COUNTY DEPARTMENT AND CASE MANAGEMENT AGENCY (CMA)

REQUIREMENTS AND RESPONSIBILITIES A. The county department shall: 1. Ensure all requirements of the county department are implemented, as appropriate for the HCA program, related to: a. General requirements, as outlined in Section 3.520; and, b. Old Age Pension, as outlined in Section 3.530; and, c. Aid to the Needy Disabled State Only and Colorado Supplement, as outlined in Section 3.540 and 3.546; and, d. Financial redetermination, as outlined in Section 3.550. 2. Determine financial eligibility for HCA in the statewide automated system and update any changes in the case record. 3. Notify the CMA in writing: a. Within five (5) working days of determining HCA eligibility. b. Within five (5) working days after the eligibility worker determines that the client is no longer financially eligible for HCA. c. Within one (1) working day when the client has filed a written appeal with the county department. d. Within one (1) working day when the client has withdrawn the appeal or a final agency decision has been entered. 4. Respond to requests for information from the CMA within ten (10) working days. B. The CMA shall: 1. Provide intake, screening, and referral activities, as follows: a. Determine the appropriateness of a referral for a client assessment. 1) If appropriate, complete intake activities within two (2) working days of the referral. 2) Obtain the client's or client's authorized representative's signature on the intake form. 3) Complete the HCA functional assessment within thirty (30) calendar days of referral. b. Provide the client information and referral to other agencies, as needed. 2. Identify potential payment source(s), including the availability of private funding: a. Refer the client to the county department to complete an application; or, b. Refer the client to another community resource that can assist in completing the application; or, c. Verify the client's ability to private pay for services. 3. Complete a functional assessment when the county department provides written notification that the client has requested HCA and is receiving or has submitted an application for Old Age Pension (OAP), Aid to the Needy Disabled Colorado Supplement (AND-CS), Aid to the Needy Disabled State Only (AND-SO), or the client is receiving Supplemental Security Income (SSI). a. If the client is being discharged from a hospital or nursing facility, the CMA shall complete the functional assessment regardless of whether an application date for State assistance or Medicaid has been provided by the county department. b. The CMA shall complete the functional assessment within two (2) working days after notification when a client is being transferred from a hospital to the HCA program. c. The CMA shall complete the functional assessment within five (5) working days after notification when a client is being transferred from a nursing facility to the HCA program. d. The CMA shall complete the functional assessment within ten (10) working days after notification for all other clients. However, the CMA shall have a procedure for prioritizing urgent referrals. 4. Document all case information. a. Documentation of contacts and case management activities shall be entered into the State prescribed system within five (5) working days of the contact or activity. b. All information related to intake, assessment, and care planning shall be thoroughly documented within ten (10) working days of the intake, assessment or care planning using State Department prescribed forms and the State prescribed system. c. Additional documentation that cannot be entered into the State prescribed system shall be maintained in the case file. 5. Notify clients of their program status using the State Department prescribed form at the time of initial eligibility, when there is a significant change in the client's payment or services, when an adverse action is taken, or at the time of discontinuation. 6. Notify the county department in writing: a. Within five (5) working days of determining HCA functional eligibility. b. Within five (5) working days after the CMA determines that the client is no longer functionally eligible for HCA. c. Within one (1) working day when the client has filed a written appeal with the CMA. d. Within one (1) working day when the client has withdrawn the appeal or a final agency decision has been entered. 7. Respond to requests for information from the county department within ten

(10) working days. 8. Notify the client, at the time of his or her application and at the time of reassessment or discontinuation of the right to request a state level fair hearing before an Administrative Law Judge as outlined in Section 3.587, and to appeal adverse actions of the CMA or county department. 9. Inform the client's Adult Protective Services caseworker, if applicable, of the client's status. The case manager shall participate in mutual staffing of the client's case. 10. Immediately report to the Colorado Department of Public Health and Environment any congregate facility, with three (3) or more residents, that is not licensed. 11. Immediately report to the county department any information that indicates an overpayment, incorrect payment, or misuse of any HCA benefit, and shall cooperate with the county department in any subsequent recovery process. 12. Be subject to routine quality control, program monitoring, and contract management to minimally include: a. Targeted review of the State prescribed system documentation; b. Case file review; c. Targeted program review conducted via phone, email, or survey; d. Onsite program review; e. A performance improvement plan to correct areas of identified non- compliance; and, f. Contract sanctions when the CMA fails to implement a performance improvement plan.