury Program funded by the Brain Injury Trust Fund.
• HB 19-1176 Enables a study of various methods of health care reform including an option for universal health care.
• HB 19-1189 Reforms wage garnishment laws to take into account medical expenses and medical debt.
• HB 19-1211 Reforms what health insurance companies can and cannot do regarding prior authorization. This is to stop insurance companies using prior authorization to harass doctors and deny patients.
• HB 19-1216 Measures to reduce the cost of insulin.
• HB 19-1233 Health care payment reform to promote increasing utilization of primary care.
• HB 19-1269 Mental Health Parity-variety of measures to require both private insurance companies and Medicaid to pay for mental health care appropriately.
• HB 19-1287 Increases treatment funding for substance use disorders
• SB 19-001 Expands the Medication Assisted Treatment pilot program
• SB 19-005 Gives state permission to request permission from the federal government to import drugs from Canada to give Colorado residents price relief
• SB 19-010 Funds professional mental health services in schools
• SB 19-073 Creates statewide system to allow electronic uploading of advance directive documents so in the case of emergency any hospital can ascertain the wishes of the individual. This is voluntary.
• SB 19-079 Requires some doctors to submit prescriptions of controlled drugs electronically
• SB 19-195 Creates a system to better coordinate children’s mental health policy
• SB 19-222 Increases mental health services for people at risk of institutionalization
• SB 19-238 Requires the 8.1% increase for personal care and homemaker be passed directly to workers, and sets up stakeholder group to address issues with personal care workforce.

THERE WERE A NUMBER OF BILLS RELATED TO THE COST OF PRIVATE INSURANCE AND HOSPITALS.  PLEASE CHECK OUT THE COLORADO CONSUMER INITIATIVE OR THE COLORADO CENTER ON LAW AND POLICY FOR REPORTS ON THOSE BILLS.

Good Government:

• HB 1062 Allowing sale of property at the Grand Junction regional center
• HB 19-1063 Allows information sharing between adult and child protective services and allowed people who are subject to adult protective services to see their own records.
• HB 19-1084 Requires that staff of legislative council prepare demographic notes on certain bills. For a handful of bills each future session the citizens and elected officials of Colorado will be able to have research on how a bill affects specific (often underrepresented) populations.
• HB 19-1239 Creates a grant program to do outreach for the 2020 census.
• HB 19-1278 A variety of changes to election law making it easier for voters
• SB 19-135 Requires a study of state procurement disparities to see if state contracting is being fair and inclusive to businesses owned by people of color, women and people with disabilities.

Education:

• HB 19-1066 Requires schools to count special education students in graduation rates.
• HB 19-1134 Research for better methods to identify dyslexia in young children
• HB 19-1194 Limits schools ability to expel and suspend children in and below the 2^nd grade
• HB 19-066 Creates grant program to help defray costs of high cost special education students

Employment:

• HB 19-1025 Limits employers’ ability to ask about criminal backgrounds (with appropriate exemptions) before employee goes through the application process.
• HB 19-1107 Creates job retention and employment support as part of the Department of Labor and Employment
• SB 19-085 Increases enforcement for those facing pay-based discrimination
• SB 19-188 Creates a study of Family Medical Leave

Transportation:

• HB 19-1257 and HB 19-1258 Brings to the voters a request for state to keep and spend excess revenue for transportation and schools
• SB 19-239 Creates a stakeholder process to address the changes in transportation

Justice Systems:

• SB 19-036 Creates pilot program to remind people of court dates
• HB 19-1045 Provides funding for an office of Public Guardianship
• HB 19-1104 Creates a right to counsel for parents who are facing custody loss to be represented through the office of respondent parent counsel.
• HB 19-1777 “Red Flag” bill that sets out when a judge can temporarily take away someone’s gun if they are at imminent risk of harming themselves or someone else. CCDC was initially concerned that this might be based on diagnosis, but it was not.  It is based only on behavior, has many protections and excellent due process.
• HB 19-1225: Prohibits money bail for some low-level offenses to avoid people being jailed for not having small amounts of money for non-violent crimes.
• SB 19-172 Makes it easier to prosecute people that abuse at risk adults and makes it clear that inappropriate confinement is abuse and illegal.
• SB 19-191 Creates defendants’ rights to pretrial bonds to reduce the number of people with low-level crimes sitting in jail just because they are poor.
• SB 19-223 Reforms regarding the competency process in the criminal court system

State Budget (aka the long bill SB 19-207)

• Increases personal care and homemaker rates for CDASS and IHSS by 8.1%
• Funds housing inspections for host homes in the I/DD system for basic life-safety issues
• Creates an Office of Employment First at JFK Partners
• State funded SLS and Family Support Services waiver slots
• Creates a Supported Employment pilot at HCPF for I/DD waivers
• Provides funding for HCPF customer service
• Provides funding for food and travel for HCPF Member Experience Advisory Council
• Provides state mental hospital funding for Disability Law Colorado settlement

Disability Specific:

• HB 19-1069 Allows Colorado to create our own certification system through the Colorado Commission on the Deaf, Hard of Hearing and Deaf/Blind CCDHHDB to adopt or develop a certification system for American Sign Language interpreters. This is address the shortage of interpreters, especially in the rural areas.  THANKS TO THE INDEPENDENCE CENTER OF COLORADO SPRINGS FOR LEADING THIS BILL.
• HB 19-1151 Revisions to the Traumatic Brain Injury Program funded by the Brain Injury Trust Fund. THANKS TO THE BRAIN INJURY ALLIANCE OF COLORADO FOR LEADING THIS BILL.
• HB 19-1223 Provides application assistance to people on the Aid to Needy Disabled program to help them obtain approval for Supplemental Security Income (SSI). THANKS TO THE COLORADO CENTER ON LAW AND POLICY FOR LEADING THIS BILL
• HB 19-1332 Funds the talking book library
• SB 19-202 Creates a path for accessible ballots for people who are print disabled to allow such individuals to vote in private in our all mail ballot system. THANKS TO THE NATIONAL FEDERATION OF THE BLIND OF COLORADO FOR LEADING THIS BILL.

Overall it was a good year.  There were some disappointments, but there always are—now we have to make sure the bills we like get implemented and make sure people know about these new laws and programs.

Congratulations to Jared Polis and Other Winners

CCDC wishes congratulations to our new Governor Jared Polis and looks forward to working with this new administration.   Our expectations of a new governor are clear and doable.   We look forward to advancing the rights of people with disabilities so that we can show our capabilities as full citizens.  This means a dramatic increase in the number of people with disabilities who are employed.  This means a dramatic improvement in the high school graduation of students with disabilities and making sure that students go to college or some sort of vocational program.   This means a government that values people with disabilities by having high expectations and providing appropriate supports.   This means a government that involves us at every level…on boards, commissions, as employees in state agencies, and on the transition team.    Governor-Elect Polis stated last night that his administration will be inclusive.   We expect to be part of this inclusion and to have disability representation in historic proportions and stand ready to help make that happen.

CCDC congratulates all of the representatives and senators that won their seats as well and we look forward to working with all of you on these same goals.

We will be solidifying legislative priorities for the next two years soon but among them will surely be:

1) Increasing protection for renters such as statewide source of income discrimination protection and habitability laws.

2) Extending the Mediciad Buy-In for Working Adults with Disabilities to people over the age of 65 and for more than 10 days in between jobs, even if we have to use state funds.   With the federal government giving the states carte blanche we should be able to get approval.

3) Getting safety protections for people living in host homes.

4) Consumer direction for all HCBS services.

5) Improving our case management systems, especially transition from institutions.

We will be focusing on money for solid transportation that has a focus on transit and affordable housing that is inclusive of everyone including those with very low income.   We will be working on increased accountability around behavioral health and overall health care in the Medicaid program.

On a federal level with the Democrats having a majority in the house, we will be holding Congresswoman DeGette accountable for her promises to us to fix the Electronic Visit Verification mess and exempt consumer direction and family caregivers.   We will also expect help with improved access to quality complex rehab equipment (power wheelchairs) including accountability for repairs.

While Colorado definitely went blue, this does not mean that CCDC will stop working with our Republican allies.   We have always been and always will be a bipartisan organization.  Our issues cross both parties.  Disability does not discriminate.

CCDC was very proud of the VERY STRONG voter turnout in the disability community.   Approximately 90% of our members had already voted before Monday and we are sure the rest voted Monday or Tuesday.     Voting is the first step of realizing NOTHING ABOUT US WITHOUT US.

How do we solve a problem like Case Management?

Despite a plethora of resources dedicated to case management, there is no true single case management system for those with high needs. There are fragments in some systems for some issues but they do not address holistic needs. There are case management systems that are really gatekeepers for government programs. Gatekeeping has its place but it is different than case management. Despite the many areas where case management is covered (even just in the Medicaid system) there has never been a process whereby the stakeholders and government get together to at least have dialogue, if not answer the following questions:

1) Who needs what level of care management across systems? What percent are likely permanent needs?

2) What are the specific tasks needed and how much time will this take on average?

3) What are the qualifications to do these tasks?

4) What are the quality measures to assess the performance of these tasks?

5) What is the cost to perform these tasks including maximum caseload size.

6) What are the total resources now dedicated to all case management?

7) What case management are we doing now that is not useful, not necessary, or could be done at a lower level?

8) How do we create a plan to take our current system and transform to a system that provides intensive case management where appropriate and reduces services where there is no benefit?

Case management is needed in the following situations:
*People with a serious but temporary medical condition or new illness, such as cancer for help accessing and coordinating medical and other resources.

*People with long-term disabilities who are unable to do their own case management and who have no family able to assist. This must be comprehensive and include non-medical issues even the mundane daily life activities that can overwhelm some people. Even dealing with a utility company or a landlord can require assistance for people with some disabilities.
Some individuals could learn to do more of their own management with teaching (or have a family member able to take over with some training) and others will need this high level over a lifetime.
This is not a huge number of people, but the lack of case management causes them to spend a lot of time in crisis and use emergency resources from multiple organizations. Case management of this type is labor intensive and requires a very low caseload and high level of training.

What is these RAEs (Regional Accountable Entities)??

• You should have received a letter from Medicaid recently.
• You may see and hear new terms describing how the system of care is changing. However, your Medicaid benefits and services are not
• You can continue to receive the same physical, mental health and long-term services and supports services you are receiving today.
• The big change starting July 1, 2018, is one organization will be coordinating your physical and behavioral health benefits. This is intended to make it easier to get the care you need. This organization is called your Regional Accountable Entity, or RAE.
• If the Primary Care Provider who is listed in your letter is not the one you want, you can pick a new one by calling the Medicaid enrollment department at 888-367-6557.
• You can continue to see any physical health provider (doctors, hospitals, etc.) who accepts Medicaid, no matter which Primary Care Provider is listed on the letter you received.
• If your behavioral health provider / therapist tells you they cannot see you because they are not part of the RAE network, please have the provider call the RAE. You should also call the RAE’s customer service line to make sure your services continue and to prevent or minimize any delays.
• If you are told you cannot get mental health care for a long time, please call your RAE.
• If you have a mental health crisis you can always call the crisis line at 1-844-493-8255 or text talk to 38255. Please call us also so we can get you connected with ongoing mental health care.
• You can call your regional organization for help with:
  • Finding a doctor or specialist
  • Finding a behavioral /mental health therapist, other mental health support or a psychiatrist
  • Getting help with your care – including understanding your benefits and getting a ride to your medical appointments
  • Referring you to a long-term services and supports program if you need help with daily activities due to age or significant disability.
  • Referring you to other resources that might affect your health such as places to get help with food

RAE Contact Information and Area Map

Consumer Directed Attendant Suppport Services (CDASS) Implementation in Supported Living Services (SLS) Waiver

This post is a reproduction of the Policy Memo put out by the Colorado Department of Health Care Policy and Financing.

POLICY MEMO

POLICY MEMO NUMBER: HCPF PM 18-002
TITLE: CONSUMER DIRECTED ATTENDANT SUPPORT SERVICES (CDASS)
IMPLEMENTATION IN SUPPORTED LIVING SERVICES (SLS) WAIVER
SUPERSEDES NUMBER: N/A
ISSUE DATE: August 3, 2018
EFFECTIVE DATE: August 15, 2018
DIVISION AND OFFICE: BENEFITS AND SERVICES MANAGEMENT  DIVISION, OFFICE OF COMMUNITY LIVING
PROGRAM AREA: CONSUMER DIRECTION
APPROVED BY: GRETCHEN HAMMER
KEYWORDS: CONSUMER DIRECTION, SUPPORT LIVING SERVICES,
IMPLEMENTATION, CDASS

Continue reading “Consumer Directed Attendant Suppport Services (CDASS) Implementation in Supported Living Services (SLS) Waiver”

Consumer Directed Attendant Support Services (Part 3)

CDASS lets you decide who you want to support you and you hire them. You become the employer and you do not have an agency for the services (personal care, homemaker, enhanced homemaker & health maintenance) available using CDASS.

If you want to use the CDASS service delivery option, you have to use it for all the CDASS services that are in your plan.  For example, if you only have personal care and homemaker services you can use the CDASS option for those.  You cannot use CDASS for one of these services and get another from an agency.  All of your  SLS services that are not available through the CDASS option will continue to come through an agency.

To get started you will need to:

Meet with Your Case Manager or Resource Coordinator

Continue reading “Consumer Directed Attendant Support Services (Part 3)”

Consumer Directed Attendant Support Services (Part 2)

CDASS: A Three-Part Series – Part 2

Read Part 1 here

Submitted by The Arc of Adams County, February 7, 2018

Part 2 of 3 in a mini-series about Consumer or Self Directed Care in Colorado’s Supported Living Services Waiver. It is meant to give you enough information to decide if you want to explore it further.

The Colorado Department of Health Care Policy Finance is responsible for assuring the implementation of this Consumer Directed Option. They will be training Case Managers/Resource Coordinators to help individuals and families use the CDASS option. All training for CDASS is done through a contract with Consumer Direct of Colorado.  Continue reading “Consumer Directed Attendant Support Services (Part 2)”

Consumer Directed Attendant Support Services (Part 1)

Submitted by The Arc of Adams County, January 29, 2018

Coloradans using the Supported Living Services (SLS) Waiver will have the option to consumer or self-direct some of their services.  People using some other Colorado waivers have had this opportunity since 2002. Until now those options have not been available in services specifically designed for persons with Intellectual and Developmental Disabilities.

This article is Part 1 of an introduction to Consumer Direction in Colorado. It is a three (3) part information mini-series written primarily to help families of people with I/DD to understand consumer direction in Colorado and decide if you want to use this option for your son or daughter. This 3 part mini-series will be sent over the next 2 weeks. It is not intended to give detailed information.
Continue reading “Consumer Directed Attendant Support Services (Part 1)”