Supported Living Services (SLS) Waiver Exception Review Process

Supported Living Services (SLS) Waiver Exception Review Process Stakeholder Engagement #1 Presented by: Lindsay Westlund August 9, 2021

Our Mission: Improving health care equity, access and outcomes for the people we serve while saving Coloradans money on health care and driving value for Colorado. 2

Meeting Purpose To advise the Department as it implements an exception process for the SLS waiver specific to spending limitations and service unit limitations. 3

Agenda Housekeeping What is the “SLS Waiver Exception Review Process?” What is the timeline? SLS Waiver Amendment Regulation Development Training and Implementation Stakeholder Response and Questions Next Steps and Stakeholder Engagement Opportunities 4

Housekeeping Mute your mic if you are not speaking Use the “raise your hand” feature if you’d like to ask a question before we pause for breaks; or, Type your question in the chat box If you are on the phone, unmute by pressing *6 to ask a question We are recording! Please do not share protected health information (PHI) during this meeting Send follow up questions to HCPF [email protected] SLS Waiver Exception Review Process web page 5

Questions? 6

What is the “SLS Waiver Exception Review Process?” Began as a budget request put forth by the Department that requested increased flexibilities to serve individuals on the SLS waiver and was authorized through 21-22 Long Bill, SB 21-205 This flexibility could help members who experience a life change or any other circumstance that may warrant a Developmental Disability (DD) waiver emergency enrollment request 7

What is the “SLS Waiver Exception Review Process?” Parameters as outlined in the Budget Request: Individuals demonstrate need Avoids a DD waiver enrollment Offer service unit limitation exceptions Offer SPAL limit exceptions Exception applied on a member by member basis Exception requests reviewed by a 3rd party reviewer 8

What is the “SLS Waiver Exception Review Process?” In summary, the exception process gives SLS waiver members access to services and/ or funding to be able to access the services and supports that ensure their health and safety in the community. 9

What is the “SLS Waiver Exception Review Process?” The SLS Waiver Exception Process is not: To replace a Support Intensity Scale (SIS) reassessment To replace a Support Level request 10

Questions? 11

Timeline Implementation: January 1, 2022 What Needs to Happen? HCBS - SLS Waiver amendment to the Centers for Medicare and Medicaid Services (CMS) for approval Regulations developed and reviewed through the Medical Services Board (MSB) process Contract procured for 3rd party reviewer Training and Implementation 12

HCBS - SLS Waiver Amendment CMS must approve the ability to implement this process Language in waiver does not outline the exception process exactly but more so allows the Department to implement an overall process: “There is an exception to the authorization limit for the set of services listed above through the SLS Waiver Exception Review. This review is completed by the Quality Improvement Organization (QIO), and allows for the authorization of services to exceed limitations as stated above when the member demonstrates a need. This review may delay or eliminate the need for an individual to move onto the DD waiver, thereby allowing the member to remain in the community of their choice.” Appendix C-4 Additional Limits on Amount of Waiver Services: Limits on Sets of Services Tentative start date for public comment for HCBS waiver amendments is August 12, 2021 HCBS Public Comment Opportunities 13

Questions? 14

Regulation Development In order for this rule to be effective by January 1, 2022, the draft rule must be ready to be presented in October 2021 to the Medical Services Board (MSB) Part of our next meeting, August 17, 2021, will be reviewing a draft document of regulations and collecting feedback OCL Stakeholder Engagement Calendar 15

Questions? 16

Contractor Procurement The Department works with Quality Improvement Organizations (QIO) like Telligen, previously eQHealth, Keppro, etc. for Prior Authorization Reviews (PARs) but also for certain program eligibility determinations Based on the budget request, the Department will be looking to use a QIO for this SLS Waiver Exception Review Process request review This will include training the QIO to how to determine “demonstrated need.” 17

Training and Implementation There is a quick turnaround time for implementing this exception process for January 1, 2022 The Department will continue to collect feedback on this initiative and coordinate training for involved entities If stakeholders have suggestions for the type of training that would be most effective and beneficial to respective groups, please share! 18

Question s and Feedbac k? 19

Next Steps Stakeholder Engagement #2 - Regulatory Review and Exception Process Parameters for “Individuals in Need” August 17, 2021 3:00 - 4:00 pm Stakeholder Engagement #3 - Review Final Draft of Process Development and Collect Final Feedback September 13, 2021 3:00 - 4:00 pm 20

Contact Info Lindsay Westlund HCBS Benefits Supervisor [email protected] HCPF [email protected] 21

Thank you! 22