Title of Proposed Rule:
Rule-making#:
Home Care Allowance (HCA) and Special Populations Home Care Allowance (SPHCA) Functional Assessment Revision
12-12-5-1
Office/Division
or
Program:
Office of Long Term Care/ Aging
and Adult Services
Rule Author: Peggy Rogers
Phone: 303-866-2829
Email:
[email protected]
___________________________________________________________________________________________
STATEMENT OF BASIS AND PURPOSE
Summary of the basis and purpose for the rule or rule change. (State what the rule says or does, explain why the
rule or rule change is necessary and what the program hopes to accomplish through this rule.)
The Division of Aging and Adult Services is requesting an emergency rule change to ensure that all eligibility
requirements related to the functional assessment scoring for Home Care Allowance (HCA) and Special
Populations Home Care Allowance (SP-HCA) are included in rule. Currently, the rules provide only a part of the
scoring system, which is a violation of statute.
An emergency rule-making (which waives the initial Administrative Procedure Act noticing requirements) is necessary:
X
to comply with state/federal law and/or
X
to preserve public health, safety and welfare
Explain: The Division of Boards and Commissions and the Attorney General’s Office agree that the rules must be
adopted on an emergency basis so that clients and providers have a complete understanding of the functional
assessment scoring process, used for eligibility for HCA and SP-HCA.
Authority for Rule:
State Board Authority: 24-4-103(6), C.R.S. (2012) provides for emergency adoption of rules; 26-1-107, C.R.S.
(2012) authorizes the State Board to promulgate rules; 26-1-111, C.R.S. (2012) authorizes the State Board to
promulgate rules for public assistance and welfare activities.
Program Authority: (give federal and/or state citations and a summary of the language authorizing the rule-making)
Section 26-2-122.3 - creates the Home Care Allowance program and grants the authority to the department to
promulgate rules;
Section 26-2-122.4 - creates the Special Populations Home Care Allowance program and grants the authority to
the state board to promulgate rules.
Initial Review
Proposed Effective Date
01/04/2013
01/04/2013
Final Adoption
EMERGENCY Adoption
02/01/2013
01/04/2013
_______________
[Note: “Strikethrough” indicates deletion from existing rules and “all caps” indicates addition of new rules.]
Rule-making Form SBA-3a (08/09)
Title of Proposed Rule:
Rule-making#:
Home Care Allowance (HCA) and Special Populations Home Care Allowance (SPHCA) Functional Assessment Revision
12-12-5-1
Office/Division
or
Program:
Office of Long Term Care/ Aging
and Adult Services
Rule Author: Peggy Rogers
Phone: 303-866-2829
Email:
[email protected]
___________________________________________________________________________________________
STATEMENT OF BASIS AND PURPOSE (continued)
Yes
X
No
Yes
X
No
Does the rule incorporate material by reference?
Does this rule repeat language found in statute?
If yes, please explain.
State Board Administration will send this rule-making package to Colorado Counties, Inc., Office of State Planning and
Budgeting, and the Joint Budget Committee. The program has sent this proposed rule-making package to which
stakeholders?
Colorado Human Services Directors Association (CHSDA), County Adult Financial Supervisors, Colorado
Senior Lobby, Community Centered Boards, Single Entry Point Agencies, Colorado Department of Health
Care Policy and Financing, Colorado Commission on Aging, Economic Security Sub-PAC
Attachments:
Regulatory Analysis
Overview of Proposed Rule
Stakeholder Comment Summary
Rule-making Form SBA-3a (08/09)
Title of Proposed Rule:
Rule-making#:
Home Care Allowance (HCA) and Special Populations Home Care Allowance (SPHCA) Functional Assessment Revision
12-12-5-1
Office/Division
or
Program:
Office of Long Term Care/ Aging
and Adult Services
Rule Author: Peggy Rogers
Phone: 303-866-2829
REGULATORY ANALYSIS
(complete each question; answers may take more than the space provided)
1. List of groups impacted by this rule:
Which groups of persons will benefit, bear the burdens or be adversely impacted by this rule?
Persons applying for Home Care Allowance (HCA) or Special Populations Home Care Allowance (SP-HCA) will
benefit from the rule adoption because it will place in rule the complete criteria used to score the functional
assessment. The functional assessment is a criteria of eligibility for both HCA and SP-HCA, thus increasing
transparency into the eligibility process for applicants and current recipients undergoing annual assessment review.
2. Describe the qualitative and quantitative impact:
How will this rule-making impact those groups listed above? How many people will be impacted? What are the
short-term and long-term consequences of this rule?
All HCA and SP-HCA clients will be affected, a total caseload of approximately 2,240 persons. All new applicants for
the HCA program will be affected. However, there is not a negative impact to this rule change. Codifying the
functional assessment scoring in rule provides transparency to the eligibility determination decisions.
3. Fiscal Impact:
For each of the categories listed below explain the distribution of dollars; please identify the costs, revenues,
matches or any changes in the distribution of funds even if such change has a total zero effect for any entity that
falls within the category. If this rule-making requires one of the categories listed below to devote resources without
receiving additional funding, please explain why the rule-making is required and what consultation has occurred
with those who will need to devote resources.
State Fiscal Impact (Identify all state agencies with a fiscal impact, including any Colorado Benefits
Management System (CBMS) change request costs required to implement this rule change)
None. This process is currently being used to determine eligibility. The requested rule change
simply codifies the process in rule.
County Fiscal Impact
None. This process is currently being used to determine eligibility. The requested rule change
simply codifies the process in rule.
Federal Fiscal Impact
None
Other Fiscal Impact (such as providers, local governments, etc.)
None. This process is currently being used to determine eligibility. The requested rule change
simply codifies the process in rule.
Rule-making Form SBA-3b (10/08)
Title of Proposed Rule:
Rule-making#:
Home Care Allowance (HCA) and Special Populations Home Care Allowance (SPHCA) Functional Assessment Revision
12-12-5-1
Office/Division
or
Program:
Office of Long Term Care/ Aging
and Adult Services
Rule Author: Peggy Rogers
Phone: 303-866-2829
REGULATORY ANALYSIS (continued)
4. Data Description:
List and explain any data, such as studies, federal announcements, or questionnaires, which were relied upon
when developing this rule?
Not applicable.
5. Alternatives to this Rule-making:
Describe any alternatives that were seriously considered. Are there any less costly or less intrusive ways to
accomplish the purpose(s) of this rule? Explain why the program chose this rule-making rather than taking no
action or using another alternative.
Without adoption of this rule, the Department will continue to be non-compliant with statute, which requires all
eligibility criteria for public assistance be outlined in rule. The current recipients of HCA and SP-HCA and future
applicants of HCA will not have the full eligibility requirements available to them. They will be unable to determine
whether the functional assessment score they received is correct under the scoring guidelines of the HCA and SPHCA programs.
Rule-making Form SBA-3b (10/08)
Title of Proposed Rule:
Rule-making#:
Home Care Allowance (HCA) and Special Populations Home Care Allowance (SPHCA) Functional Assessment Revision
12-12-5-1
Office/Division
or
Program:
Office of Long Term Care/ Aging
and Adult Services
Rule Author: Peggy Rogers
Phone: 303-866-2829
OVERVIEW OF PROPOSED RULE
Compare and/or contrast the content of the current regulation and the proposed change.
Section Numbers
Current Regulation
3.720.2
Eligibility for Home Care
Allowance
3.720.3
Proposed Change
Stakeholder Comment
Technical cleanup
__
Yes
X
No
Rules list the areas of
functional assessment that are
reviewed for Home Care
Allowance (HCA) and Special
Populations Home Care
Allowance (SP-HCA)
Adds rules to provide detail of
the types of activities included
in each area of assessment
and provides the detail on how
each area of assessment is
scored. Combines this section
with previous section 3.720.32
to ensure all assessment
scoring rules are in one
section of rules. Updates the
Need for Paid Care rules so
that the scoring process is
more clearly defined. Moves
rules related to the scoring
process from Section
3.721.22, so that all scoring
rules are in one location.
__
Yes
X
No
3.720.31
Title – Functional Capacity
Score
Removes sub-title
__
Yes
X
No
3.720.32
Title – Need for Paid Care.
Rules outline the Need for
Paid Care scoring
Removes sub-title. Moves
Need for Paid Care scoring
rules into Section 3.720.3 so
that all scoring rules are in one
area.
__
Yes
X
No
3.720.33
HCA Payment Amount
Re-numbers sub-section to
3.720.31 and makes revisions.
__
Yes
X
No
3.721.22
Rules outline the Single Entry
Point’s role in conducting the
functional assessment
Deletes rules related to
assessment scoring that are
out of place in the rules to the
more logical location of
3.720.3. This ensures all rules
related to assessment scoring
are in one location.
__
Yes
X
No
Rule-making Form SBA-3c (10/08)
Title of Proposed Rule:
Rule-making#:
Home Care Allowance (HCA) and Special Populations Home Care Allowance (SPHCA) Functional Assessment Revision
12-12-5-1
Office/Division
or
Program:
Office of Long Term Care/ Aging
and Adult Services
Section Numbers
3.744
Rule Author: Peggy Rogers
Current Regulation
Rules list the functional
assessment areas for SPHCA
Phone: 303-866-2829
Proposed Change
Adds rules to provide detail of
the types of activities included
in each area of assessment
and provides the detail on how
each area of assessment is
scored. Updates the Need for
Paid Care rules so that the
scoring process is more
clearly defined. Aligns SPHCA rules with HCA rules for
the same processes.
Stakeholder Comment
__
Yes
X
No
Rule-making Form SBA-3c (10/08)
Title of Proposed Rule:
Rule-making#:
Home Care Allowance (HCA) and Special Populations Home Care Allowance (SPHCA) Functional Assessment Revision
12-12-5-1
Office/Division
or
Program:
Office of Long Term Care/ Aging
and Adult Services
Rule Author: Peggy Rogers
Phone: 303-866-2829
STAKEHOLDER COMMENT SUMMARY
DEVELOPMENT
The following individuals and/or entities were included in the development of these proposed rules (such as other
Program Areas, Legislative Liaison, Sub-PAC, and the Child Welfare Action Committee):
None.
THIS RULE-MAKING PACKAGE
The following individuals and/or entities were contacted and informed that this rule-making was proposed for
consideration by the State Board of Human Services:
Colorado Human Services Directors Association (CHSDA), County Adult Financial Supervisors, Colorado
Senior Lobby, Community Centered Boards, Single Entry Point Agencies, Colorado Department of Health
Care Policy and Financing, Colorado Commission on Aging, Economic Security Sub-PAC,
Are other State Agencies (such as Colorado Department of Health Care Policy and Financing) impacted by these
rules? If so, have they been contacted and provided input on the proposed rules?
X
Yes
No
Have these rules been reviewed by the appropriate Sub-PAC Committee?
Yes
X
No
Date presented: Will be sent to them via email no later than December 17, 2012. Were there any issues
raised? ____ Yes __X__ No
If not, why. Have not received the rule package as of this date.
Comments were received from stakeholders on the proposed rules:
Yes
X
No
Rule-making Form SBA-3c (10/08)
(9 CCR 2503-7)
3.720 HOME CARE ALLOWANCE
3.720.1 DEFINITION [Rev. eff. 1/1/12]
Home Care Allowance (HCA) is a special allowance for the purpose of securing services to an individual in his/her
home, based on the case manager's assessment. Home Care Allowance is a non-entitlement program, which
cannot be combined with other long-term care programs such as a Home and Community Based Services waiver
or adult foster care. The HCA program is designed to serve those recipients with the lowest functional abilities and
the greatest need for paid care. Eligibility for, and authorized amounts of, the Home Care Allowance are subject to
available appropriations.
3.720.2 ELIGIBILITY [Rev. eff. 1/1/12]
Eligibility for the Home Care Allowance program shall be based on financial need, the applicant's or recipient's
fFunctional cCapacity score, and the applicant's or recipient's nNeed for pPaid cCare score. The applicant or
recipient must:
A. Meet all eligibility criteria required for either the Old Age Pension (OAP) or Aid to the Needy Disabled/Aid to the
Blind-State Only (AND/AB-SO) program; or,
B. Be approved for Supplemental Security Income (SSI) benefits and be receiving at least a $1.00 SSI payment;
and,
C. Have an HCA eligible functional capacity ASSESSMENT score and need for paid care score as outlined in
Sections 3.720.31 and 3.720.32.
3.720.21 Single Entry Point Agencies [Eff. 1/1/12]
Single Entry Point (SEP) agencies shall utilize the State prescribed form to determine Home Care Allowance (HCA)
eligibility and authorized amounts for all applicants and recipients.
3.720.3 FUNCTIONAL ASSESSMENT SCORING AND ELIGIBILITY
3.720.31 Functional Capacity Score [Rev. eff. 1/1/12]
A. In order to be eligible for the Home Care Allowance Program, each CLIENT (applicant or recipient) SHALL must
meet the SCORE A minimum OF TWENTY ONE (21) POINTS ON THE functional capacity score of 21
points in the following areas SCALE and shall score a minimum of one (1) point on the total need for paid
care SCALE score.
1. Activities of daily living: includes transfers, bladder care, bowel care, mobility, dressing, bathing,
hygiene, and eating;
2. Basic instrumental activities of daily living: includes meal preparation, housework, laundry, and
shopping;
3. Supportive services: includes medicine management, appointment management, money management,
accessing resources, and telephoning.
B. The need for skilled personal care shall not be included in the case manager's scoring FOR THE FUNCTIONAL
CAPACITY OR NEED FOR PAID CARE. of the need for paid care score. Skilled personal care is not a
paid service of the Home Care Allowance program (see HCPF rules, Section 8.489.30 (10 CCR 2505-10)
for the definition of skilled personal care).
C. FUNCTIONAL CAPACITY IMPAIRMENT SHALL BE SCORED FOR EACH ACTIVITY OF DAILY LIVING (ADL)
OUTLINED IN SECTION 3.720.3, D, USING THE FOLLOWING SCALE:
1. INDEPENDENT: SCORE ZERO (0) IF THE CLIENT IS PHYSICALLY ABLE TO PERFORM ALL
ESSENTIAL COMPONENTS OF THE ADL, WITH OR WITHOUT AN ASSISTIVE DEVICE.
2. LOW: SCORE ONE (1) IF THE CLIENT IS ABLE TO PERFORM ALL ESSENTIAL COMPONENTS OF
THE FUNCTION, BUT SOME IMPAIRMENT OF FUNCTION EXISTS EVEN WITH AN ASSISTIVE
DEVICE. THE CLIENT REQUIRES SOME SUPERVISION OR PHYSICAL ASSISTANCE IN A
FEW OF THE COMPONENTS OF THE ACTIVITY.
3. MODERATE: SCORE TWO (2) IF THE CLIENT IS UNABLE TO PERFORM MOST OF THE
ESSENTIAL COMPONENTS OF THE FUNCTION EVEN WITH AN ASSISTIVE DEVICE, AND
REQUIRES A GREAT DEAL OF ASSISTANCE OR SUPERVISION TO ACCOMPLISH THE
ACTIVITY.
4. SEVERE: SCORE THREE (3) IF THE CLIENT IS TOTALLY UNABLE TO PERFORM THE FUNCTION
AND REQUIRES SOMEONE TO PERFORM THE TASK, OR THE CLIENT REQUIRES
CONSTANT SUPERVISION FOR THE TASK.
D. ACTIVITIES OF DAILY LIVING SHALL BE SCORED USING THE FUNCTIONAL CAPACITY IMPAIRMENT
SCALE OUTLINED IN SECTION 3.720.3, C, TO INCLUDE:
1. CRITICAL ADLS:
a. TRANSFERS: THE ABILITY TO MOVE BETWEEN SURFACES, SUCH AS GETTING IN AND
OUT OF BED; TRANSFERRING FROM A BED TO A CHAIR, WHEELCHAIR, OR
WALKER; MOVING FROM A CHAIR OR WHEELCHAIR TO A WALKER OR TO A
STANDING POSITION; AND THE ABILITY TO USE ASSISTIVE DEVICES, INCLUDING
PROSTHETICS.
b. BLADDER CARE: THE EXTENT TO WHICH THE CLIENT HAS CONTROL OF HIS/HER
BLADDER FUNCTIONS AND THE ABILITY OF THE CLIENT TO ACCOMPLISH THE
TASKS OF TOILETING, INCLUDING CATHETERIZING, GETTING ON AND OFF THE
TOILET, CHANGING INCONTINENCE PRODUCTS, AND CLEANING HIS/HER SELF.
c. BOWEL CARE: THE EXTENT TO WHICH THE CLIENT HAS CONTROL OF HIS/HER BOWEL
FUNCTIONS AND THE ABILITY OF THE CLIENT TO ACCOMPLISH THE TASKS OF
TOILETING, INCLUDING GETTING ON AND OFF THE TOILET, CHANGING
INCONTINENCE PRODUCTS, AND CLEANING HIS/HER SELF.
2. BASIC ADLS:
a. MOBILITY: THE ABILITY OF THE CLIENT TO AMBULATE AROUND THE HOUSE AND
AROUND ESSENTIAL PLACES OUTSIDE THE HOUSE, AND THE ABILITY TO
CHANGE POSITIONS WHILE SEATED OR LAYING DOWN, WITH OR WITHOUT
ASSISTIVE DEVICES.
b. DRESSING: THE ABILITY OF THE CLIENT TO ACCOMPLISH ALL PHASES OF THE
ACTIVITIES OF DRESSING AND UNDRESSING, INCLUDING GETTING, PUTTING ON,
FASTENING, AND TAKING OFF ALL ITEMS OF CLOTHING, BRACES, AND ARTIFICIAL
LIMBS.
c. BATHING: THE ABILITY OF THE CLIENT TO SAFELY ACCOMPLISH THE TASK OF
WASHING BODY PARTS INCLUDING GETTING INTO BATHING WATERS, WITH OR
WITHOUT ASSISTIVE DEVICES OR WITH OR WITHOUT STAND BY OR HANDS-ON
ASSISTANCE FROM ANOTHER PERSON.
d. HYGIENE: THE ABILITY OF THE CLIENT TO MAINTAIN PERSONAL HYGIENE OTHER
THAN BATHING, INCLUDING COMBING HAIR, BRUSHING TEETH, CLIPPING NAILS,
AND SHAVING.
e. EATING: THE ABILITY TO CUT FOOD INTO MANAGEABLE SIZE PIECES, CHEW, AND
SWALLOW FOOD, WITH OR WITHOUT ASSISTIVE DEVICES.
3. INSTRUMENTAL ACTIVITIES OF DAILY LIVING (IADLS)
a. MEALS: THE ABILITY TO SAFELY PREPARE FOOD TO MEET THE BASIC NUTRITIONAL
REQUIREMENTS OF THE INDIVIDUAL, INCLUDING CUTTING FOOD, TRANSFERRING
FOOD TO COOKING VESSELS AND/OR DISHES, UTILIZING UTENSILS, USING A
STOVE OR MICROWAVE, AND IMPLEMENTING SPECIAL DIETARY NEEDS.
b. HOUSEKEEPING: THE ABILITY TO MAINTAIN THE INTERIOR OF THE INDIVIDUAL’S
RESIDENCE FOR THE PURPOSE OF HEALTH AND SAFETY, SUCH AS WIPING
SURFACES, CLEANING FLOORS, MAKING A BED, AND CLEANING DISHES.
c. LAUNDRY: THE ABILITY TO GATHER AND WASH SOILED CLOTHING AND LINENS; USE
WASHING MACHINES AND DRYERS; HANG, FOLD, AND PUT AWAY CLEAN
CLOTHING AND LINENS.
d. SHOPPING: THE ABILITY TO PURCHASE GOODS THAT ARE NECESSARY FOR HEALTH
AND SAFETY. ACTIVITIES INCLUDE ABILITY TO MAKE NEEDS KNOWN, TO MAKE A
LIST, REACH FOR THE NEEDED ITEMS AT THE STORE, ABILITY TO ESTIMATE OR
DETERMINE THE COST OF THE ITEM, AND TO MOVE ITEMS INTO THE HOME AND
PUT THEM AWAY.
4. SUPPORTIVE ADLS
a. MEDICINE: THE ABILITY TO MANAGE MEDICATIONS, INCLUDING KNOWING THE NAME
OF THE MEDICATION, KNOWING THE AMOUNT, FREQUENCY, AND HOW TO TAKE
THE MEDICINE, UNDERSTANDING THE REASON FOR TAKING IT, AND
UNDERSTANDING POSSIBLE SIDE EFFECTS.
b. APPOINTMENT: THE ABILITY TO SCHEDULE OR MAKE AN APPOINTMENT FOR
ESSENTIAL ACTIVITIES, SUCH AS DOCTOR VISITS, MEETINGS WITH
CASEWORKERS, AND TRANSPORTATION.
c. MONEY: THE ABILITY TO MANAGE MONEY, SUCH AS BALANCING A CHECK BOOK,
WRITING CHECKS OR PAYING A BILL ELECTRONICALLY, AND ABILITY TO
UNDERSTAND FINANCIAL DECISIONS.
d. ACCESS: THE ABILITY TO ACCESS RESOURCES OR SERVICES IN THE COMMUNITY,
SUCH AS LOCATING THE RESOURCE/SERVICE AND COMPLETING THE PROCESS
NECESSARY TO RECEIVE THE RESOURCE OR SERVICE.
e. TELEPHONE: THE ABILITY TO USE THE TELEPHONE TO COMMUNICATE ESSENTIAL
NEEDS, SUCH AS ANSWERING THE PHONE IN A REASONABLE TIME, SPEAKING
CLEARLY AND LOUDLY ENOUGH TO BE UNDERSTOOD, DIALING THE PHONE,
INITIATING A CONVERSATION, HEARING THE CALLER, AND PLACING A CALL IN AN
EMERGENCY.
3.720.32 Need for Paid Care Score [Eff. 1/1/07]
AE. The need for paid care score shall be based on the frequency of the applicant's or recipient's CLIENT’S
UNMET need for paid care as follows:
SCORE
FREQUENCY
DEFINITION OF FREQUENCY
0
NONE
CLIENT’S NEEDS ARE MET. NO NEED FOR PAID CARE.
1
WEEKLY
CLIENT NEEDS PAID CARE UP TO AND INCLUDING ONCE A
WEEK.
2
DAILY
CLIENT NEEDS PAID CARE MORE THAN ONCE A WEEK
AND UP TO ONCE A DAY, SEVEN DAYS A WEEK.
3
TWICE DAILY
CLIENT NEEDS PAID CARE TWO OR MORE TIMES PER DAY
AT LEAST FIVE DAYS PER WEEK.
Frequency of Need for Paid
Care
No need for paid care
Up to and including once a
week
More than once a week and
up to seven days a week
At least two times per day,
five days per week
Need for Paid Care Score
0
1
2
3
F. THE NEED FOR PAID CARE SCORE SHALL BE MODIFIED BY THE FOLLOWING FACTORS:
1. NEED FOR PAID CARE SHALL BE SCORED AS ZERO (0) WHEN THOSE SERVICES ARE IN
PLACE THROUGH ANOTHER PROGRAM, AGENCY, OR INDIVIDUAL.
2. FOR CLIENTS LIVING WITH OTHERS, THE NEED FOR PAID CARE SHALL BE SCORED ONLY ON
THE CLIENT’S NEEDS THAT ARE GREATER THAN AND DIFFERENTIATED FROM NORMAL
HOUSEHOLD ROUTINE AND THE NORMAL EXPECTATION OF ASSISTANCE BY FAMILY
MEMBERS LIVING IN THE HOME.
3. FOR CLIENTS APPROVED FOR SPECIAL POPULATIONS HOME CARE ALLOWANCE, AS
DEFINED AT SECTION 3.740, THE NEED FOR PAID CARE SHALL BE SCORED ONLY ON THE
CLIENT’S NEEDS THAT ARE GREATER THAN AND DIFFERENTIATED FROM SERVICES
RECEIVED THROUGH THE HOME AND COMMUNITY BASED SERVICES SUPPORTIVE
LIVING SERVICES (HCBS-SLS) OR CHILDREN’S EXTENSIVE SUPPORT (HCBS-CES)
WAIVER.
4. FOR CHILDREN AGE ZERO (0) THROUGH FIVE (5) YEARS, FUNCTIONAL CAPACITY AND NEED
FOR PAID CARE SHALL BE SCORED ACCORDING TO THE FOLLOWING AGE APPROPRIATE
CRITERIA:
a. BLADDER AND BOWEL CARE: A CHILD AGE 0 TO 36 MONTHS SHALL NOT BE SCORED
FOR BOWEL AND BLADDER INCONTINENCE.
b. MOBILITY: A CHILD AGE 0 TO 36 MONTHS SHALL NOT BE SCORED FOR MOBILITY,
INCLUDING POSITIONING.
c. DRESSING: A CHILD AGE 0 TO 60 MONTHS SHALL NOT BE SCORED FOR DRESSING.
d. BATHING AND HYGIENE: A CHILD 0 TO 60 MONTHS SHALL NOT BE SCORED FOR
BATHING AND HYGIENE.
e. EATING: A CHILD 0 TO 48 MONTHS SHALL NOT BE SCORED FOR EATING.
f. TRANSFERS: A CHILD 0 TO 48 MONTHS SHALL NOT BE SCORED FOR ANY TRANSFERS.
A CHILD 0 TO 60 MONTHS SHALL NOT BE SCORED FOR CAR SEAT, HIGHCHAIR,
OR CRIB TRANSFERS.
3.720.33 3.720.31 Home Care Allowance Authorized Payment Amount [Rev. eff. 1/1/12]
A. THE MAXIMUM HCA AUTHORIZED GRANT AMOUNT in FOR EACH range TIER IS ESTABLISHED BY THE
COLORADO DEPARTMENT OF HUMAN SERVICES AND IS SUBJECT TO CHANGE TO STAY WITHIN
AVAILABLE APPROPRIATIONS.
B. The case manager shall approve Each CLIENT (applicant or recipient), who meets the minimum SCORING
requirements for the HCA program AND OTHER PROGRAM REQUIREMENTS as defined in Section
3.720 or 3.740, SHALL BE an authorized amount of FOR A Home Care Allowance OR SPECIAL
POPULATIONS HOME CARE ALLOWANCE GRANT. The case manager shall determine the authorized
HCA TIER amount, up to the maximum amount allowable, based upon the FUNCTIONAL ASSESSMENT
AND Nneed for Ppaid Ccare scoreS, as follows: The three ranges of the need for paid care score are listed
below. The maximum HCA authorized amount in each range is approved by the Colorado Department of
Human Services and is subject to change.
Functional
Capacity Score
Need for Paid
Care Score
1
21 or higher
1 to 23
2
21 or higher
24 to 37
3
21 or higher
38 to 51
Tier
C. The case manager shall not approve the maximum authorized HCA amount FOR THE TIER if the applicant's or
recipient's needs can be fully or partially met from other paid or unpaid sources, if the HCA provider is able
to provide the authorized services for less than the maximum authorized amount, or if the applicant or
recipient is unwilling or unable to use the maximum authorized amount. In determining the authorized HCA
amount, the case manager shall ensure that there is no duplication of services in accordance with Section
3.721.23, D, 4.
Need for Paid Care Score
1-23
24-37
38 and over
A. D. Payment of the Home Care Allowance authorized grant will begin on the first day of the month following the
month in which the HCA is authorized.
B. E. There shall be no retroactive Home Care Allowance payments. The hardship exceptions at Section
3.140.173 shall not apply to Home Care Allowance grant payments.
C. F. The Home Care Allowance recipient's grant standard for OAP or AND/AB-SO will increase based on the
authorized HCA amount per Section 3.360.44 of the Old Age Pension rules, and Section 3.460.13 of the
State AND/AB rules.
D. G. The HCA amount determined by the Need for Paid Care score shall be authorized for an SSI recipient
receiving at least a $1.00 payment. For persons approved for SSI but not receiving at least a $1.00
payment, the HCA grant standard for Aid to the Needy Disabled/Aid to the Blind-Colorado Supplement
(AND/AB-CS) will be increased based upon the authorized HCA amount per Section 3.460.45 of the
AND/AB-CS rules.
E. H. HCA payments shall be adjusted by the Colorado Department of Human Services based on available
appropriations. A county conference or State appeal need not be granted unless the reason for an
individual appeal is incorrect grant computation.
***************
3.721.22 Assessment [Rev. eff. 1/1/12]
A. The Single Entry Point (SEP) case manager shall complete an assessment when the county department of
social/human services provides written notification that the client has requested HCA or AFC and is
receiving or has submitted an application for OAP, State AND/AB, AND/AB/SSI-CS, or the client is
receiving SSI. If the client is being discharged from a hospital or nursing facility, the Single Entry Point case
manager shall complete the assessment regardless of whether the Medicaid application date has been
provided by the county department.
B. The SEP case manager shall complete an assessment within the following time frames:
1. For a client who is being transferred from a hospital to the Home Care Allowance or Adult Foster Care
program, the SEP case manager shall complete the evaluation within two (2) working days after
notification.
2. For a client who is being transferred from a nursing facility to the Home Care Allowance or Adult Foster
Care program, the SEP case manager shall complete the evaluation within five (5) working days
after notification.
3. For an individual who is not being discharged from a hospital or a nursing facility, the client evaluation
shall be completed within ten (10) working days.
C. The SEP case manager shall conduct the following activities for a client assessment:
1. Determine the client's fFunctional cCapacity SCORE during an evaluation, with observation of the client
and family, if appropriate, in his or her residential setting and determine the functional capacity
score in each of the areas on the State DEPARTMENT prescribed assessment tool, USING THE
SCORING SYSTEM OUTLINED IN SECTION 3.720.3.
2. Determine the CLIENT’S nNeed for pPaid cCare SCORE for Home Care Allowance (HCA) clients to
determine the monthly HCA authorized TIER amount in accordance with AS OUTLINED IN Section
3.720.2 3.720.3.
3. Determine if the Home Care Allowance services provided by a caregiver living with the client are above
and beyond the workload of the normal family/household routine. If services are not beyond normal
family/household routine, the client may not be scored as needing paid care for that service.
4. For HCA, score children age zero (0) through thirteen (13) years in both functional capacity and need for
paid care according to the following age appropriate criteria:
a. Toileting: a child age 0 to 36 months will not be scored for bowel and bladder incontinence.
b. Mobility and positioning: a child age 0 to 36 months will not be scored for mobility and
positioning.
c. Dressing: a child age 0 to 60 months will not be scored for dressing.
d. Bathing and hygiene: a child 0 to 60 months will not be scored for bathing and hygiene.
e. Eating: a child 0 to 48 months will not be scored for eating.
f. Transfers: a child 0 to 48 months will not be scored for transfers. A child 0 to 60 months will not
be scored for car seat, highchair, or crib transfers.
5 3. Determine the ability and appropriateness of the client's caregiver(s) who must be at least eighteen
(18) years of age or older to provide the client assistance in activities of daily living;
6 4. Determine the client's service needs, taking into consideration services available, or already being
received, from all funding sources;
7 5. If an out-of-home placement is required, review placement options based on the client's needs, the
potential funding sources, and the availability of resources;
8 6. Maintain appropriate documentation of the authorization for Home Care Allowance or Adult Foster
Care program eligibility;
9 7. Refer the client to alternative services, if the client does not meet the eligibility requirements for Home
Care Allowance or Adult Foster Care programs administered by the Department;
10 8. The State prescribed assessment form and the Appropriateness of Placement form shall be
completed to determine eligibility for the Adult Foster Care program.
a. The assessment shall indicate whether there is a minimal need for care. A specific functional or
Need for Paid Care score is not required.
b. An applicant that meets one or more of the criteria on the Appropriateness of Placement form is
ineligible for the AFC program, regardless of the need for care.
11 9. Obtain diagnoses from the client's medical provider for Adult Foster Care program applicants.
12 10. If found eligible for AFC, the recipient must be placed in an appropriate AFC facility within forty-five
(45) calendar days. If the date of placement will not occur within the forty-five day period, the case
manager must complete a new assessment, using the Appropriateness of Placement form.
**************
3.740 SPECIAL POPULATIONS-HOME CARE ALLOWANCE (SP-HCA) PROGRAM
===
3.744 Functional Assessment, Care Plan, and Provider Agreement [Rev. eff. 11/9/12]
A. The Single Entry Point (SEP) agency shall complete a functional assessment for each client as follows:
1. Upon referral by the State Department to determine initial eligibility for the SP-HCA program; or,
2. Immediately whenever the SEP, during ordinary case management services and in his/her professional
opinion, identifies a significant change in the client’s ability to perform activities of daily living; or,
3. Immediately whenever the client or authorized representative reports a significant change in the client’s
ability to perform activities of daily living; or,
4. Annually, at a minimum, the annual functional assessment shall be completed no earlier than forty five
(45) calendar days prior to and no later than the client’s reassessment due date. The assessment
shall include, but may not be limited to:
a. A new functional assessment during a face-to-face visit at the client's place of residence;
b. Evaluation of the appropriateness of services, service effectiveness, and quality of care over the
past year; and,
c. Completion of an updated care plan and provider agreement.
B. The functional assessment shall determine the fFunctional cCapacity score and the Need for Paid Care scoreS
and shall be completed on the State Department required form.
1. The client shall meet requirements for both scores to be eligible for a SP-HCA grant. FUNCTIONAL
CAPACITY IMPAIRMENT SHALL BE SCORED FOR EACH ACTIVITY OF DAILY LIVING (ADL)
OUTLINED IN SECTION 3.744, B, 2, USING THE FOLLOWING SCALE:
a. INDEPENDENT: SCORE ZERO (0) IF THE CLIENT IS PHYSICALLY ABLE TO PERFORM
ALL ESSENTIAL COMPONENTS OF THE ADL, WITH OR WITHOUT AN ASSISTIVE
DEVICE.
b. LOW: SCORE ONE (1) IF THE CLIENT IS ABLE TO PERFORM ALL ESSENTIAL
COMPONENTS OF THE FUNCTION BUT SOME IMPAIRMENT OF FUNCTION EXISTS
EVEN WITH AN ASSISTIVE DEVICE. THE CLIENT REQUIRES SOME SUPERVISION
OR PHYSICAL ASSISTANCE IN A FEW OF THE COMPONENTS OF THE ACTIVITY.
c. MODERATE: SCORE TWO (2) IF THE CLIENT IS UNABLE TO PERFORM MOST OF THE
ESSENTIAL COMPONENTS OF THE FUNCTION EVEN WITH AN ASSISTIVE DEVICE,
AND REQUIRES A GREAT DEAL OF ASSISTANCE OR SUPERVISION TO
ACCOMPLISH THE ACTIVITY.
d. SEVERE: SCORE THREE (3) IF THE CLIENT IS TOTALLY UNABLE TO PERFORM THE
FUNCTION AND REQUIRES SOMEONE TO PERFORM THE TASK, OR THE CLIENT
REQUIRES CONSTANT SUPERVISION FOR THE TASK.
2. A functional capacity score of twenty one (21) or higher and a Need for Paid Care score of one (1) or
higher shall be required.
a. The functional capacity assessment shall assess the client’s capacity to meet his/her needs in
the following areas: physical transfers, bladder and bowel care, mobility, dressing, bathing
and hygiene, eating and meal preparation, housework and laundry, shopping, medication
management, money management and accessing resources, and ability to set
appointments and use the telephone.
b. The scoring guidelines are as follows:
1) Independent – Client is able to perform all components of the function with or without an
assistive device. Score = 0.
2) Little – Client is able to perform all essential components of the function but some
impairment of function exists even with an assistive device. The client requires
some supervision or physical assistance in some components of the activity. Score
= 1.
3) Moderate – Client is unable to perform most of the essential components of the function
even with an assistive device. Client requires a great deal of assistance or
supervision to accomplish the activity. Score = 2.
4) Severe – Client is totally unable to perform the function and needs someone to perform
the task, or the client requires constant supervision. Score = 3.
2. ACTIVITIES OF DAILY LIVING SHALL BE SCORED USING THE FUNCTIONAL CAPACITY
IMPAIRMENT SCALE OUTLINED IN SECTION 3.744, B, 1, TO INCLUDE:
a. CRITICAL ADLS:
1) TRANSFERS: THE ABILITY TO MOVE BETWEEN SURFACES, SUCH AS GETTING
IN AND OUT OF BED; TRANSFERRING FROM A BED TO A CHAIR,
WHEELCHAIR, OR WALKER; MOVING FROM A CHAIR OR WHEELCHAIR TO
A WALKER OR TO A STANDING POSITION; AND THE ABILITY TO USE
ASSISTIVE DEVICES, INCLUDING PROSTHETICS.
2) BLADDER CARE: THE EXTENT TO WHICH THE CLIENT HAS CONTROL OF
HIS/HER BLADDER FUNCTIONS AND THE ABILITY OF THE CLIENT TO
ACCOMPLISH THE TASKS OF TOILETING, INCLUDING CATHETERIZING,
GETTING ON AND OFF THE TOILET, CHANGING INCONTINENCE
PRODUCTS, AND CLEANING HIS/HER SELF.
3) BOWEL CARE: THE EXTENT TO WHICH THE CLIENT HAS CONTROL OF HIS/HER
BOWEL FUNCTIONS AND THE ABILITY OF THE CLIENT TO ACCOMPLISH
THE TASKS OF TOILETING, INCLUDING GETTING ON AND OFF THE TOILET,
CHANGING INCONTINENCE PRODUCTS, AND CLEANING HIS/HER SELF.
b. BASIC ADLS:
1) MOBILITY: THE ABILITY OF THE CLIENT TO AMBULATE AROUND THE HOUSE
AND AROUND ESSENTIAL PLACES OUTSIDE THE HOUSE, AND THE ABILITY
TO CHANGE POSITIONS WHILE SEATED OR LAYING DOWN, WITH OR
WITHOUT ASSISTIVE DEVICES.
2) DRESSING: THE ABILITY OF THE CLIENT TO ACCOMPLISH ALL PHASES OF THE
ACTIVITIES OF DRESSING AND UNDRESSING, INCLUDING GETTING,
PUTTING ON, FASTENING, AND TAKING OFF ALL ITEMS OF CLOTHING,
BRACES, AND ARTIFICIAL LIMBS.
3) BATHING: THE ABILITY OF THE CLIENT TO SAFELY ACCOMPLISH THE TASK OF
WASHING BODY PARTS INCLUDING GETTING INTO BATHING WATERS,
WITH OR WITHOUT ASSISTIVE DEVICES OR WITH OR WITHOUT STAND BY
OR HANDS-ON ASSISTANCE FROM ANOTHER PERSON.
4) HYGIENE: THE ABILITY OF THE CLIENT TO MAINTAIN PERSONAL HYGIENE
OTHER THAN BATHING, INCLUDING COMBING HAIR, BRUSHING TEETH,
CLIPPING NAILS, AND SHAVING.
5) EATING: THE ABILITY TO CUT FOOD INTO MANAGEABLE SIZE PIECES, CHEW,
AND SWALLOW FOOD, WITH OR WITHOUT ASSISTIVE DEVICES.
c. INSTRUMENTAL ACTIVITIES OF DAILY LIVING (IADLS)
1) MEALS: THE ABILITY TO SAFELY PREPARE FOOD TO MEET THE BASIC
NUTRITIONAL REQUIREMENTS OF THE INDIVIDUAL, INCLUDING CUTTING
FOOD, TRANSFERRING FOOD TO COOKING VESSELS AND/OR DISHES,
UTILIZING UTENSILS, USING A STOVE OR MICROWAVE, AND
IMPLEMENTING SPECIAL DIETARY NEEDS.
2) HOUSEKEEPING: THE ABILITY TO MAINTAIN THE INTERIOR OF THE
INDIVIDUAL’S RESIDENCE FOR THE PURPOSE OF HEALTH AND SAFETY,
SUCH AS WIPING SURFACES, CLEANING FLOORS, MAKING A BED, AND
CLEANING DISHES.
3) LAUNDRY: THE ABILITY TO GATHER AND WASH SOILED CLOTHING AND
LINENS, USE WASHING MACHINES AND DRYERS, HANG, FOLD AND PUT
AWAY CLEAN CLOTHING AND LINENS.
4) SHOPPING: THE ABILITY TO PURCHASE GOODS THAT ARE NECESSARY FOR
HEALTH AND SAFETY. ACTIVITIES INCLUDE ABILITY TO MAKE NEEDS
KNOWN, TO MAKE A LIST, REACH FOR THE NEEDED ITEMS AT THE STORE,
ABILITY TO ESTIMATE OR DETERMINE THE COST OF THE ITEM, AND TO
MOVE ITEMS INTO THE HOME AND PUT THEM AWAY.
d. SUPPORTIVE ADLS
1) MEDICINE: THE ABILITY TO MANAGE MEDICATIONS, INCLUDING KNOWING THE
NAME OF THE MEDICATION, KNOWING THE AMOUNT, FREQUENCY, AND
HOW TO TAKE THE MEDICINE, UNDERSTANDING THE REASON FOR
TAKING IT, AND UNDERSTANDING POSSIBLE SIDE EFFECTS.
2) APPOINTMENT: THE ABILITY TO SCHEDULE OR MAKE AN APPOINTMENT FOR
ESSENTIAL ACTIVITIES, SUCH AS DOCTOR VISITS, MEETINGS WITH
CASEWORKERS, AND TRANSPORTATION.
3) MONEY: THE ABILITY TO MANAGE MONEY, SUCH AS BALANCING A CHECK
BOOK, WRITING CHECKS OR PAYING A BILL ELECTRONICALLY, AND
ABILITY TO UNDERSTAND FINANCIAL DECISIONS.
4) ACCESS: THE ABILITY TO ACCESS RESOURCES OR SERVICES IN THE
COMMUNITY, SUCH AS LOCATING THE RESOURCE/SERVICE AND
COMPLETING THE PROCESS NECESSARY TO RECEIVE THE RESOURCE
OR SERVICE.
5) TELEPHONE: THE ABILITY TO USE THE TELEPHONE TO COMMUNICATE
ESSENTIAL NEEDS, SUCH AS ANSWERING THE PHONE IN A REASONABLE
TIME, SPEAKING CLEARLY AND LOUDLY ENOUGH TO BE UNDERSTOOD,
DIALING THE PHONE, INITIATING A CONVERSATION, HEARING THE
CALLER, AND PLACING A CALL IN AN EMERGENCY.
3. The Need for Paid Care score reflects the frequency of assistance required by the client to perform the
functional activities. The need for paid care shall be SCORED ONLY FOR NEEDS THAT ARE
greater than and differentiated from:
a. Normal household routine and the normal expectation of assistance by family members living in
the home; AND,
b. SERVICES RECEIVED THROUGH THE HOME AND COMMUNITY BASED SERVICES
SUPPORTIVE LIVING SERVICES (HCBS-SLS) OR CHILDREN’S EXTENSIVE
SUPPORT (HCBS-CES) WAIVER.
If the need is not more than or differentiated from normal household routine and the normal expectation of
assistance by family members, the client shall not be scored as needing paid care for that service.
4. THE NEED FOR PAID CARE SCORE SHALL BE BASED ON THE FREQUENCY OF THE CLIENT’S
UNMET NEED FOR PAID CARE:
SCORE
FREQUENCY
DEFINITION OF FREQUENCY
a. 0
NONE
CLIENT’S NEEDS ARE MET. NO NEED FOR PAID CARE.
b. 1
WEEKLY
CLIENT NEEDS PAID CARE UP TO AND INCLUDING ONCE A
WEEK.
c. 2
DAILY
CLIENT NEEDS PAID CARE MORE THAN ONCE A WEEK
AND UP TO ONCE A DAY, SEVEN DAYS A WEEK.
d. 3
TWICE DAILY
CLIENT NEEDS PAID CARE TWO OR MORE TIMES PER DAY
AT LEAST FIVE DAYS PER WEEK.
4. For SP-HCA, the SEP shall score children age zero (0) through thirteen (13) years in both functional
capacity and need for paid care according to the following age appropriate criteria:
a. Toileting: a child age zero (0) to thirty six (36) months shall not be scored for bowel and bladder
incontinence.
b. Mobility and positioning: a child age 0 to 36 months shall not be scored for mobility and
positioning.
c. Dressing: a child age zero (0) to sixty (60) months shall not be scored for dressing.
d. Bathing and hygiene: a child 0 to 60 months shall not be scored for bathing and hygiene.
e. Eating: a child zero (0) to forty eight (48) months shall not be scored for eating.
f. Transfers: a child 0 to 48 months shall not be scored for transfers. A child 0 to 60 months shall
not be scored for car seat, highchair, or crib transfers.
5. THE NEED FOR PAID CARE SCORE SHALL BE MODIFIED BY THE FOLLOWING FACTORS:
a. NEED FOR PAID CARE SHALL BE SCORED AS ZERO (0) WHEN THOSE SERVICES ARE
IN PLACE THROUGH ANOTHER PROGRAM, AGENCY, OR INDIVIDUAL.
b. FOR CLIENTS LIVING WITH OTHERS, THE NEED FOR PAID CARE SHALL BE SCORED
ONLY ON THE CLIENT’S NEEDS THAT ARE GREATER THAN AND DIFFERENTIATED
FROM NORMAL HOUSEHOLD ROUTINE AND THE NORMAL EXPECTATION OF
ASSISTANCE BY FAMILY MEMBERS LIVING IN THE HOME.
c. FOR CLIENTS APPROVED FOR SPECIAL POPULATIONS HOME CARE ALLOWANCE, AS
DEFINED AT SECTION 3.740, THE NEED FOR PAID CARE SHALL BE SCORED ONLY
ON THE CLIENT’S NEEDS THAT ARE GREATER THAN AND DIFFERENTIATED FROM
SERVICES RECEIVED THROUGH THE HOME AND COMMUNITY BASED SERVICES
SUPPORTIVE LIVING SERVICES (HCBS-SLS) OR CHILDREN’S EXTENSIVE
SUPPORT (HCBS-CES) WAIVER.
d. FOR CHILDREN AGE ZERO (0) THROUGH FIVE (5) YEARS, FUNCTIONAL CAPACITY AND
NEED FOR PAID CARE SHALL BE SCORED ACCORDING TO THE FOLLOWING AGE
APPROPRIATE CRITERIA:
1) BLADDER AND BOWEL CARE: A CHILD AGE 0 TO 36 MONTHS SHALL NOT BE
SCORED FOR BOWEL AND BLADDER INCONTINENCE.
2) MOBILITY: A CHILD AGE 0 TO 36 MONTHS SHALL NOT BE SCORED FOR
MOBILITY, INCLUDING POSITIONING.
3) DRESSING: A CHILD AGE 0 TO 60 MONTHS SHALL NOT BE SCORED FOR
DRESSING.
4) BATHING AND HYGIENE: A CHILD 0 TO 60 MONTHS SHALL NOT BE SCORED FOR
BATHING AND HYGIENE.
5) EATING: A CHILD 0 TO 48 MONTHS SHALL NOT BE SCORED FOR EATING.
6) TRANSFERS: A CHILD 0 TO 48 MONTHS SHALL NOT BE SCORED FOR ANY
TRANSFERS. A CHILD 0 TO 60 MONTHS SHALL NOT BE SCORED FOR CAR
SEAT, HIGHCHAIR, OR CRIB TRANSFERS.
5 6. The overall score shall determine the maximum grant that shall be authorized for the client.
a. A need for paid care score of 1-23 with a functional capacity score of 21 or higher meets the
criteria for the low tier grant standard.
b. A need for paid care score of 24-37 with a functional capacity score of 21 or higher meets the
criteria for the middle tier grant standard.
c. A need for paid care score of 38 and over with a functional capacity score of 21 or higher meets
the criteria for the high tier grant standard.
6 7. The grant standards shall equal the grant standards for the Home Care Allowance (HCA) program.
a. The SP-HCA grant is not taxable income to the client.
b. The payment made to the care provider using the SP-HCA grant received by the client is
income to the care provider and subject to taxation under State and Federal laws.
===
*************