COLORADO
The Colorado legislature enacted a range of long-term care measures in 2002 that included a new consumer-directed care program, expanded services for people with brain injury, changed rules on personal care boarding homes, and established a pilot program on nursing home quality. State fiscal problems caused cuts, however, in the Medicaid long-term care budget, affecting home care services and providers.
2002 Legislation
The legislature enacted a bill that requires the Department of Health Care Policy and Financing to implement a consumer-directed care program for the elderly under which eligible people can receive a voucher to purchase home and community-based services or supports. The voucher amount will be based on the person's historical use of services or a care plan. A physician must certify that the individual is able to direct his or her own care and the individual must demonstrate the ability to manage the financial aspects of that care. The voucher program also covers assisted living. (Another consumer-directed program, the Consumer-Directed Attendant Support Program, went into operation in 2002. Limited to 150 people, the program is open to Medicaid recipients of home care services who must complete training and pass an attendant support management proficiency test to be enrolled.) Other long-term care measures enacted in 2002 include the following.
- Expanded services for individuals with brain injury by allowing them access to "supportive living" services on residential campuses that provide such services.
- Eliminated budget neutrality provisions that require home and community-based services for an individual to be less costly than the average cost of nursing home care.
- Changed the licensing category for personal care boarding homes to assisted living residences. The new rules define an "assisted living residence" as a residential facility that provides room, board and certain services to three or more adults. The services must include personal services, protective oversight, social care due to impaired capacity to live independently, and regular supervision available on a 24-hour basis (not including 24-hour medical or nursing care).
- Created the Assisted Living Residence Improvement Cash Fund to collect civil fines. Funds are used for education, technical assistance, and relocation of residents or closure of a residence.
- Created a pilot program to survey quality of care and living in nursing homes. The consumer satisfaction surveys were to be distributed to no more than 10 percent of residents and their families.
The Budget
The Colorado General Assembly's failure to enact a balanced budget during the 2002 general legislative session caused Governor Bill Owens to order a 4 percent across-the-board cut for state agencies. The result was a $24.5 million reduction in the Medicaid long-term care budget administered by the Department of Health Care Policy and Financing. One example of a program cut was home health services where reimbursement for a 90-minute visit by a certified nurse's aide dropped from the 2001 rate of $41.12 to $31.06 if the patient was short term and to $39.07 if the patient was long-term. Budget constraints also resulted in a freeze on new admissions to the state-funded Home Care Allowance Program. The freeze went into effect on July 1, 2002.
Grant Initiatives
The Department of Health Care Policy and Financing received a $1.1 million federal Systems Change grant in 2002. The agency planned to contract with the Center for Research Strategies to design and conduct a service capacity survey and a statewide needs assessment for community-based care with an emphasis on rural areas. Activities include developing an education campaign on community-based options, developing recommendations for pilot respite care programs, and improving the mental health assessment tool. A consumer task force will advise the agency staff and subcontractors on all project goals.
Another $725,000 Systems Change grant was awarded to Colorado in 2002 to design and implement a personal assistance services and supports option in which consumers exercise control over their care decisions. The project will provide extensive training through a "train-the-trainer" program so the trainers will become community-based resources for the state, provider agencies, advocacy groups and individuals.
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