DEPARTMENT OF HUMAN SERVICES State and Veterans Nursing Homes RULE MANUAL VOLUME 11 STATE AND VETERANS NURSING HOMES 12 CCR 2511-1 [Editor’s Notes follow the text of the rules at the end of this CCR Document.] STATEMENT OF BASIS AND PURPOSE, FISCAL IMPACT AND SPECIFIC STATUTORY AUTHORITY OF REVISIONS MADE TO STAFF MANUAL VOLUME 11 Revisions to Sections 11.100.01; 11.201.01 were emergency adoption of Executive Director rules at the 8/1/86 meeting, with an effective date of 8/1/86 (Documents 1 E.D., 2 E.D.). Statement of Basis and Purpose, Fiscal Impact and specific statutory authority for these revisions were incorporated by reference into the rule. These materials are available for review by the public during normal working hours at the Office of the State Board Administrator, Department of Social Services. Addition of Section 11.251.01 was emergency adopted at the 3/6/87 State Board meeting, with an effective date of 3/6/87 (Document 2 E.D.). Statement of Basis and Purpose, Fiscal Impact, and specific statutory authority for these revisions were incorporated by reference into the rule. These materials are available for review by the public during normal working hours at the Office of the State Board Administrator. Department of Social Services.

Addition of Section 11.251.01 was finally adopted emergency at the 4/3/87 State Board meeting, with an effective date of 3/6/87 (Document 1 E.D.). Statement of Basis and Purpose, Fiscal Impart, and specific statutory authority for these revisions were incorporated by reference into the rule. These materials are available for review by the public during normal working hours at the Office of the State Board Administrator, Department of Social Services.

Addition of Sections 11.250.01 - 11.250.04 and 11.251.02 - 11.262.02 were finally adopted following publication at the 4/3/87 State Board meeting, with an effective date of 6/1/87 (Document 16) Statement of Basis and Purpose, Fiscal Impact and specific statutory authority for these revisions were incorporated by reference into the rule. These materials are available for review by the public during normal working hours at the Office of the State Board Administrator, Department of Social Services. Revisions to Sections 11.101.01 and 11.201.01 were final adoption following publication of Executive Director rules at the 5/1/87 State Board meeting, with an effective date of 7/1/87 (Documents 1 E.D. and 2 E.D.). Statement of Basis and Purpose, Fiscal Impact and specific statutory authority for these revisions were incorporated by reference into the rule. These materials are available for review by the public during normal working hours at the Office of the State Board Administrator, Department of Social Services. Revisions to Section 11.300 through 11.301 were final adoption following publication at the 9/11/87 State Board meeting, with an effective date of 11/1/87 (Document 7). Statement of Basis and Purpose, Fiscal Impact and specific statutory authority for these revisions were incorporated by reference into the rule. These materials are available for review by the public during normal working hours at the Office of the State Board Administrator, Department of Social Services. Removal of Section 11.400 and addition of Section 11.500 was final adoption following publication at the 11/3/89 State Board meeting, with an effective date of 1/1/90 (CSPR# 89-6-6-1). Statement of Basis and Purpose and specific statutory authority for these revisions were incorporated by reference into the rule. These materials are available for review by the public during normal working hours at the State Board Office, Department of Social Services.

Revisions to Sections 11.100 through 11.300 were final adoption following publication at the 3/4/2000 State Board meeting, with an effective date of 10/1/2000 (CSPR# 00-5-25-1). Statement of Basis and Purpose and specific statutory authority for these revisions were incorporated by reference into the rule. These materials are available for review by the public during normal working hours at the Colorado Department of Human Services, State Board Administration. 11.000 COLORADO STATE AND VETERANS NURSING HOMES 11.100 DEFINITIONS [Rev. eff. 10/1/07] "Applicant" means the individual applying for residency in a State or Veterans Nursing Home, which includes the applicant’s legal representative.

"Colorado resident" means an individual who currently resides in Colorado, intends to reside in Colorado permanently and who does not maintain a primary residence in another state. "Colorado State Veterans Center" means the State Veterans Nursing Home at Homelake and the Domiciliary at Homelake located in Monte Vista, Colorado. "Legal representative" means an individual who has the legal authority to take a particular action on behalf of an applicant or resident.

"Medical leave" means absence of the resident from the Home due to admittance to a hospital or other institution as defined in the Department of Health Care Policy and Financing rules, Section 8.482.43 (10 CCR 2505-10).

"Surviving spouse" means a person who was married to a Veteran at the time of the Veteran's death, and who has not remarried or held himself or herself out to the public to be the spouse of another person. "State Nursing Home (Home)" means any nursing home and/or related long term care program owned by the State of Colorado and operated by the Colorado Department of Human Services. "State Veterans Nursing Home" means any State Nursing Home or a nursing home administered under contractual obligation with a party that has been designed and constructed to qualify for federal funds and that is operated so as to qualify for per diem payments from the United States Department of Veterans Affairs.

"Veteran" means a person who served in the active military, naval, or air service, and who was discharged or released there from under conditions other than dishonorable. 11.110 RESIDENT ELIGIBILITY [Rev. eff. 10/1/07] A. An eligible resident in a State Veterans Nursing Home shall: 1. Be a Colorado resident Veteran; or, 2. Be a non-Colorado resident Veteran; or, 3. Be a spouse/surviving spouse of a Colorado resident or non-Colorado resident Veteran; or, 4. Be a surviving parent whose child(ren) who (all) died while serving in the armed forces of the United States; and, 5. Be able to be served safely by the reasonable and customary care provided in the State Veterans Nursing Home as determined by the Home’s admission staff in conjunction with any applicable state or federal law or regulation.

B. An eligible resident in a State Nursing Home shall be able to be served safely by the reasonable and customary care provided in the State Nursing Home as determined by the Home’s admission staff in conjunction with any applicable state or federal law or regulation. 11.120 ADMISSION PROCESS, WAIT LIST, AND PRIORITY [Rev. eff. 10/1/07] A. A person seeking admission to a State or Veterans Nursing Home may obtain an application form and information describing the application procedures from the individual Home. Staff shall provide the applicant with information regarding all required documentation, information and verifications necessary to complete the application when the application is requested. B. Staff shall conduct a preadmission screening of the applicant to determine if the applicant meets the eligibility requirements stated in Section 11.110 within five business days of receipt of the application. If the requirements are met, the Home’s admissions staff shall review the submitted materials as outlined in Section 11.120, C. Once the applicant has been determined eligible, the applicant shall be admitted to the home or placed on the home’s wait list, if applicable. C. Applicants shall provide the following information:

1. A signed admission application, including completed financial information, a functional assessment, medical information and authorization for release of information; and, 2. Verification of eligibility for admission, including proof of discharge from the armed services and a copy of the DD-214 Form, if applicable.

D. In the event admission is denied, admission’s staff shall provide the applicant with information regarding their right to request a review of the denial and the review process. The applicant can request a review of the denial by sending a request in writing to the administrator of the home within thirty (30) calendar days of the date on the applicant's notice of denial. The administrator shall conduct a final review of the admission’s staff decision within ten calendar days of receipt from the applicant and shall notify the applicant in writing of the final decision. The decision of the administrator shall constitute final agency action.

E. If a State or Veteran’s Nursing Home does not have a vacant bed for an approved admission, the applicant shall be placed on a wait list administered by each home. Wait list protocols shall be based on the following rank:

1. Date of completed application.

2. Applicant is a resident Veteran.

3. Applicant is a non-resident Veteran.

4. Applicant is a spouse/surviving spouse.

5. Applicant is a parent of a child(ren) who (all) died while serving in the United States Armed Forces.

F. An applicant on the wait list offered admission has ten business days from the date of the written notice of admission to accept or decline admission to the Home. If the applicant declines the offer of admission, the applicant’s name shall be removed from the list, unless the applicant requests to be moved to the bottom of the wait list. If the applicant fails to respond to the offer of admission within ten business days from the date of the written notice, the applicant shall be moved to the bottom of the wait list.

G. The State or Veterans Nursing Home shall require all approved applicants to declare all sources and amounts of monthly income. Staff shall evaluate the financial status of an approved applicant to determine the person's ability to pay toward the cost of care and to calculate the maintenance rate.

11.130 STATE OR VETERANS NURSING HOME RESPONSIBILITIES [Rev. eff. 10/1/07] A. A resident shall be provided with the following information upon admission to a State or Veterans Nursing Home:

1. General information about the Home, resident care, services and activities available. 2. Resident Rights as found in Section 25-1-120, C.R.S. 3. Grievance procedures per the Colorado Department of Public Health and Environment Regulations for long-term care facilities (6 CCR 1011-1). 4. Other applicable Home policies including the Home’s rates, room reservation policy and charges.

B. The Home’s staff shall review the above stated information with the resident or the resident's legal representative. After reviewing this information, the resident or resident's legal representative shall sign a statement indicating the they have received and reviewed the information and agrees to abide by the Home’s rules and regulations. This statement shall be kept with the resident's admission agreement. If changes occur to the information, the Home shall inform the resident and provide a copy of the changes. The resident or resident's legal representative shall sign a statement indicating they have received and reviewed a copy of the changes and agrees to abide by the changes.

11.140 ROOM RESERVATION CHARGES [Rev. eff. 10/1/07] A. The resident or the resident’s legal representative shall notify the Home twenty-four (24) hours in advance of any planned absences of over ten hours.

B. A resident whose bed is held during an absence shall be responsible for any charges that accrued before or during the leave period. If the resident or resident’s legal representative does not agree in writing to pay the reservation charge, the Home may reassign the resident’s bed to another resident or discharge the resident and place the resident on the Home’s wait list. C. There shall be no room reservation charge to a Medicaid resident on medical leave if no source of payment, other than the resident’s funds, are available and the Home’s current occupancy is less than ninety percent (90%) of capacity.

D. Calculation of room reservation charges shall be as follows: 1. For non-Veteran Medicaid residents the room reservation charge shall be the Home’s current Medicaid per diem rate, less total food and linen service costs as computed from the most recent Med-13 Cost Report submitted to the Colorado Department of Health Care Policy and Financing (HCPF). In no case shall the charge be greater than the per diem rate less $2.

2. For Veteran Medicaid residents the room reservation charge shall be the Home’s current Medicaid per diem rate less total food and linen service costs as computed from the most recent Med-13 Cost Report submitted to the HCPF. In no case shall the charge be greater than the per diem rate less $2. If the resident is absent from the Home less than 96 hours, the current per diem rate provided by the U.S. Department of Veterans Affairs shall be subtracted from the room charge.

Room reservation charges for a Veteran Medicaid resident, whose absence results in a loss of U.S. Department of Veterans Affairs per diem payment (greater than 96 hours), shall include the current per diem reimbursement provided by the U.S. Department of Veterans Affairs, retroactive to the resident’s date of departure. 3. For private pay residents the room reservation charge shall be the Home’s private pay daily rate, less the daily total food and linen service costs as computed from the most recent Med-13 Cost Report submitted to HCPF.

4. Homelake Domiciliary residents shall be allowed thirty (30) days of approved leave per state fiscal year, excluding Medical Leave. Residents absent from the domiciliary over thirty days per fiscal year may be subject to discharge. The Homelake Domiciliary room reservation charge during any approved leave shall be the resident’s current daily rate at the time of leave. At the resident’s request, a domiciliary room shall be held for a resident admitted to the nursing Home for up to thirty days at the resident’s current daily rate. If the resident fails to return to the facility within thirty days, the resident shall be evaluated for continued stay at the domiciliary. If the resident is not approved for continued stay, the resident shall be given five business days to vacate the Homelake Domiciliary. The resident shall be responsible for the payment of rent through the day of departure. E. A bed may be held without charge for an approved applicant for up to two weeks from the date of acceptance of the offer of admission. Bed holds prior to admission may exceed two weeks from the date of acceptance with the approval of the Home’s administrator; however, the applicant shall be responsible for the daily rate following the first two weeks from the date of acceptance of the offer of admission.

11.150 FINANCIAL INFORMATION [Rev. eff. 10/1/07] A. An applicant or resident shall be the primary source of financial information to determine ability to pay except when management of the applicant's or resident's financial affairs has been designated to the legal representative. If the applicant or resident is not the source of financial information, the reason shall be noted in the financial information file. B. Residents shall apply for all federal and state benefits for which they may be eligible within thirty days of admission. The resident’s status with the home and eligibility for continued care shall not be affected if the resident is denied benefits.

11.160 MAINTENANCE RATES – PAYMENT FOR CARE [Rev. eff. 10/1/07] A. Pursuant to Section 26-12-108, C.R.S., the Department shall establish rates for care of residents as nearly equal to the cost of operation and maintenance of the homes as practicable. B. Current rates shall be given to each applicant. Each home shall send a written notice of any increase in proposed rates to each resident no later than fourteen business days prior to the effective date of the new rate.

C. Each Home shall have the authority to request pre-payment from a resident. 11.170 PAST DUE ACCOUNTS [Rev. eff. 10/1/07] A. A resident's account shall be deemed past due if the debt has not been paid by the close of business on the due date. The due date is ten calendar days from the end of the month for which a resident resided at the home. Interest may be accrued on accounts which are thirty days past due, and may be referred to the State Controller for collection. B. Discharge proceedings may be instituted per the Colorado Department of Public Health and Environment Regulations for long-term care facilities (6 CCR 1011-1) when an account is past due. Discharge proceedings shall be stopped if full payment is received by Home prior to the discharge taking place.

11.200 BURIAL AT THE COLORADO STATE VETERANS CENTER [Rev. eff. 10/1/07] A. The following individuals are eligible for burial and interment at the Colorado State Veterans Center: 1. A Veteran who at the time of his or her death was a Colorado resident. 2. A Veteran’s spouse, surviving spouse; dependant parent, or child, including a minor child or an unmarried child who was physically or mentally disabled and incapable of self-support when such spouse, surviving spouse, or dependant parent was an occupant of the Colorado State Veterans Center at the time of death.

B. Documented proof of Veteran status or Veteran relationship shall be provided. C. All necessary expenses incidental to the burial and interment shall be paid from the estate of the decedent.

D. Requests for burial and interment shall be made at least two business days prior to the funeral. E. Burial and interments shall be conducted Monday through Friday at noon. F. Site selection shall be at the discretion of the Colorado State Veterans Center. G. Only upright marble markers or headstones furnished by U.S. Department of Veterans Affairs shall be permitted.

11.300 LOCAL ADVISORY BOARD [Rev. eff. 10/1/07] A. Each State and Veterans Nursing Home shall institute a local advisory board. The local advisory board shall ensure appropriate communication channels are in place between the Home, the local community, and other stakeholder groups in order to resolve issues or celebrate successes at the earliest opportunity.

B. The local advisory board shall consist of a minimum five members, at least one of the members shall be a resident of the Home or a person who at the time of his or her appointment is a family member of a resident at the Home.

C. The local advisory board shall submit a year-end report to the Office Director of the State and Veterans Nursing Homes by July 30 of each year beginning in 2008. The year-end report shall summarize board activities, member concerns, resident concerns, staffing vacancies, accomplishments and any other issues the board deems appropriate. 11.400 (NONE)

11.500.1 OPERATION OF THE COUNTY VETERANS SERVICE OFFICER PROGRAM In carrying out the responsibilities for the appointment of County Veterans Service officers, the Board of County Commissioners of individual counties or the Board of adjacent counties, as applicable, shall follow the mandates of C.R.S. 26-9-101 through 26-9-102. Additionally, the following specific qualifications are recommended for County Veterans Service officers:

For Part Time Positions:

A high school diploma or its equivalent (G.E.D.), one year adult counseling, office management, human services, supervision, law enforcement, health services or other equivalent experience in direct public contact with adults. (Experience in Veterans programs is preferred.) For Full Time Positions:

A bachelors degree from an accredited university or college and One year adult counseling or equivalent experience dealing with the public. Adult counseling/public contact experience may be substituted on a year for year basis for the college degree. (Experience in Veterans programs is preferred.)

11.500.2 The primary duty of the County Veterans Service Officer shall be to assist any resident of the State of Colorado who is a veteran or any other person who is entitled or potentially entitled to any right or benefit under Federal or State laws by virtue of their own veteran status or the veteran status of another person. This assistance shall be consistent with and in conformance to the rules governing the operation of the County Veterans Service Officer Program.

11.500.3 Such County Service Officer shall cooperate with the State Division of Veterans Affairs and its staff members in all areas of the performance of his or her duties as defined in these rules. A. Information - County Veterans Service Officers shall respond to all requests for information regarding veterans rights and benefits by giving accurate and complete information. He or she shall work to develop a knowledge of veterans programs, rights and issues by attendance at training conferences conducted by the Division of Veterans Affairs and by furnishing the local office with appropriate and current resource materials regarding veterans programs (i.e., Code of Federal Regulations - 38, the I-S-1 Fact Sheet etc.). Additionally he or she should maintain and become familiar with these rules and the other portions of the Manual for the Operation of the County Veterans Service Officer Program.

B. Outreach - County Veterans Service Officers shall engage in outreach activities- within their counties. These activities should include public announcements of the office location and hours of operation (i.e., prominently located signs, media announcements etc.), attendance at meetings of veterans organizations and other community groups, contact/networking with other human service providers within the county (e.g., Job Service Centers, Mental Health Centers, Social Services), and cooperation with the Division of Veterans Affairs in the distribution of news releases to local media outlets and/or any other outreach activities requested by the Division of Veterans Affairs.

C. Claims Assistance - He or she shall assist claimants in the proper completion of applications for veterans benefits, assist in the development and securing of all evidence and documents necessary for the adjudication of claims and provide all other appropriate assistance or referral as requested by the Division of Veterans Affairs.

D. Cooperation with County. Departments of Social Services - County Veterans Service Officers shall provide claims information and assistance to all individuals referred from county departments of social services. He or she shall also furnish accurate information regarding receipt of benefits or potential eligibility requests from the county departments. Additionally, the County Veterans Service Officer shall cooperate with the Division of Veterans Affairs in efforts to assist applicants for or recipients of state public assistance benefits, in applying for and securing federal veterans benefits.

E. Equality of Service - County Veterans Service Officers shall provide uniform service and assistance to all individuals seeking their help, regardless of the race, color, creed, national origin, disability, gender or any other characteristic or belief of the claimant. F. Ethical Considerations - The County Veterans Service Officer shall always work in the best interest of his or her clients. However, he or she should never counsel or be party to an attempt to submit fraudulent claims information or to participate in an attempt to defraud the federal, state or county government. He or she shall not engage in activities or interests which conflict with the best interest of his or her clients. He or she shall protect the privacy of all confidential information in the files and records.

11.500.4 Duties and Functions of the Division of Veterans Affairs - The Division of Veterans Affairs shall formulate, establish and supervise a plan and standard procedures to enable the provision of prompt and efficient service to all veterans and other eligible persons in the State of Colorado on a uniform basis. It shall accomplish this by carrying out the following specific functions:

A. Semi-Annual Training Conferences - Provide adequate training to all County Service Officers on a regular basis by conducting semi-annual training conferences on veterans benefits, rights, and issues as well as such other topics as may be necessary for the proper job performance of the County Veterans Service Officers.

B. Training and Certification of Newly Appointed County Service Officers - Provide training to newly appointed County Veterans Service Officers both in their county offices and in the Office of the Division of Veterans Affairs. During their first year on the job, newly appointed County Veterans Service Officers shall accomplish the following_training. The Division shall conduct at least two on-site trainings with them. County Veterans Service Officers shall make at least one training trip to the Offices of the Division of Veterans Affairs.

Newly appointed County Veterans Service Officers shall attend both the spring and the fall training conferences conducted by the Division.

After approximately one year, a newly appointed County Service Officer shall be required to pass a basic proficiency test regarding veterans benefits and the other information contained in the Manual For The Operation Of The County Veterans Service Officer Program. This test will be administered by the Division along with a performance review and evaluation of the County Veterans Service Officer. Based on the results of the tests and the office review the Division will certify the County Service Office as eligible to receive State funding and assistance. Count Veterans Service Officers who are not certified initially will be given remedial training and allowed to retest for up to six months from the date of failure to certify. If the County Veterans Service Officer still cannot qualify for certification, the county commissioners will be requested by the Division to take corrective action and state funds and assistance may not be paid until a qualified individual is appointed.

C. Periodic Performance Reviews - The Division of Veterans Affairs shall continuously review the performance of each of the County Veterans Service Officer Programs. This review should include at least one on site visit to the county annually. The results of the Division's performance evaluation shall be communicated on an annual basis in writing to the county commissioners of that county.

D. Non-Compliance with State Rules or Below-Standard Performance - County Veterans Service Officers who are notified by the Division that their program is out of compliance with the state rules or that their job performance is below standard, will be given ninety days from the date of such notice to come into compliance or to improve his/her performance to a standard level. At their discretion, they may request the assistance of the Division of Veterans Affairs in remedial training. If after ninety days they still are not in compliance or are performing inadequately state funds and assistance will be discontinued until such time as a new County Service Officer is appointed. 11.500.5 Required Reports - Each county shall file a Monthly Report (Form CVA-26) with the Division detailing its Veterans Service Officers activities and expenditures for operation of its Veterans Service Office. The semi-annual payments from the state above will not be made until the required reports are received. All reports for the fiscal year (July 1 through June 30) being reported must be submitted by July 31 of the subsequent fiscal year or payments for the unreported months will not be made. 11.500.6 MISCELLANEOUS PROVISIONS Appeal of Administrative Decisions of the Division of Veterans Affairs - Any decision not to certify or to cease state funding and assistance to any county service program may be appealed by the county commissioners of that county. Such appeal must be initiated within sixty days of the official notification of state action. Such appeal will be made to the Board of Veterans Affairs who will review it and make a recommendation to the Executive Director of the Department of Social Services whether it should be granted. The decision of the Executive Director regarding the appeal will be final. _____________________________________________________ Editor’s Notes History Sections 11.100 thru 11.400 eff. 10/1/2007.