NAVIGATING LONG-TERM SERVICES AND SUPPORTS (LTSS) TO ENSURE INDIVIDUALIZED CARE AND COMMUNITY INTEGRATION

Case Management Services in Colorado help individuals with disabilities, chronic conditions, and age-related needs access and coordinate Home and Community-Based Services (HCBS) and other Medicaid supports. Under Colorado’s Medicaid redesign, Case Management is transitioning to a conflict-free model, meaning individuals receiving services must work with case managers not affiliated with direct service providers. Services are authorized by the Colorado Department of Health Care Policy and Financing (HCPF) and delivered through Case Management Agencies (CMAs).

1. GOVERNING AGENCIES

Agency: Colorado Department of Health Care Policy and Financing (HCPF)
Role: Oversees Medicaid and HCBS waiver programs, authorizes case management agencies, and sets compliance standards

Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Provides federal oversight for Medicaid-funded case management and ensures HCBS compliance

2. CASE MANAGEMENT SERVICE OVERVIEW

Case Management Services help individuals assess their needs, create person-centered plans, coordinate services, and monitor outcomes. This includes ensuring that services are accessible, appropriate, and aligned with the individual’s goals.

Approved providers may deliver:

• Comprehensive assessments and level of care determinations
• Development and implementation of person-centered service plans
• Referral to HCBS waiver and non-waiver resources
• Ongoing monitoring of service delivery and progress toward goals
• Crisis response planning and reassessments
• Documentation and data entry into the state case management system (e.g., Bridge)

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3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

• Register business with the Colorado Secretary of State
• Obtain EIN from the IRS and NPI (Type 2)
• Apply and be designated as a Case Management Agency (CMA) by HCPF
• Demonstrate separation from direct service provision (conflict-free criteria)
• Employ qualified case managers with experience in HCBS, social work, or human services
• Maintain HIPAA-compliant recordkeeping and secure electronic documentation systems
• Carry general liability and professional insurance

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4. PROVIDER ENROLLMENT PROCESS

Step 1: Review HCPF Case Management Redesign Requirements

• Familiarize yourself with the HCPF CMA Readiness Tool and regional realignment plans

Step 2: Apply for CMA Designation

• Submit application, conflict-free attestation, organizational chart, and staff resumes to HCPF

Step 3: Enroll as a Colorado Medicaid Provider

• Apply through the Gainwell Provider Web Portal
• Submit NPI, ownership details, policies, and procedures
• Step 4: System Onboarding and Training

Complete HCPF training modules and Bridge system onboarding

5. REQUIRED DOCUMENTATION

• Articles of Incorporation or business registration
• IRS EIN Letter
• NPI confirmation
• CMA designation from HCPF
• Colorado Medicaid provider ID

Policy & procedure manual including:

• Intake and eligibility verification forms
• Person-centered service planning templates
• Monitoring and reassessment schedules
• Confidentiality and client rights policies
• Complaint and grievance resolution procedures
• Crisis planning protocols
• Staff training requirements and supervision documentation
• Quality assurance and compliance review tools

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6. STAFFING REQUIREMENTS

Role: Case Manager
Requirements:

• Bachelor’s degree in social work, nursing, psychology, or related field (or equivalent experience)
• Knowledge of HCBS services and Medicaid eligibility
• Background check and system access approval
• Person-centered planning training (provided by HCPF)

Role: Supervisor / Clinical Reviewer (if applicable)
Requirements:

• Clinical or advanced human services background
• Oversight of plan approvals, reassessments, and documentation audits

Training Requirements for All Staff:

• HCPF-required modules (person-centered planning, critical incident reporting, etc.)
• HIPAA and confidentiality
• Bridge case management system use
• Ongoing CEUs and quarterly refreshers

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7. MEDICAID WAIVER SERVICES

Case Management Services are required for participants in:

• HCBS-EBD (Elderly, Blind, and Disabled) Waiver
• HCBS-DD (Developmental Disabilities) Waiver
• HCBS-SLS (Supported Living Services) Waiver
• HCBS-CES (Children’s Extensive Support) Waiver
• HCBS-CMHS (Community Mental Health Supports) Waiver
• Children with Life-Limiting Illness (CLLI) and other Medicaid LTSS programs

Approved providers may deliver:

• Intake and eligibility screening
• Person-centered service planning and authorizations
• Crisis intervention and referrals
• Ongoing monitoring and care team coordination
• Required data entry and audit-ready documentation

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8. TIMELINE TO LAUNCH

Phase: Business Formation
Timeline: 1–2 weeks

Phase: CMA Application and HCPF Review
Timeline: 60–90 days

Phase: Medicaid Enrollment and System Access
Timeline: 30–45 days

Phase: Staff Hiring and Bridge Training
Timeline: 2–4 weeks

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9. CONTACT INFORMATION

Colorado Department of Health Care Policy and Financing (HCPF)
Email: hcpf_cmrd@state.co.us
Website: https://hcpf.colorado.gov

Gainwell Technologies – Provider Web Portal
Website: https://portal.co.gov

10. SCOPE OF WORK

• Business registration (LLC, EIN, NPI)
• HCPF Case Management Agency (CMA) application support
• Policy & procedure manual for eligibility, planning, and monitoring
• Templates for care plans, assessments, and progress tracking
• Website, domain, and email setup
• Staff credentialing trackers and Bridge training guidance
• Client intake packet, consent forms, and complaint protocols
• Incident reporting systems and audit preparation tools
• Referral networking with providers, hospitals, and county programs

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