2023 Colorado Revised Statutes › Title 25.5 - HEALTH CARE POLICY AND FINANCING (§§ 25.5-1-101 — 25.5-11-101) › COLORADO MEDICAL ASSISTANCE ACT (§§ 25.5-4-101 — 25.5-6-2001) › Article 6 - COLORADO MEDICAL ASSISTANCE ACT - LONG-TERM CARE (§§ 25.5-6-101 — 25.5-6-2001) › Part 1 - LONG-TERM CARE ADMINISTRATION (§§ 25.5-6-101 — 25.5-6-116) › Section 25.5-6-104 - [Effective 8/7/2024] Long-term care placements - comprehensive and uniform assessment instrument - report - legislative declaration - definitions - repeal

(1)
(a)
The general assembly hereby finds, determines, and declares that there is an increasing strain on long-term care services in the state; that the number of persons in need of long-term care continues to grow; that community-based resources are not integrated into a centralized system for referrals, assessment of needs, development of care plans, and case management; and that persons in need of long-term care services have difficulty accessing and using the current system, which is fragmented and which results in inappropriate placements.
(b)
The general assembly further finds, determines, and declares that the state is in need of a long-term care system that organizes each long-term care applicant's and member's entry, assessment of need, and service delivery into a single unified system, and that the system must include, at a minimum, a locally established single entry point administered by a designated entity, a single assessment instrument and administrative process, targeted case management in order to maximize existing federal, state, and local funding, case management, and an accountability mechanism designed to assure that budget allocations are being effectively managed.
(c)
The general assembly therefore concludes that it is appropriate to develop and implement a comprehensive and uniform long-term care assessment process and to study the establishment of a single entry point system that provides for the coordination of access and service delivery to long-term care members at the local level, that is available to all individuals in need of long-term care, and that is well managed and cost-efficient.
(2)
As used in this section and in sections
25.5-6-105
to
25.5-6-107
, unless the context otherwise requires:
(a)
"Activities of daily living" means the basic self-care activities, including eating, bathing, dressing, transferring from bed to chair, bowel and bladder control, and independent ambulation.
(b)
"Case management services" means the assessment of an individual's need for long-term care, the development and implementation of a care plan for the member, the coordination and monitoring of long-term care service delivery, the direct delivery of services as provided by this article 6 or by rules adopted by the state board pursuant to this article 6, the evaluation of service effectiveness, and the reassessment of the member's needs, all of which shall be performed by a single entry point as defined in subsection (2)(k) of this section.
(c)
"Community-based" means services provided in an individual's home or in a homelike setting. "Community-based" does not include a hospital, hospital unit, nursing facility, or nursing home.
(d)
"Comprehensive and uniform assessment process" means a standard procedure, which includes the use of a uniform assessment instrument, to measure a member's or applicant's functional capacity, to determine the social and medical needs of a current or potential member or applicant of any long-term care program, and to target resources to the functionally impaired.
(e)
"Continuum of care" means an organized system of long-term care, benefits, and services to which a Member has access and which enables a Member to move from one level or type of care to another without encountering gaps in or barriers to service.
(f)
"Information and referral" means the provision of specific, accurate, and timely public information about services available to aging and disabled adults in need of long-term care and referral to alternative agencies, programs, and services based on Member inquiries.
(g)
"Instrumental activities of daily living" means home management and independent living activities such as cooking, cleaning, using a telephone, shopping, doing laundry, providing transportation, and managing money.
(h)
"Long-term care" means those services designed to provide diagnostic, preventive, therapeutic, rehabilitative, supportive, and maintenance services for individuals who have chronic physical or mental impairments, or both, in a variety of institutional and noninstitutional settings, including the home, with the goal of promoting the optimum level of physical, social, and psychological functioning of the individuals.
(i)
"Resource development" means the study, establishment, and implementation of additional resources or services which will extend the capabilities of community long-term care systems to better serve long-term care members.
(j)
"Screening" means a preliminary determination of need for long-term care services and, on the basis of the determination, the making of an appropriate referral for An assessment in accordance with subsection (3) of this section or referral to another community resource to assist individuals who are not in need of long-term care services.
(k)
"Single entry point" means the availability of a single access or entry point within a local area where a current or potential long-term care member or applicant can obtain long-term care information, screening, assessment of need, and referral to appropriate long-term care program and case management services.
(3)
(a)
On or before July 1, 1991, the state department shall establish, by rule in accordance with article
4
of title
24
, a comprehensive and uniform assessment process for all individuals in need of long-term care, the purpose of which is to determine the appropriate services and levels of care necessary to meet members' or applicants' needs, to analyze alternative forms of care and the payment sources for the care, and to assist in the selection of long-term care programs and services that meet members' or applicants' needs most cost-efficiently.
(b)
Participation in the assessment process is mandatory for members of publicly funded long-term care programs, including, but not limited to, the following:
(I)
Nursing facilities;
(II)
Home- and community-based services for the elderly, the blind, and the disabled;
(III)
Alternative care facilities;
(IV) to (VI)
(Deleted by amendment, L. 2008, p. 437, § 1, effective August 5, 2008.)
(VII)
Home health services for long-term care members; and
(VIII)
Repealed.
(c)
Private paying members of long-term care programs may participate in the process for a fee to be established by the state department and adopted through rules.
(d)
The state department, through rules, shall develop and implement no later than July 1, 1991, a uniform long-term care needs assessment instrument for all individuals in need of long-term care. The instrument must be used as part of the comprehensive and uniform assessment process to be established in accordance with subsection (3)(a) of this section and must serve the following functions:
(I)
To obtain information on each member's or applicant's status in the following areas:
(A)
Activities of daily living and instrumental activities of daily living;
(B)
Physical health;
(C)
Cognitive and emotional well-being;
(D)
Social interaction and current support resources;
(II)
To assess each member's or applicant's physical environment in terms of meeting the member's or applicant's needs;
(III)
To obtain information on each member's or applicant's payment sources, including obtaining financial eligibility information for publicly funded long-term care programs;
(IV)
To disclose the need for more intensive needs assessments in areas such as nutrition, adult protection, dementia diseases and related disabilities, and mental health;
(V)
To prioritize a member's or applicant's need for care using criteria established by the state department for specific publicly funded long-term care programs;
(VI)
To serve as the functional assessment for the determinations of medical necessity.
(e)
On and after July 1, 1991, a member must not be placed in a long-term care program unless the placement is in accordance with rules adopted by the state board in implementing this section.
(4)
Repealed.
(5)
(a)
On or before July 1, 2018, pursuant to the state department's ongoing stakeholder process relating to eligibility determination for long-term services and supports pursuant to this article 6, the state department shall select a needs assessment tool for individuals receiving long-term services and supports, including individuals with intellectual and developmental disabilities who are eligible for services pursuant to section
25.5-6-409
. Once selected, the state department shall begin assessing the individual's needs using the needs assessment tool as soon as practicable.
(b)
Pursuant to the state department's ongoing stakeholder process relating to eligibility determination for long-term services and supports pursuant to this article, the state department shall develop or select the needs assessment tool in collaboration with persons with intellectual and developmental disabilities who receive services, legal guardians, case managers, and any other stakeholders as determined by the state department.
(c)
The needs assessment tool developed or selected by the state department must include a reasonable reassessment process, set forth in state board rules, that allows a reassessment to be completed within thirty days after receipt of a request for reassessment made by a person with intellectual and developmental disabilities or his or her legal guardian.
(d)
Repealed.
(6)
This section is repealed, effective July 1, 2024.
Amended by 2024 Ch. 152,§ 70, eff. 8/7/2024.
Repealed by 2021 Ch. 83, § 69, eff. 7/1/2024.
Amended by 2018 Ch. 74, § 4, eff. 8/8/2018.
Amended by 2018 Ch. 62, § 5, eff. 8/8/2018.
Amended by 2016 Ch. 256, § 1, eff. 6/8/2016.
L. 2006: Entire article added with relocations, p. 1911, § 7, effective July 1. L. 2007: (4) added, p. 1393, § 2, effective May 30. L. 2008: (3)(b) amended, p. 437, § 1, effective August 5. L. 2016: (5) added, (SB 16-192), ch. 1051, p. 1051, § 1, effective June 8. L. 2018: (3)(b)(VIII) repealed, (SB 18-093), ch. 62, p. 610, § 5, effective August 8; IP(3)(d) and (3)(d)(IV) amended, (HB 18-1091), ch. 643, p. 643, § 4, effective August 8. L. 2021: (6) added by revision, (HB 21-1187), ch. 83, pp. 353, 354, §§ 69, 70.
(1) This section is similar to former § 26-4-507 as it existed prior to 2006.
(2) Subsection (4)(c) provided for the repeal of subsection (4), effective July 1, 2008. (See L. 2007, p. 1393.)
(3) Subsection (5)(d)(II) provided for the repeal of subsection (5)(d), effective July 1, 2019. (See L. 2016, p. 1051.)
2024 Ch. 152, was passed without a safety clause. See Colo. Const. art. V, § 1(3).
This section is set out more than once due to postponed, multiple, or conflicting amendments.
For the legislative declaration contained in the 2007 act enacting subsection (4), see section 1 of chapter 328, Session Laws of Colorado 2007. For the legislative declaration in SB 18-093, see section 1 of chapter 62, Session Laws of Colorado 2018.