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What to Expect of the ULTC 100.2 in Colorado

Two cups and saucers on a tray waiting to have coffee poured into them.

After applying for an HCBS Waiver through one of Colorado’s contracted Case Management Agencies, the next step will be a Uniform Long Term Care or ULTC 100.2 Assessment. ULTC 100.2 in Colorado determines level of care needed for long term services and supports. The good news is, the ULTC 100.2 is not a ‘test.’ As such, there is no preparation required. This post will cover what to expect with the ULTC 100.2 in Colorado.

What is ULTC 100.2 in Colorado?

ULTC 100.2 is a functional assessment tool specific to Colorado. Functional assessment tools are instruments used by state Medicaid services to determine an individual’s need for long term supports and services. The particular instrument used in our state is the Uniform Long Term Care or UTLC 100.2 Colorado. It is ‘uniform’ meaning it is used by all case management agencies in Colorado, statewide.

Basically, ULTC 100.2 is an assessment process that is documented in paperwork form. It’s completed in an interview-style questionnaire, initially prior to enrollment in Medicaid Waiver services and again annually thereafter. These are called the Initial 100.2 and the Continued Stay Review (CSR) 100.2, respectively. The ULTC 100.2 will need to be repeated annually, at a minimum, or when the participant’s needs or circumstances change significantly. ULTC 100.2 forms are available to be reviewed online here

The end result of the assessment is to certify the need for long term services and supports, particularly the kind that necessitate nursing home level of care. In order to qualify for an HCBS Waiver in Colorado, the ULTC 100.2 assessment must certify that the individual meets the definition of functional need for nursing home level of care.

Other helpful purposes for the ULTC 100.2

In addition to being used to certify functional need for nursing level of care, the ULTC 100.2 in Colorado:

  1. aids in determining services and level of care,
  2. helps determine which Waiver is best suited to the need of the applicant, and
  3. is also helpful for identifying necessary services and supports regardless of the funding source.

What to Expect of the ULTC 100.2 in Colorado

First of all, you need to know that the ULTC 100.2 assessment takes place at the applicant’s home in a face to face interview. A representative from the Case Management Agency with which the Two cups and saucers on a tray waiting to have coffee poured into them.applicant applied for an HCBS Waiver will meet with the applicant and any family members who wish to be present. The ULTC 100.2 consists of answering a lot of questions asked by the interviewer.

Types of questions that will be asked at ULTC 100.2 assessment

In the level of care determination, the interviewer will ask questions about how much support is needed in two key areas:

  1. Activities of Daily Living (ADL), and
  2. Supervision, which encompasses Behaviors and Memory Cognition. 

Questions about ADL

There are six categories of ADL which will be addressed in the interview. These include:

  • Bathing
  • Dressing
  • Toileting
  • Mobility
  • Transferring
  • Eating

Here are examples of types of questions that will be asked regarding ADL:

  1. Does applicant bathe or shower and how often?
  2. Does applicant need reminders or hands on assistance to bathe and who sets water temperature?
  3. Does applicant need assistance getting in and out of shower/tub or assistance with washing and rinsing of body/hair?
  4. Is applicant generally independent or does applicant you need assistance with toileting? What does that look like?
  5. Does applicant have accidents or need for protective undergarments?
  6. Is applicant on a bowel program or require ostomy or catheter care?

Similar types of questions are asked regarding all six ADL mentioned above.

Questions about supervision

Questions about supervision will be asked during the interview. Key areas addressed will be:

  • Behavior, and
  • Memory/ Cognition.

Below are sample questions about behavior and cognition that might be asked.

  1. Does applicant ever harm himself or herself or others or cause property damage?
  2. Does applicant need redirection? And what type of redirection? (e.g. Verbal cues? Hands-on?)
  3. Who manages applicant’s money and purchases? Does applicant need assistance to complete paperwork?
  4. Does applicant have the ability to recognize and respond to an emergency?

In Addition to the Interview: PMIP

Together with the ULTC 100.2 assessment will be a request for Professional Medical Information Page (PMIP) to be completed by the applicant’s physician. The purpose of the PMIP is to provide supporting information to the interview of the ULTC 100.2. The supporting information will include medication, diagnosis (if any), prognosis, diet, and allergies, etc.
The PMIP is an additional component to determining level of care and targeting criteria. As a part of the ULTC 100.2, the PMIP will need to be completed annually after Waiver enrollment.

Certification Requirements to Qualify for an HCBS Waiver in Colorado

To receive Medicaid Waiver certification through the ULTC 100.2, the assessment must document a moderate need for support in either the area of ADLs or Supervision, as determined by the scores on the ULTC 100.2.

Conclusion

As you can see, what to expect of the ULTC 100.2 in Colorado is no cause for worry. There’s no preparation required. All it requires is the applicant’s time commitment to the process and willingness to be open and honest about level of care needs with the interviewer. A copy of the full ULTC 100.2 assessment is available to be reviewed online here.

If you have any questions regarding applying for HCBS Waivers in Colorado, please contact The Independence Center at (719) 471-8181 ext. 130. As southern Colorado’s disability resource center, The Independence Center can help connect you with the right person to navigate the application process.

 

How to Apply for HCBS Waivers in Colorado

woman holding young child on her lap while she looks at the computer

In our last post we introduced Home and Community Based Services or HCBS Waivers in Colorado. In this post we’re going to cover how to apply for HCBS Waivers. HCBS Waivers are designed to give you more choice and decision making capability over your care and to help you avoid institutionalized care such as nursing homes.

If you or a family member need services at home to help live independently, you may qualify for one of Colorado’s HCBS Waivers, which are provided under the Health First Colorado medicaid program. HCBS Waivers can be confusing and this post will help you understand how to apply for a waiver and what eligibility requirements must be met.

Here’s a list of the available waivers in Colorado:

Adult waivers

  • Persons with Brain Injury (BI)
  • Community Mental Health Supports (CMHS)
  • Persons who are Developmentally Disabled (DD)
  • Persons who are Elderly, Blind and Disabled (EBD)
  • Persons with Spinal Cord Injury (SCI)
  • Supported Living Services (SLS)

Children’s waivers

  • Children’s Extensive Support (CES)
  • Children’s Home and Community Based Services (CHCBS)
  • Children’s Habilitation Residential Program (CHRP)
  • Children with Life Limiting Illness (CLLI)

Click on this link to see a chart depicting the children’s HCBS waivers, their targeting criteria, and available services.

To Apply for an HCBS Waiver, Start with a State-Sanctioned Case Management Agency

Application for any one of Colorado’s HCBS Waivers starts with one of Colorado’s 47 contracted Case Management Agencies or your county human or social service office.

In 2017, Governor Bill Hickenlooper signed HB17-1343 into law, which allows Health First Colorado members (Medicaid participants) to choose a Case Management Agency that is separate from their direct service provider. This was done so that the agency that handles applications, assessments, care plans and monitoring of services is not the same agency that provides home health and other community based services. Essentially it removes conflicts of interest and provides better care for Colorado residents who are on HCBS Waivers. In the past, if a person filed a complaint against a provider, it was often the same provider who also was the case manager, making reporting complaints a tangled affair. Now, keeping case management separate allows for more checks and balances, and fair dealings for persons with disabilities.

Three Types of Case Management Agencies for HCBS Waiver Case Management

There are three types of agencies, in addition to your local county human social service office. These different types of case management agencies handle applications, assessments, paperwork and monitoring for specific waivers and their services.

1. Single Entry Point Agencies (SEP)

Single Entry Point Agencies (SEP) provide care planning and case management for the following HCBS Waivers:
  • Children with Life Limiting Illness,
  • Brain Injury,
  • Community Mental Health Supports,
  • Persons who are Elderly, Blind and Disabled and
  • Persons with Spinal Cord Injury.

2. Community Centered Boards (CCB)

Since Community Centered Boards (CCB) are often the only local resource in rural areas, they are allowed to provide targeted case management and services for individuals with intellectual and developmental disabilities.
They are just not allowed to provide both case management and direct services for the same individual, to avoid conflict of interests.
CCBs provide case management and services for the following waivers:
  • Children’s Extensive Support,
  • Persons who are Developmentally Disabled, and
  • Supported Living Services.
One example of a Community Centered Board is The Resource Exchange in El Paso County.

3. Private Case Management Agencies

Private Case Management Agencies provide case management and services for:
  • Children’s Home and Community Based Services
An example of a Private Case Management agency is A Rise Above in El Paso County

4. County Human Social Service office

Your county human social service office provides case management only for the Children’s Habilitative Residential Program Waiver

Which Case Management Agency is Right for Me?

If you know which waivers you may qualify for, click on the above links to be taken to lists of all the Case Management Agencies. You can then reach out to the woman holding young child on her lap while she looks at the computerindividual agency to begin the HCBS Waiver application process. If you’re unsure which agency to start with, contact April Clark at The Independence Center Home Health at (719) 471-8181 x 130. April may be able help you decide the best place to start.

Your Case Management Agency will be your point of contact for your HCBS Waiver application. As part of your application, there will be a Uniform Long Term Care ULTC 100.2 Assessment. Our next post will talk about what you can expect with this assessment.

HCBS Waivers in Colorado: An Introduction

Triangle depicting 'Health First Colorado, Colorado State Medicaid plan (regular Medicaid)' at the base of the triangle [larger area] and 'HCBS Waivers, Benefits for participants with more intensive needs & specialized diagnoses' at the top of the triangle [smaller area].

If you’ve heard the term ‘HCBS Waiver’, but you’re confused about what this means, this article is for you. We’ll break it down into plain language so you can understand HCBS Waivers in Colorado. Our state has 10 Medicaid HCBS waiver programs, one of the highest counts of waiver programs in the nation. This is good news for Colorado residents with disabilities who need home health care services! Let’s talk about the terms you’ll hear frequently so you’ll know what they mean.

What is Medicaid?

Medicaid is an entitlement program that was created in 1965 by the Federal government. An ‘entitlement program’ means that if you meet the income and eligibility requirements, the state is required to give you the services you qualify for. Even though it is optional (not mandated by the Federal government) to participate, all 50 states have a Medicaid program. Each state’s Medicaid program is jointly funded between the state and the Federal government. Basically, the Federal government matches dollar for dollar what each state puts toward their Medicaid program.

What is HCBS?

HCBS stands for Home and Community Based Services. Programs for Home and Community Based Services are called HCBS Waivers. A ‘waiver’ can be thought of as a ‘program.’ Anytime you see or hear the word ‘waiver,’ you can replace it in your mind with the word ‘program’ and it will make more sense.

HCBS Waivers (programs) are designed to help specific populations with the most intensive medical needs. Most often, these are people with disabilities. HCBS Waivers in Colorado are designed to give people with disabilities or certain diagnoses greater level of choice in how and where services are obtained. This often means the difference between having to be in a healthcare setting to receive medical services, or receiving services at home. For many people, receiving services at home leads to increased independence and quality of life.

What is Colorado Department of Health Care Policy and Financing (HCPF)?

If you see or hear about the Colorado Department of Health Care Policy and Financing (HCPF),  related to HCBS, this is because it is the state agency that oversees Colorado’s Medicaid program and HCBS Waivers. Most of the time, you’ll probably just hear Colorado’s Medicaid program being called Health First Colorado.

What is the difference between Medicaid and HCBS?

Home and Community Based Services (HCBS) are part of Medicaid. If you can imagine a

Triangle depicting 'Health First Colorado, Colorado State Medicaid plan (regular Medicaid)' at the base of the triangle [larger area] and 'HCBS Waivers, Benefits for participants with more intensive needs & specialized diagnoses' at the top of the triangle [smaller area].

As you can see by the graphic, a much smaller population fits into the HCBS Waivers population as compared to the greater regular Medicaid population.

triangle with the base of the triangle representing the general population who qualifies for regular Medicaid, and the top of the triangle representing a smaller group of participants, this is helpful when thinking about the relationship between HCBS and Medicaid. Many fewer participants in Medicaid will qualify for or need Home and Community Based Services than regular Medicaid.

How do I qualify for a HCBS Waiver?

Functional Eligibility

HCBS Waivers in Colorado have three eligibility criteria that need to be met. The first is functional eligibility. This means: do you meet the requirements for the level of care? Functional eligibility is determined by a caseworker for one of Colorado’s 47 contracted Case Management Agencies.

Case Management Agencies are contracted on a regional basis with the state to assess participant needs, provide referrals, develop service plans, track delivery of services and oversee participants’ experience with the program.

The assessment for services handled by Case Management Agencies is called the Uniform Long Term Care (ULTC) 100.2 assessment. We’ll talk more about this assessment in a future post.

Targeting Criteria

“Targeting criteria” is just a fancy way of saying: “Do you meet the certain age, specific injury, or diagnosis requirements?”

Participants may meet targeting criteria for more than one waiver. Therefore, it’s important for the Case Manager to be familiar with all the Waivers and their eligibility requirements so they can fully inform you of your options

Financial Eligibility

Financial eligibility has to do with income requirements. Eligibility for HCBS Waivers is determined by your county’s human or social service office. You’ll need to apply with them.

Conclusion

Waivers can vary greatly from state to state and have different names and services. Just because you have qualified for a waiver in another state does not mean you will qualify in Colorado. If you move to Colorado from another state where you qualified for a waiver, you will need to go through a new application process in Colorado.

Unlike regular Medicaid, which is based on entitlement, Waivers can have waiting lists. Participants can only be enrolled in one waiver at a time. Participants are allowed to be on one kind of waiver while waiting for a spot to open up on another waiver.

Once eligibility for a waiver has been met as described above, your case manager will work with you to develop an individualized service plan. In our next posts we’ll talk about how to apply for HCBS Waivers in Colorado, and what to expect at the ULTC 100.2 assessment in Colorado.

What to Expect from Home Health Care

What to Expect from Home Health Care: image shows two sets of feminine hands grasping each other as if for comfort

Once you choose a home health agency, it’s time to get your care off to a good start. Do you know what to expect from home health care? Knowing your rights as you enter a relationship with a new home health provider is key to a good start. Every good relationship is two-sided. There are things you can do to help start the relationship on good terms.

What to Expect from Home Health Care

By law, patients served by a Medicare-approved home health agency have certain rights. Home health patient rights involve the right to have a say in your care, be respected, and have your information treated as confidential.

As a home health client, you have a right to:

  • Choose your home health agency and provider(s).
  • Be treated with respect and have your property treated with respect.
  • Participate in decisions regarding your care and receive a copy of your care plan.
  • Have your family act on your behalf if you are unable.
  • Additionally, you have the right to know why questions are being asked during your assessments, and the right to refuse to answer. It’s in your best interest to give as much information as you feel comfortable giving to your care assessor. The more information about your needs they have, the better they can help you design a care plan that will meet your needs to help you continue to live independently.

Getting off to a Good Start with Your Home Health Provider

Here are five tips for building a good working relationship with your home health care provider:

  1. Learn to be able to ask and receive help. This is no small feat for some. However, it can greatly ease the beginning of the relationship when What to Expect from Home Health Care: image showing two sets of feminine hands grasping each other as if for comfortyou are able to ask for help when needed and receive help. Help goes both ways. Your provider will also need your help getting accustomed to your needs and routines. The more patience you show your caregiver, the more patience you should receive in return.
  2. Practice mutual respect. Just as you deserve to have your person and your home respected by your caregiver, your caregiver deserves your respect as a person. Practicing mutual respect encourages healthy communication and will lead to a more trusting relationship.
  3. Set and abide by expectations. The biggest thing here, as with any relationship, is setting expectations and boundaries from the get go. Just as a partner or parent or child cannot read your mind, neither can your home health caregiver. Being clear about your needs and expectations up front will help prevent misunderstandings later. Also, it’s important to understand that caregivers are expected to follow the care plans for your daily care. Don’t expect your caregiver to deviate from the care plan.
  4. Communicate. Address issues early. If issues arise, it is best to handle them early, rather than allowing things to progress and misunderstandings to happen. By giving regular feedback about your caregiver’s care, you can help your caregiver learn your preferences. When you use common courtesies like “please,” “thank you,” and giving genuine compliments when they are deserved, your caregiver will enjoy working with you.
  5. Inform. Keep your home health agency informed of health changes, hospitalizations, and other pertinent health information throughout the year. Maintain good communication with the scheduling department, HCBS coordinators, and supervisors when necessary.

A good relationship with your home health provider is made easier when you follow these basic etiquette guidelines. Also, when you know what to expect from home health care, you’ll know when your care is falling short. A mutually satisfying relationship between you and your provider is possible. Check out this heartwarming page where home care nurses tell their stories.

Calming Colors, Restful Space: Designing a Bedroom for a Child with Autism

Calming Room Design for Child on Autism Spectrum

By Jenny Wise

 

Calming Room Design for Child on Autism SpectrumParents are inclined to decorate a child’s bedroom with bright colors and lots of fun knick-knacks, creating an engaging, often whimsical environment designed to delight a child. For parents of autistic children, the reality is somewhat different. A child on the autism spectrum does much better in a calming, distraction-free space that’s conducive to relaxation and restful sleep. An autistic child’s bedroom should be a haven from the chaos of the world, which confronts them with a daily sensory onslaught that’s exhausting and makes it difficult to function. This hyper-sensitivity to stimuli makes it important establish a room their child can retreat to whenever he needs a personal retreat.

A Natural, Muted Look

Bright reds and sunny yellows look cheery but challenge an autistic child with a visual onslaught he or she will find difficult to cope with. Instead, opt for earth tones (beige, tan, and brown), or soft shades of blue and green, complemented by rugs made of soft, natural fibers. The natural look and feel of wood furniture can help create a safe haven. Make sure there are no sharp corners or metal attachments on furniture that could cause injury.

Lighting

Soft lighting that fosters a relaxing environment is ideal, so emphasize LED or incandescent light bulbs and use window treatments that allow natural light in and can be shuttered easily. Exposure to natural light is healthy and helps a child sleep better at night, but other external elements — particularly sound — may be problematic if your child is especially susceptible to noise (many autistic children are). Automated lighting, which senses when someone enters and leaves the room, is very useful in creating a soothing play and sleep environment for autistic children.

The Importance of Sleep

Good, restful sleep is essential for any child. For a youngster on the autism spectrum, however, it can help prevent sudden mood swings and emotional reactions to frustrations that occur during the day. If your child is having trouble getting to sleep at night, discomfort may be the reason, so take a close look at his mattress. A lumpy, uneven mattress, or one that holds body heat, may be causing insomnia. If so, it may be necessary to get a new one with thin, breathable material that helps keep his body temperature down.

 

Separate Spaces

Spatial orientation is also an important factor when designing for an autistic child, so try to create a bedroom with distinct areas for sleep, study, and play. This will minimize distraction and make it easier for your child to focus on one activity at a time. Soft, simple, and comfortable furnishings are best, as are soft toys. Be careful to establish a homework space that’s clearly distinguishable from other parts of the room to help concentration on schoolwork.

Noise-Inhibiting Accoutrements

Make liberal use of sound-inhibiting materials in your child’s bedroom. Consider using acoustic wall panels and flooring, which can mitigate the sound of passing cars and trucks and TVs from other rooms. Soft rugs, pillows, and blankets are also helpful in muffling sound and helping an autistic child feel both safe and comfortable. Wicker can be a much better option than a hardwood chest of drawers or a wooden toy chest, which can be upsetting if slammed shut. Try using colored plastic bins that can easily be accessed for storing frequently used objects.

A well-planned bedroom can give your child a room that’s conducive to healthy sleep, focused study, and creative play. Bear in mind the need to design an environment suffused in calm, soothing colors and with distinct, easily distinguishable spaces.

 

Image courtesy of Pixabay.com

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