9 CCR 2503-7
DEPARTMENT OF HUMAN SERVICES Income Maintenance (Volume 3)
OTHER ASSISTANCE PROGRAMS 9 CCR 2503-7 [Editor’s Notes follow the text of the rules at the end of this CCR Document.] _________________________________________________________________________
3.700 OTHER ASSISTANCE PROGRAMS
3.705 NONCITIZEN EMERGENCY ASSISTANCE PROGRAM
3.705.1 GENERAL DEFINITIONS
“Legal Immigrant” means an individual who is not a citizen or national of the United States and who was lawfully admitted to the United States by the Immigration and Naturalization Services (INS) as an actual or prospective permanent resident or whose physical presence is known and allowed by U.S. Citizenship and Immigration Services (USCIS), and:
A. Is a resident of Colorado, B. Meets the requirements for public assistance or Food Stamps other than citizenship, C. Is not eligible for or receiving any other public assistance and/or Food Stamps.
3.705.11 EMERGENCY ASSISTANCE
A. Emergency Assistance my be available to legal immigrants, as defined above. To receive emergency assistance the applicant/recipient must:
1. provide documentation of immigrant status (see Section 3.140), 2. provide income and resource information and the sponsor's income and resource information (sponsor's income and resources, if applicable, are deemed to be available to the legal immigrant).
3. provide a copy of the Affidavit of Support signed by the immigrant's sponsor, if applicable, 4. establish that the sponsor's income and resources are not available, or that meeting the responsibilities of the affidavit would cause an undue hardship on the sponsor. Hardships may include loss or substantial reduction of income, or catastrophic or irreconcilable circumstances affecting the sponsor's household.
5. while receiving Emergency Assistance, refrain from executing an Affidavit of Support for the purposes of sponsoring an immigrant, and 6. assign rights under an Affidavit of Support to the state department up to the amount of Emergency Assistance received, as a condition of receipt of public assistance.
B. Emergency Assistance may include, but is not limited to:
1. housing 2. food 3. clothing 4. social services for children.
C. Requests for funding to counties under this program shall be subject to approval by the State Department.
D. Assistance under this program is limited by funding as appropriated and assistance will cease when such funds are exhausted.
E. Applicants and recipients whose benefits have been denied, reduced, or discontinued shall receive adequate and timely notice, and have the right to appeal such actions in accordance with state rules.
3.705.2 SPONSOR RESPONSIBILITY
Sponsors shall be expected to meet their commitments to the immigrants whom they sponsor and for whom they sign affidavits of support.
3.705.21 RECOVERIES
Public assistance that was improperly paid may be recovered from the immigrant or the sponsor, as described under Sponsor Responsibility. These recoveries may include, but no limited to, the following:
A. Income assignments;
B. State income tax refund offset;
C. State lottery winnings offset; and, D. Administrative lien and attachment.
Enforcement of duties under an affidavit of support shall be the responsibility of the sponsored immigrant.
3.710 COLORADO REFUGEE SERVICES PROGRAM (CRSP)
3.710.1 PROGRAM SUMMARY
3.710.11 [Rev. eff. 5/1/12]
The Colorado Department of Human Services, through the Colorado Refugee Services Program (CRSP), is the single State agency with responsibility for the overall supervision and coordination of this program in Colorado, and for the development and supervision of the annual state plan for Colorado. The Colorado Refugee Services Program (CRSP) operates under the Refugee Act of 1980 and Title IV of the Immigration and Naturalization Act (INA), as amended. Copies of the Immigration and Naturalization Act are available for public inspection by contacting the Colorado State Refugee Coordinator during regular business hours at the Colorado Department of Human Services, Colorado Refugee Services Program, 1120 Lincoln Street, Suite 1007, Denver, Colorado 80203; or at a state publications depository library. No later editions or amendments are incorporated.
3.710.2 GENERAL DEFINITIONS
3.710.21 Groups of Refugees
The following categories are refugees for purpose of CRSP eligibility:
A. A “refugee” is a person who is outside his/her country of nationality (or habitual residence) who is unable or unwilling to return to that country because of persecution or a well- founded fear of persecution on account of race, religion nationality, membership in a particular social group or political opinion A refugee has been granted refugee status outside of the United States.
B. An “asylee” is a person who has been granted asylum by the U.S. Citizenship and Immigration Service (USCIS) while residing in the United States. An asylee has the same rights and benefits as refugees from their date of entry. An asylee's entry date is the date that the individual was granted final asylum in the U.S. by USCIS and not the date that individual was admitted into the U.S. Individuals admitted to the United States who are classified by USCIS as “applicants for asylum” are not eligible for CRSP benefits unless they are Cuban or Haitian (refer to Sections 3.710.21, C and 3.710.31, D).
C. Cuban/Haitian entrants, parolees or asylum seekers. For documentation requirements, refer to Section 3.710.31, D.
D. Certain Amerasians with the following codes: AM-1, AM-2, AM-3, AM-6, AM-7, AM-8 on one of the following documents: form I-551, temporary I-551 stamp in passport, I-94 form, or any verification from the USCIS or other authoritative document.
E. “Victims of a Severe Forms of Trafficking” are persons who have been certified as such by the U.S. Department of Health and Human Services (HHS). and are eligible for benefits and services to the same extent as refugees.
F. Iraqi and Afghan individuals who worked as translators for the U.S. military, or on behalf of the U.S. government, or families of such individuals; and admitted under a Special Immigrant Visa (SIV) with specific visa categories of SI1, SI2, SI3, SI6, SI7, SI9, SQ1, SQ2, SQ3, SQ6, SQ7, or SQ9. Eligibility limitations are outlined in Section 3.710.31, I.
G. An I-551 (“Green Card” ) holder with class or admission codes AS-6 through AS-8, RE-6 through RE-9, CH-6.
3.710.3 VERIFICATION OF STATUS
3.710.31 Refugee [Rev. eff. 10/1/09]
Applicants for assistance under the Colorado Refugee Services Program as a “refugee” must possess in their name, documentation provided by the United States Citizenship and Naturalization Service (USCIS) under the Immigration and Nationality Act (INA) with one of the following statuses:
A. Admitted as a refugee under Section 207 of the INA.
B. Granted as an asylee under Section 208 of the INA; may have an I-94 form with Section 208 notation or, as an alternative, the individual may have a letter from the U.S. Department of Justice Executive Office for Immigration Review immigration judge indicating that final asylum has been granted and the date of asylum status.
C. Paroled as a refugee or asylee under Section 212(D)5) of the INA;
D. Cuban/Haitian entrants, parolees, or asylum seekers who have an I-94 form with a stamp indicating “Cuban/Haitian entrant” or a notation indicating “parolee” , with a notation of 212(D)(5)(a); any documents indicating pending exclusion or deportation proceedings; any documents indicating a pending asylum application, including a receipt from an USCIS asylum office indicating filing of form I-589 application for asylum; form I-688B employment authorization document coded 274A.12(A)(4) or 274.12(C)(11) or I-766 employment authorization document with code A04 or C11; or I-551 with an adjustment code of CH6.
E. Certain Amerasians with the following codes: AM-1, AM-2, AM-3, AM-6, AM-7, AM-8 on one of the following documents: form I-551, temporary I-551 stamp in passport, I-94 form or any verification from the USCIS or other authoritative document.
F. Adult Victims of a Severe Form of Trafficking will have an original letter from the U.S. Department of Health and Human Services certifying the person as a Victim of a Severe Form of Trafficking. Children under eighteen (18) years of age who have been subjected to trafficking do not need to be certified in order to receive benefits. The Office of Refugee Resettlement (ORR) will issue a letter stating that the person is a Victim of a Severe Form of Trafficking. Confirmation of the certification letter or similar letter may be made by calling the trafficking verification line 1-866-401-5510 and notifying ORR of the benefits for which the individual has applied.
G. Iraqi and Afghan SIVs who meet one of the criteria listed below are eligible for refugee services and other federal means tested public benefits for eight months from date of entry into the U.S.
1. A holder of an Iraqi or Afghan passport with a Department of Homeland Security visa noting the individual has been approved for admission under one of the Immigrant Visa (IV) categories of SI1, SI2, SI3 and a Department of Homeland Security admission stamp on the passport or I-94 noting date of entry.
2. A holder of a green card (I-551) showing Iraqi or Afghan nationality, or Iraqi or Afghan passport, showing one of the following immigrant visa categories: SI6, SI7, SI9.
3. A holder of an Iraqi passport with a Department of Homeland Security visa noting the individual has been approved for admission under one of the Immigrant Visa (IV) categories of SQ1, SQ2, SQ3 and a Department of Homeland Security admission stamp on the passport or I-94 noting date of entry.
4. A holder of a green card (I-551) showing Iraqi nationality, or an Iraqi passport, showing one of the following immigrant visa categories: SQ6, SQ7, SQ9.
H. An I-551 form (“green card” ) with class of admission codes AS-6, AS-7, AS-8, RE-6, RE-7, RE-8, RE-9, CH-6, HA6, HB6, GA6, GA7, GA8.
If not eligible for the assistance of TANF/Colorado Works, individuals with this immigration status may be eligible for Cares cash assistance through the Colorado Refugee Services Program if income eligibility criteria are met. Individuals admitted to the United States who are classified by USCIS as “Applicants for Asylum” are not eligible for CRSP benefits. Once granted asylum, those individuals are eligible. The exception to this rule is Cuban and Haitian individuals applying for asylum who are eligible for CRSP benefits.
3.711 (None) [Rev. eff. 5/1/12]
3.711.1 (None) [Rev. eff. 5/1/12]
3.711.2 REFUGEE MEDICAL ASSISTANCE (RMA)
3.711.21 Each individual member of a household that applies for medical assistance must first be screened for eligibility under the State Medicaid Program. If the individual is determined ineligible for Medicaid, then a determination of eligibility under the Refugee Medical Assistance (RMA) Program must be made. A "household" is defined as a single adult with no children, a married couple, a single parent with minor children, or a married couple with their minor children. Any individual of a household who is not eligible for Medicaid shall be considered for Refugee Medical Assistance (RMA).
Persons applying for Refugee Medical Assistance will use the State prescribed application for Medicaid. Applicants will first be screened for State Medicaid programs in accordance with the Colorado Department of Health Care Policy and Financing's Medical Assistance Manual (10 CCR 2505-10).
3.711.22 Initial Refugee Medical Assistance Determination and Definitions (Eligibility Determinations) [Rev. eff. 10/1/09] Refugees residing in the U.S. fewer than eight months, asylees who are within eight months from the date that their final asylum was granted, Victims of a Severe Form of Trafficking who are within their eight months from date of certification, and SIVs within their eight-month period of eligibility who lose their eligibility for Medicaid because of earnings from employment, will be transferred to RMA without an eligibility determination and the 200% of poverty rule shall not be applied. The increased earnings from employment shall not affect the refugee's continued medical assistance (RMA) eligibility. In cases where a refugee obtains private medical coverage, Third Party criteria applies in accordance with the Colorado Department of Health Care Policy and Financing's Medical Assistance manual, Sections 8.060-8.066 (10 CCR 2505-10) A. RMA shall continue until the individual eligible for refugee services reaches the end of his or her 8-month eligibility period. For Afghan SIVs, the duration of RMA is six months from their date of entry into the United States.
B. Initial RMA eligibility determination (where the applicant was not previously eligible for Medicaid) is based on 200% of the federal poverty level.
1. In determining eligibility for and receipt of RMA, the following are not considered: in- kind services and shelter provided to an applicant by a sponsor or local resettlement agency and any cash assistance payments provided to an applicant. This includes the Cares Program grant from the voluntary agency, matching grant, and reception and placement (R&P) grant payments.
2. Determination of RMA eligibility will be based on an applicant's income on the date of application.
3. Denial or termination of Cares payments does not cause denial or termination of RMA benefits.
3.720 HOME CARE ALLOWANCE [Em. eff. 2/1/13; Rev. eff. 5/1/13]
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 Medicaid 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.
3.720.1 SINGLE ENTRY POINT AGENCIES [Em. eff. 2/1/13; Rev. eff. 5/1/13]
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.
3.720.2 ELIGIBILITY [Em. eff. 2/1/13; Rev. eff. 5/1/13]
Eligibility for the Home Care Allowance program shall be based on both financial need and the applicant's or recipient's functional needs. The client shall meet eligibility for both financial and functional requirements to be approved for a Home Care Allowance payment.
A. To be financially eligible, the applicant or recipient shall:
1. 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, 2. Be approved for Supplemental Security Income (SSI) benefits and be receiving at least a $1.00 SSI payment.
B. To be functionally eligible, the applicant or recipient (client) shall have an HCA eligible functional assessment score as outlined in Section 3.720.3. The functional assessment score is calculated by determining the client’s functional capacity score and need for paid care score, as follows:
1. Functional Capacity: determined by assessing the applicant’s or recipient’s ability to complete all Activities of Daily Living (ADLs) and applying a score to their ability to complete the ADLs using the functional impairment scale, as outlined in Section 3.720.3; and, 2. Need for Paid Care: determined by identifying the unmet need for paid care and applying a score to the unmet need using the need for paid care scale as outlined in Section 3.720.3; and, 3. Combining the functional capacity score, as referenced in Section 3.720, B, 1, and the need for paid care score, as referenced in Section 3.720, B, 2, to determine whether the client meets the minimum scores for eligibility and, if eligible, the tier of benefits to be approved, as follows:
TIER CAPACITY SCORE CARE SCORE 1 21 or Higher 1 to 23 2 21 or Higher 24 to 37 3 21 or Higher 38 to 51 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 through 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.
3.720.3 FUNCTIONAL ASSESSMENT SCORING [Em. eff. 2/1/13; Rev. eff. 5/1/13]
A. The need for skilled personal care shall not be included in the scoring of the functional capacity or need for paid care. 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).
B. In order to be eligible for the Home Care Allowance Program, each client (applicant or recipient) shall score a minimum of twenty one (21) points when assessed for the ability to complete the Activities of Daily Living (ADL) using the following functional impairment 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 impairment of function exists even with an assistive device. The client requires occasional or intermittent supervision or physical assistance in a limited number of the components of the activity.
a. Occasional or intermittent means the client does not need assistance daily, but may need assistance a few times a month or up to one to two (1-2) times per week.
b. Supervision or assistance means verbal prompting, cueing, and reminders, and means stand-by assistance or monitoring to help the client if he/she needs physical assistance up to two (2) times per week.
3. Moderate: score two (2) if the client is unable to perform the majority of the essential components of the function even with an assistive device, and the client requires hands on and frequent assistance to accomplish the activity.
a. Frequent means the client needs assistance at least three to four (3-4) times per week and up to daily.
b. Hands on assistance means the care provider must physically assist the client in completing the task.
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.
C. The need for paid care score shall be based on the frequency of the client’s unmet need for paid care and shall be modified by the following factors:
1. Need for paid care shall be scored as zero (0) when those services are provided 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 typical household routine and the typical 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 Medicaid 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.
D. The need for paid care scale is 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.
E. The functional assessment shall be scored on the State-prescribed form, which shall list each activity of daily living, the functional capacity score and the need for paid care score for each ADL.
3.720.31 Activities of Daily Living [Em. eff. 2/1/13; Rev. eff. 5/1/13]
A. Activities of Daily Living (ADLs) shall be scored using the functional capacity impairment scale outlined in Section 3.720.3, B, and the need for paid care scale outlined in Section 3.720.3, C and D.
B. The Activities of Daily Living are:
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 him/herself.
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 him/herself.
2. Basic ADLs:
a. Mobility: the ability of the client to ambulate around the home and around essential places outside the home, 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 whether the client requires 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 Home Care Allowance Authorized Payment Amount [Em. eff. 2/1/13; Rev. eff. 5/1/13] A. The maximum HCA authorized grant amount for each tier is established by the Colorado Department of Human Services.
1. HCA payments shall be adjusted by the Colorado Department of Human Services to stay within available appropriations.
2. A county conference or state appeal shall not be granted when HCA payments have been adjusted to stay within available appropriations.
B. Each client (applicant or recipient), who meets the minimum scoring requirements for the HCA program and other program requirements as defined in Sections 3.720 or 3.740 shall be functionally eligible for a Home Care Allowance (HCA) or Special Populations Home Care Allowance (SP-HCA) grant.
1. The authorization by the Single Entry Point shall be forwarded to the county department to determine financial eligibility.
2. Clients shall not be approved for HCA if financially ineligible, even if the client is functionally eligible, as per Section 3.720.2.
3. Clients shall not be approved for HCA if functionally ineligible, even if the client is financially eligible, as per Section 3.720.2.
C. If financially and functionally eligible for HCA, 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 approved.
D. 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.
E. 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.
F. 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.
3.720.4 SERVICES FOR HCA RECIPIENTS [Rev. eff. 1/1/12]
Home care Allowance can be used to purchase:
A. Non-skilled assistance with activities of daily living, instrumental activities of daily living or supportive services; and;
B. Electronic monitoring; and, C. One-time deep cleaning if a referral is initiated by Adult Protective Services and determined necessary by the Single Entry Point case manager.
3.720.5 COUNTY RESPONSIBILITIES [Rev. eff. 1/1/12]
A. The county department must retain a copy of the State prescribed assessment form in the case file.
B. The county department must review each State prescribed form for completion.
C. The county department must update any changes in the case file. These changes must be updated in the State prescribed data system.
D. The county shall have the case organized and available for State review.
E. The county shall send written notice to the Single Entry Point (SEP):
1. Within five (5) working days of determining the authorized grant amount. Notice will be given on the State prescribed assessment tool.
2. Within five (5) working days after the eligibility worker determines that the client is no longer eligible for Home Care Allowance.
3. Within one (1) working day when the applicant or client has filed a written appeal with the county department of social/human services.
4. Within one (1) working day when the applicant or client has withdrawn the appeal or a final agency decision has been entered.
F. The county shall respond to requests for information from the SEP within twenty (20) working days.
3.721 FUNCTIONS OF THE SINGLE ENTRY POINT AGENCIES FOR THE HOME CARE
ALLOWANCE (HCA) AND ADULT FOSTER CARE (AFC) PROGRAMS
3.721.1 CASE MANAGEMENT AND PROGRAM FUNCTIONS [Rev. eff. 10/1/10]
Case management and program functions for the Home care Allowance and Adult Foster Care programs shall be administered through the Single Entry Point agencies designated by the Colorado Department of Health Care Policy and Financing pursuant to Section 25.5-6-106, C.R.S.
3.721.11 Definitions [Rev. eff. 1/1/12]
"Appropriateness of placement" means the determination of whether an applicant would be appropriate for an Adult Foster Care setting. The appropriateness of placement form shall be used to determine eligibility for the program.
"Assessment" means a comprehensive evaluation by the case manager with the client and appropriate collaterals (such as family members, friends and/or caregivers) to determine the client's level of functioning, service needs, available resources, and necessity for paid care. The functional needs assessment shall be documented on the State prescribed assessment tool. "Authorized representative" means an individual designated by the applicant or recipient, or by the parent or guardian of the applicant or recipient, if appropriate, to assist in acquiring or utilizing Home Care Allowance or Adult Foster Care services or supports. The extent of the authorized representative’s involvement shall be determined upon designation. "Care planning" means identifying client goals and choices for the care needed, services needed, appropriate service providers based on the client assessment and knowledge of the client and of community resources. The care plan shall be documented on the State prescribed care plan tool. "Case management" means the assessment of a client’s long-term care needs, development and implementation of a care plan, coordination and monitoring of the long-term care service delivery, evaluation of service effectiveness, and periodic reassessment of client needs. "Intake/screening/referral" means the initial contact with individuals by the Single Entry Point agency and shall include, but not be limited to, a preliminary screening in the following areas: an individual's need for long term care services, an individual's need for referral to other programs or services, an individual's eligibility for financial and program assistance, and the need for a comprehensive assessment.
"Ongoing case management" means the evaluation of the effectiveness and appropriateness of services, on an ongoing basis, through contacts with the client, appropriate collaterals, and service providers.
"Program" means a publicly funded program, including Adult Foster Care or Home Care Allowance.
"Reassessment" means a comprehensive re-evaluation by the case manager with the client and appropriate collaterals (such as family members, friends and/or caregivers) to determine the client's level of functioning, service needs, available resources, potential funding resources, and necessity for paid care. The reassessment of functional needs shall be documented on the State prescribed assessment tool.
"Single Entry Point (“SEP” ) agency" means the agency selected by the Colorado Department of Health Care Policy and Financing to provide case management functions for persons in need of long term care services within specific demographic areas. "State prescribed assessment tool" means the form approved by the Department for use in determining functional eligibility for the Home Care Allowance and Adult Foster Care programs.
3.721.12 Allocations and Reimbursement [Rev. eff. 10/1/10]
A. At the beginning of each fiscal year, the Department allocates funds for case management services provided by Single Entry Point agencies within the amount appropriated. Payments to Single Entry Point agencies shall not exceed this allocation unless additional funding is appropriated by the General Assembly.
B. The Department shall make monthly payments to each designated Single Entry Point agency based upon the methodology established by the Department.
3.721.13 Audit [Rev. eff. 10/1/10]
Single Entry Point agencies may be audited by representatives of the Department, its designee, and/or independent audit firms in accordance with State rules.
3.721.14 Service Functions of the Single Entry Points [Rev. eff. 10/1/10]
A. The Single Entry Point agency shall provide case management services in compliance with rules by the Department.
B. If at any time throughout the case management process the case manager suspects an individual to be a victim of abuse, neglect or exploitation, the case manager shall immediately refer the individual for protective services to the county department of social/human services in the individual’s county of residence and/or the local law enforcement agency.
3.721.2 CASE MANAGEMENT REQUIREMENTS
3.721.21 Intake/Screening/Referral [Rev. eff. 1/1/12]
A. The intake/screening/referral function of a Single Entry Point agency shall include, but not be limited to, the following activities:
1. The completion of the Department prescribed long term care Single Entry Point intake form;
2. The provision of information and referral to other agencies, as needed;
3. The determination of the appropriateness of a referral for a client assessment;
4. The identification of potential payment source(s), including the availability of private funding resources; and, 5. The implementation of a Single Entry Point agency procedure for prioritizing urgent inquiries.
B. If a referral to Single Entry Point long term care services is determined to be appropriate, the State prescribed intake form shall be completed with the applicant or applicant's representative within two (2) working days of the referral.
C. When reimbursement for long term care services are requested through the Home Care Allowance or Adult Foster Care programs, the Single Entry Point staff shall:
1. Verify the applicant's current financial eligibility status;
2. Refer the applicant to the county department of social/human services of the client's county of residence for application; or, 3. Refer the applicant to other community resources that can assist in the process of completing the application; and, 4. Document follow-up on return of forms.
D. The determination of the applicant's financial eligibility shall be completed by the county department of social/human services for the county in which the applicant resides.
E. Single Entry Point staff shall obtain the client’s or representative's signature on the intake form.
F. The SEP shall notify the applicant, at the time of his or her application for publicly funded long term care services, of the right to request a fair hearing before an Administrative Law Judge in accordance with Section 3.850, and to appeal adverse actions of the SEP, county department of social/human services, or contractors acting on behalf of the Department.
3.721.22 SEP Functional Assessment Responsibilities [Em. eff. 2/1/13; Rev. eff. 5/1/13] 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 Functional Capacity assessment score during an evaluation, with observation of the client and family, if appropriate, in his or her residential setting on the State Department prescribed assessment tool, using the scoring system outlined in Section 3.720.3;
2. 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;
3. Determine the client's service needs, taking into consideration services available, or already being received, from all funding sources;
4. 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;
5. Maintain appropriate documentation of the authorization for Home Care Allowance or Adult Foster Care program eligibility;
6. 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;
7. 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.
8. Obtain diagnoses from the client's medical provider for Adult Foster Care program applicants.
9. 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.
3.721.23 Care Planning [Rev. eff. 1/1/12]
A. The SEP case manager shall develop the care plan after completion of the client assessment and prior to the arrangement for services. The SEP case manager shall complete the care plan using the State prescribed care plan form within ten (10) working days after determination of program eligibility.
B. Care planning shall include, but not be limited to, the following tasks:
1. The identification and documentation of care plan goals and client choices;
2. The identification and documentation of services, including type, duration and frequency;
3. The formalization of the care plan agreement, including appropriate signatures, in accordance with program requirements;
4. For the Adult Foster Care clients, The arrangement for services by contacting service providers, coordinating service delivery, negotiating with the provider and the client regarding service provision, and formalizing provider agreements in accordance with program rules;
5. The completion of program requirements for authorization of services;
6. Referral to community resources as needed and development of resources for individual clients if a resource is not available within the client's community;
7. The explanation of complaint procedures to the client as listed on the care plan document;
8. The explanation of appeals process to the client, if necessary.
C. Authorization of Home Care Allowance 1. The case manager shall negotiate with the applicant or recipient and care provider to arrive at the total number of paid care hours to be provided monthly. The applicant, recipient or authorized representative and the provider shall sign the State prescribed provider agreement. Each party shall receive a copy of the agreement.
2. In all cases, Home Care Allowance payments shall be made directly to the applicant, recipient or authorized representative who is responsible for paying the provider the agreed upon, authorized amount monthly. No portion of the authorized HCA amount shall be withheld by the recipient for personal use. The entire HCA authorized amount must be spent for HCA allowable services.
3. The case manager shall send a signed copy of the assessment instrument to the county eligibility worker authorizing payment of the Home Care Allowance within one working day of making the determination that the client is eligible to receive services.
D. Prudent Purchase of Services 1. The case manager shall meet the client's needs, with consideration of the client's choices, using the most cost effective methods available.
2. When services are available to the client at no cost from family, friends, volunteers, or others, these services shall be utilized before the purchase of services, providing these services adequately meet the client's needs.
3. When public dollars must be used to purchase services, the case manager shall encourage the client to select the lowest cost provider of service when quality of service is comparable.
4. The case manager shall assure there is no duplication in services provided by Single Entry Point programs and any other public or privately funded services.
3.721.24 Ongoing Case Management [Rev. eff. 10/1/10]
A. The case manager shall:
1. Monitor the quality of care provided to clients;
2. Identify and resolve any problems with service delivery, including corrective action processes, as appropriate;
3. Identify changes in the client's needs that may require a full reassessment or a change in the care plan; and, 4. Make changes in service plans as appropriate to client needs.
B. Ongoing case management shall include, but not be limited to, the following tasks:
1. Review of the client's assessment, care plan, and service agreements to include changes in client functioning, service effectiveness, appropriateness, and cost- effectiveness;
2. Contact with service providers concerning service coordination, effectiveness and appropriateness, as well as concerning any complaints raised by the client or others;
3. Contact with appropriate individuals in the event any issues or complaints have been presented by the client or others;
4. Conflict resolutions and/or crisis intervention, as needed;
5. Notification of appropriate law enforcement and/or protective services agencies, as needed; and, 6. Referral to community resources as needed.
C. The case manager shall immediately report to the appropriate agency any information that indicates an overpayment, incorrect payment or misuse of any public assistance benefit, and shall cooperate with the appropriate agency in any subsequent recovery process in accordance with the rules in Section 3.810.
D. The case manager shall complete a review of the client’s current assessment or reassessment and the care plan with the client six months following the assessment or reassessment. The review shall be conducted by telephone, at the client’s place of residence, at the place of service or other appropriate setting as determined by the client’s needs. A face-to-face home visit shall be completed when significant changes in the client’s condition are identified.
E. The case manager shall contact the service providers to monitor service delivery as determined by the client's needs or as required by the specific service requirements.
3.721.25 Reassessment [Rev. eff. 1/1/12]
A. The case manager shall complete a face-to-face reassessment with the client within twelve (12) months of the initial client assessment and every twelve months thereafter. A reassessment shall be completed sooner if the client's condition changes.
B. The case manager shall update the information provided at the previous assessment or reassessment, utilizing the State prescribed assessment tool. When a new assessment is completed for a Home Care Allowance or Adult Foster Care client, a copy shall be sent to the county department of human/social services within thirty (30) days of the reassessment.
C. Reassessment shall include, but not be limited to, the following activities:
1. For Adult Foster Care clients, obtain diagnoses from the client's medical provider at least annually, or sooner if the client's condition changes;
2. Assess client's functional status face-to-face at the client's place of residence;
3. Review the care plan, service agreement, and provider contract or agreement;
4. Evaluate service effectiveness, quality of care, and appropriateness of services;
5. Verify continuing financial and program eligibility;
6. Annually, or more often if indicated, complete a new care plan and service agreement;
7. Refer the client to community resources, as needed;
8. For Adult Foster Care clients, a State prescribed appropriateness of placement form must be completed.
3.721.3 CASE DOCUMENTATION AND PROGRAM EVALUATION
3.721.31 Case Documentation [Rev. eff. 10/1/10]
A. Documentation of contacts and case management activities shall be entered into the data system(s) prescribe d by the State within five (5) working days of the contact or activity.
B. All information related to intake, assessment, and care planning shall be thoroughly documented within ten (10) working days of the intake, assessment or care planning using forms and data system(s) prescribed by the State.
C. Additional documentation that cannot be entered into the data system(s) prescribed by the State shall be maintained in the case file.
3.721.32 Completion of Single Entry Point Forms [Rev. eff. 10/1/10]
The SEP case manager shall notify applicants and clients of their services status using the State prescribed form at the time of initial eligibility, when there is a significant change in the client's payment or services, when an adverse action is taken, or at the time of discontinuation.
3.721.4 DENIALS OR DISCONTINUATIONS [Rev. eff. 1/1/12]
Clients shall be denied or discontinued from the Home Care Allowance or Adult Foster Care programs if they are determined ineligible and shall be informed of appeal rights in accordance with rules under Section 3.850, et seq.
A. Financial Eligibility The county department of social/human services shall notify the applicant or client of denial for reasons of financial eligibility. The SEP case manager shall not attend the appeal hearing for a denial or discontinuation based on financial eligibility unless subpoenaed or requested by the county.
B. Level of Care The Single Entry Point agency shall notify the applicant or client of denial for reasons of level of care when:
1. Home Care Allowance functional capacity and/or need for paid care scores do not meet minimum requirements.
2. Adult Foster Care appropriateness for placement criteria is not met (see Section 3.733).
3. Persons who are developmentally disabled or who are receiving, or are eligible to receive, services administered by the Colorado Department of Human Services, Division of Developmental Disabilities, are not eligible for AFC. The case manager shall attend the appeal hearing to defend a denial or discontinuation.
C. Receipt of Services The SEP case manager shall notify the current client of denial for reasons of receipt of service when the client or authorized representative:
1. Has not received services for one month;
2. Has refused to schedule an appointment for an initial assessment, six-month review, or reassessment twice within a thirty (30) day consecutive period;
3. Has failed to keep three (3) scheduled appointments within a thirty (30) consecutive day period;
4. Has refused to schedule an appointment for a required visit after an inter-district transfer;
5. Refuses to use the Home Care Allowance or Adult Foster Care payment to pay for services or uses the payment for services not identified in the service agreement; or, 6. Refuses to sign the intake form, care plan, or other documents and forms required to receive services.
The case manager shall attend the appeal hearing to defend the denial or discontinuation.
D. Institutional Status The SEP case manager shall notify the applicant or current client of denial or discontinuation for reasons of institutional status when:
1. The applicant is a resident of a nursing facility, hospital, or other institution;
2. The current client enters a hospital for treatment and hospitalization continues for thirty (30) days or more;
3. An applicant for Home Care Allowance (HCA) is residing in an Adult Foster Care or alternative care facility; or, 4. A current client receiving HCA has resided in such a facility more than thirty (30) days. The case manager shall attend the appeal hearing to defend the denial or discontinuation.
E. Service Limitations Related to Safety or Cost Effectiveness The SEP case manager shall notify the applicant or client of denial or discontinuation when the case manager determines that the applicant or client cannot be safely served given the type and/or amount of services available or the level of service need is not cost effective under the Home Care Allowance or Adult Foster Care programs.
1. The case manager shall attend the appeal hearing to defend the denial or discontinuation.
2. To support a denial or discontinuation for safety reasons related to service limitations, the case manager shall document the limitations and evidence of safety concerns, when available, including, but not limited to:
3. To support a denial or discontinuation due to cost effectiveness the case manager shall document the level of service need and more cost effective alternatives.
F. Living Arrangements The SEP case manager shall notify the applicant or client of denial for reasons of living arrangements when:
1. A Home Care Allowance applicant or client is residing in a licensed or unlicensed facility.
2. An Adult Foster Care (AFC) applicant or client is residing anywhere other than an approved AFC facility.
G. Move Out of State The SEP case manager shall notify the client of discontinuation when the client has moved out of state. Discontinuation shall be effective the day after the date of the move. Clients who leave the state on a temporary basis with intent to return to Colorado within thirty (30) calendar days shall not be discontinued.
H. Voluntary Withdrawal from the Program The SEP case manager shall notify the client of discontinuation from the program effective upon the day after the date on which the client requests withdrawal from the program.
I. Death A client shall be discontinued from the program effective upon the day after the date of death. No notice of discontinuation shall be sent.
3.721.41 Referrals and Notifications Upon Denial or Discontinuation [Rev. eff. 1/1/12] In the case of denial or discontinuation, the case manager shall:
A. Provide appropriate referrals to other community resources, as needed, within one (1) working day of discontinuation.
B. The case manager shall notify all providers on the care plan within one (1) working day of discontinuation.
C. The case manager shall notify the county department of human services within one (1) working day of discontinuation.
3.721.42 Notification to the County Department [Rev. eff. 1/1/12]
The Single Entry Point agency shall notify the income eligibility section of the appropriate county department of social/human services:
A. When it notifies the applicant or client of the adverse action;
B. When the applicant or client has filed a written appeal with the Single Entry Point agency; or, C. When the applicant or client has withdrawn the appeal or a final agency decision has been entered.
3.721.5 COMMUNICATION REQUIREMENTS [Rev. eff. 1/1/12]
In addition to any communication requirements specified elsewhere in these rules, the case manager shall be responsible for the following communications:
A. Informing the income maintenance technician of any and all changes effecting the client's participation in the Home Care Allowance or Adult Foster Care programs, including changes in income or placement in an identified hospital or nursing facility, within one working day after the case manager learns of the change.
B. Informing the client’s adult protective services caseworker, if applicable, of the client's status. The case manager shall participate in mutual staffing of the client's case.
C. Reporting to the Colorado Department of Public Health and Environment any congregate facility, with three (3) or more residents, that is not licensed.
3.721.6 CASE TRANSFERS
3.721.61 Intercounty Transfers [Rev. eff. 1/1/12]
Single Entry Point agencies shall complete the following procedures to transfer case management clients to another county:
A. Notify the income maintenance technician of the client's plans to relocate to another county and the date of transfer and instruct the technician to follow the procedures for intercounty transfers (see Section 3.140.3).
B. If the client's current service providers do not provide services in the area where the client is relocating make arrangements, in consultation with the client, for new service providers.
C. If an Adult Foster Care client is moving from one county to another county to enter a new facility, forward copies of the following client records to the facility prior to the client’s admission to the facility:
1. Current client assessment;
2. Verification of financial eligibility status.
3.721.62 Interdistrict Transfers [Rev. eff. 1/1/12]
Single Entry Point agencies shall complete the following procedure in the event a client transfers from one Single Entry Point district to another single entry point district:
A. The transferring Single Entry Point agency shall contact the receiving Single Entry Point agency by telephone to give notification that the client is planning to transfer, to negotiate a transfer date, and to provide information.
B. If the transfer is from one county to another county, the transferring Single Entry Point agency shall notify the income maintenance technician of the client's plans to relocate to another county and the date of transfer, and instruct the technician to follow the procedures for intercounty transfers (see Section 3.140.3).
C. The transferring Single Entry Point agency shall forward copies of the client's case records, including forms required by the publicly funded program, to the receiving Single Entry Point agency prior to the relocation, if possible, but in no case later than five (5) working days after the client's relocation.
D. If the client is moving from one Single Entry Point district to another Single Entry Point district to enter an Adult Foster Care facility, the transferring Single Entry Point agency shall forward copies of client records to the facility prior to the client's admission to the facility in accordance with the procedures for intercounty transfers.
E. The receiving Single Entry Point agency shall complete a face-to-face meeting with the client and a case summary update within ten (10) working days after notification of the client's relocation, in accordance with assessment procedures (see Section 3.721.22) for Single Entry Point agency clients.
F. The receiving Single Entry Point agency shall review the care plan and the assessment tool and revise as necessary, and coordinate services and providers, as necessary.
G. If indicated by changes in the care plan, the receiving Single Entry Point agency shall revise the service authorization form and notify the county as required by the publicly funded program.
3.730 ADULT FOSTER CARE [Rev. eff. 1/1/12]
"Adult Foster Care (AFC) " means care provided on a twenty-four (24) hour basis for no more than sixteen (16) residents in a non-medical facility. The facility is licensed by the Department of Public Health and Environment. This program serves the frail elderly, physically or emotionally disabled adults, eighteen (18) years of age and over, who do not require twenty-four hour medical care. The Adult Foster care program cannot be combined with other long-term care programs, such as Home Care Allowance or a Home and Community Based Services (HCBS) waiver that provides services for any person receiving or eligible to receive services pursuant to any provision in Title 27, C.R.S.
3.730.1 DEFINITIONS [Rev. eff. 1/1/12]
A. "Adult Foster Care Facility" means a licensed Assisted Living Residence (ALR) that meets all applicable federal, state, and local laws and regulations. AFC facilities shall provide the following:
1. Twenty-four hour residential care for no more than sixteen (16) residents;
2. An environment that is sanitary and safe from physical harm;
3. Adequate sleeping and living areas; and, 4. Adequate recreational areas.
B. "Adult Foster Care Services" means those services which shall be provided by an AFC facility to each resident. These services shall include, but are not limited to:
1. Availability of three balanced meals per day with provision for special diets when those diets have been prescribed as part of a medical plan;
2. Assistance with transportation;
3. Protective oversight;
4. Assistance with basic personal tasks, such as bathing, hair care, and dressing;
5. Supervision of self-administration of medications;
6. Housekeeping services such as changing of bed linen, cleaning of living areas, and rearrangement of furniture as needed to promote freer mobility;
7. Laundering of resident's clothing and bedding; and, 8. Opportunities for structured recreational activities and socializing.
C. "Operator" means any person who owns an AFC facility or an individual with authority delegated by the owner who manages, controls or performs the day-to-day tasks for operating an AFC facility.
D. "Protective Oversight" means guidance of a resident, as required by the needs of the resident or as reasonably requested by the resident, including the following:
1. Being aware of a resident's general whereabouts, although the resident may travel independently in the community;
2. Monitoring the activities of the resident while on the premises to ensure the health, safety, and well-being of the resident, including monitoring of prescribed medications;
3. Reminding the resident to carry out activities of daily living; and, 4. Reminding the resident of any important activities, including appointments.
E. "Resident" means an individual who has met all the eligibility requirements for Adult Foster Care, has met the appropriate placement criteria for the AFC program, and has been approved for placement or currently resides in a certified Adult Foster Care facility.
F. "Restraint" means any physical or chemical device, application of force, or medication which is designed or used for the purpose of modifying, altering, or controlling behavior for the convenience of the facility and excludes medication prescribed by a physician as part of an on-going treatment plan or pursuant to a diagnosis. Restraints as defined herein are prohibited.
G. Staff" means a paid employee of the facility.
H. "Substance Abuse" means the use of any mind or mood altering material in a manner which deviates from standard medical practice in the community, which acts to the detriment of the individual residents or the public, and which includes but is not limited to, alcohol, dangerous drugs, or narcotic drugs.
1. Alcohol refers to beverage alcohol, ethylene alcohol, or ethanol.
2. Dangerous drugs refers to cannabis or any depressant drug, hallucinogenic drug, stimulant drug, or tranquilizer, or any such mixture or compound with any other substances.
3. Narcotic drugs refers to any drug to which the Federal Controlled Substance Act of 1970 may apply and any drug found by the State Board of Health to be addiction forming or to have an addiction sustaining character similar to morphine or cocaine.
I. "Universal Precautions" refers to a system of infection control, which assumes that every direct contact with body fluids is potentially infectious. This includes any reasonably anticipated skin, eye, mucous membrane or potential contact with blood, blood-tinged body fluids, or other potentially infectious materials.
3.730.2 ELIGIBILITY [Eff. 1/1/07]
Eligibility for the Adult Foster Care program shall be based on financial need, the recipient's need for 24- hour supervision and assistance with activities of daily living, appropriateness for the AFC program, and available appropriations. The applicant or recipient must meet all eligibility criteria required for the appropriate program, OAP or AND/AB/SSI-CS.
3.730.21 Financial Eligibility [Rev. eff. 1/1/12]
The county department eligibility worker in the recipient's county of residence shall determine financial eligibility for Adult Foster Care. In determining financial need, the applicant's or the recipient's total countable income is subtracted from the AFC grant amount to derive the net payment to the applicant or recipient.
A. In addition to the needs of the individual, an Adult Foster Care allowance shall be included in the grant of an AND/AB/SSI-CS or OAP recipient when:
1. The need for such care has been determined by the Single Entry Point agency;
2. The care is authorized by the Single Entry Point agency; and, 3. The applicant or recipient is or will be residing in a currently licensed Adult Foster Care facility.
B. The maximum amount which can be allowed as Adult Foster Care is the difference between the AND/AB/SSI-CS or OAP standard and the State approved Adult Foster Care rate plus $50 personal needs allowance.
C. The AFC payment to providers may be adjusted by the State Department to stay within available appropriations.
D. If a current recipient of Home Care Allowance or a Home and Community Based Services (HCBS) waiver that provides services for any person receiving or eligible to receive services pursuant to any provision in Title 27, C.R.S., is seeking AFC services, eligibility for placement or payment cannot begin until the first day of the month following the discontinuation of HCBS.
3.730.22 County Responsibilities [Rev. eff. 1/1/12]
A. The county department must retain a copy of the State prescribed assessment form in the electronic or paper case record.
B. The county department must review each State prescribed form.
C. The county department must update any changes in the case record. These changes must be updated in the State prescribed data system.
D. The county department shall have the case organized and available for State review.
E. The county shall notify the Single Entry Point (SEP) in writing:
1. Within five (5) working days of determining the authorized grant amount. Notice shall be given on the State prescribed assessment tool.
2. Within five (5) working days after the eligibility worker determines that the client is no longer eligible for Adult Foster Care.
3. Within one (1) working day when the applicant or client has filed a written appeal with the county department of social/human services.
4. Within one (1) working day when the applicant or client has withdrawn the appeal or a final agency decision has been entered.
F. The county shall respond to requests for information from the SEP within twenty (20) working days.
3.730.3 FUNCTIONAL ASSESSMENT [Rev. eff. 10/1/10]
Refer to Section 3.721.22 for functional assessment responsibilities of the Single Entry Point agencies.
3.730.4 ADMISSION PROCEDURE
3.730.41 Applicant Intake [Rev. eff. 10/1/10]
Refer to Section 3.721 for the Adult Foster Care intake responsibilities of the Single Entry Point agencies.
3.730.42 Assessment [Rev. eff. 1/1/12]
Refer to Section 3.721 for the Adult Foster Care assessment responsibilities of the Single Entry Point agencies.
3.730.43 Appropriate Facility Review [Rev. eff. 1/1/12]
The case manager shall review available Adult Foster Care facilities to determine if the applicant's or recipient's needs can be met by a current facility. This review may include contact with other counties which have AFC facilities. This review must include discussion of the needs of the recipient with the licensed Adult
3.730.44 Agreement to Placement Services [Eff. 1/1/07]
A recipient shall not be placed in an Adult Foster Care facility unless one or more of the following conditions are met:
A. The competent recipient gives informed consent for placement; or, B. The court-appointed guardian of the recipient requests placement; and, C. The recipient or his legal representative understands and agrees to adhere to facility rules.
3.730.5 CARE PLANNING [Rev. eff. 1/1/12]
When the decision is made that the applicant is appropriate for Adult Foster Care program, the case manager shall:
A. Discuss the facility and the provider with the recipient;
B. Arrange for an initial visit by the recipient to the facility;
C. Have a care plan negotiated with and signed by the recipient and case manager prior to admission. The care plan shall be developed in conjunction with the ALR Board and Care Plan required and must be renewed at least every twelve months or sooner if there is a change in the recipient's condition;
D. Have a current provider agreement signed by the manager of the Adult Foster Care facility prior to placement. This agreement shall be renewed at least annually, contingent upon the facility having a license as an Assisted Living Residence.
E. The case manager shall send a signed copy of the State prescribed form to the county eligibility worker authorizing the Adult Foster Care payment. The Adult Foster Care payment effective date shall be the date that the applicant was admitted to the AFC facility or the date he/she is determined to be financially eligible, whichever is later. If the applicant is a current recipient of HCBS that provides services for any person receiving or eligible to receive services pursuant to any provision in Title 27, C.R.S, the effective date is the first day of the month following the discontinuation of HCBS.
F. In all cases, Adult Foster Care payments shall be made directly to the recipient or the recipient's authorized representative. The recipient or representative is responsible for paying the AFC provider the agreed amount on a regular monthly basis.
G. The case manager shall explain that the recipient or recipient's authorized representative is responsible to pay the AFC provider on a monthly basis.
3.730.6 SINGLE ENTRY POINT AGENCY FUNCTIONS [Rev eff. 10/1/10]
Refer to Section 3.721, et seq.
3.730.7 NOTIFICATION OF ACTION AND APPEAL RIGHTS [Rev. eff. 10/1/10]
Refer to Sections 3.830, et seq., and 3.850, et seq.
3.731 OPERATOR/STAFF QUALIFICATIONS [Rev. eff. 1/1/12]
Adult Foster Care providers must be licensed by the Colorado Department of Public Health and Environment. Providers shall be in compliance with "Standards for Hospitals and Health Facilities: Chapter VII: Assisted Living Residences" (6 CCR 1011-1), including operator and staff qualifications, training, records, reporting, and resident rights.
3.732 APPROPRIATENESS OF PLACEMENT [Rev. eff. 1/1/12]
Only residents whose needs can be met by the facility shall be admitted to that facility. A facility shall not admit or keep any resident requiring a level of care or type of service which the facility does not provide or is unable to provide. In no event shall a facility admit or keep a resident who:
A. Needs skilled services on more than an intermittent basis. If skilled services are provided on an intermitted basis, they must be provided by a skilled provider.
B. Is unable or unwilling to meet his/her own personal hygiene needs under supervision.
C. Has an acute physical illness which cannot be managed through medications or prescribed therapy.
D. Has a substance abuse problem, unless the substance abuse is no longer acute and a physician determines it to be manageable.
E. Has ambulation limitations, unless compensated for by an assistive device with minimal assistance from staff.
F. Has a reportable communicable or infectious disease, unless the transmittal of the disease can be managed through the use of universal precautions and appropriate medical and/or drug treatment.
G. Is consistently disoriented to time, person, and place to such a degree that he/she poses a danger to self or others.
H. Has seizure disorders which are not adequately controlled by medications.
I. Requires tray food services on a continuous basis.
J. Exhibits behavior which poses a physical threat to self or others. Such behavior includes, but is not limited to, violent and disruptive behavior and/or any behavior which involves physical, sexual or psychological force or intimidation.
K. Requires intravenous or tube feeding.
L. Is consistently unwilling to take medications prescribed by a physician.
M. Is incapable of self-administration of medications unless the facility has a staff member trained in medication administration, in accordance with Section 25-1-107, C.R.S., et seq., or who possesses all necessary licenses to do so.
N. Is a person whose, physical safety cannot be assured in an AFC.
O. Is consistently, uncontrollably incontinent of bowel or bladder that cannot be managed by resident with assistance from staff.
P. Needs restraints, as defined herein, of any kind.
Q. Has a primary diagnosis of mental illness and is unwilling to comply with medications prescribed by the physician and is not receiving services from the local community mental health center or other mental health professional.
R. A copy of the ALR Board and Care Plan, jointly developed by the resident, family, caseworker, and operator, must be provided to all parties prior to admission to the facility.
S. Any client admitted for respite care in an AFC must meet the requirements for appropriate placement.
3.733 SERVICES PROVIDED [Rev. eff. 1/1/12]
Facilities shall provide those services indicated in Section 3.730.1.
3.734 FACILITY RESPONSIBILITIES TO THE SINGLE ENTRY POINT [Rev. eff. 1/1/12]
Facilities serving Adult Foster Care residents shall:
A. Provide a copy of their current license from the Colorado Department of Public Health and Environment to the SEP annually.
B. Notify the Single Entry Point (SEP) within twenty-four (24) hours after any revocation or suspension of any licenses or violation of codes or ordinances has occurred.
C. Notify the SEP of a potential crisis situation where intervention from the case manager may be necessary.
D. Notify the SEP case manager of any death, acute illness, or accident requiring medical attention.
E. Provide updates or cooperate in periodic conferences relating to the resident.
F. Immediately notify the Single Entry Point agency of any AFC resident’s planned or unplanned medical or non-medical leave of more than twenty-four hours.
1. "Medical leave" means the absence of the resident from the AFC facility due to admittance to a hospital or other institution. This must be on the order of a physician, and there must be a presumption on the part of the physician that the resident will be returning to the AFC facility.
2. "Non-medical leave" means the absence of the resident from the AFC facility for non- medical reasons that are not part of a recipient's care plan.
3.735 REIMBURSEMENT METHOD FOR ADULT FOSTER CARE [Rev. eff. 1/1/12]
A. AFC facilities shall charge a standard rate of payment per resident, per month as determined by the State Department.
B. AFC facilities shall not submit bills or otherwise attempt to collect payments from residents or residents' estates for any services provided to the resident which are benefits reimbursable under the program in accordance with the rules of the Colorado Department of Human Services.
C. AFC facilities shall charge private pay residents an amount at least equal to that charged to AFC residents.
3.740 SPECIAL POPULATIONS-HOME CARE ALLOWANCE (SP-HCA) PROGRAM
3.741 Definitions [Rev. eff. 7/1/12]
The following definitions shall apply to the rules related to SP-HCA: "Activities of daily living" means physical transfers, bladder care, bowel care, mobility, dressing, bathing, hygiene, and eating.
"Authorized representative" means an individual designated by the client, or by the parent or guardian of the client, if appropriate, to assist in acquiring or utilizing SP-HCA services. "Care planning" means identifying client goals and choices for the care needed, services needed, appropriate service providers based on the client assessment and knowledge of the client and of community resources.
"Case management" means the assessment of a client’s long-term care needs, development and implementation of a care plan, coordination and monitoring of the long-term care service delivery, evaluation of service effectiveness, and periodic reassessment of client needs. "Client" means any person identified by the State Department as meeting the minimal eligibility criteria to apply for a Special Populations - Home Care Allowance (SP-HCA) program grant as outlined at Section 3.742, A-B, or any person approved for a SP-HCA program grant. "Functional Assessment" means a comprehensive evaluation by the case manager with the client and appropriate collaterals (such as family members, friends and/or caregivers) to determine the client's level of functioning, service needs, available resources, and necessity for paid care. "Home" means a non-institutional residence.
"Instrumental activities of daily living" means meal preparation, housework, laundry, and shopping. "Non-skilled services" mean activities of daily living, instrumental activities of daily living, and supportive services.
"Single Entry Point" means the agencies designated by the Colorado Department of Health Care Policy and Financing pursuant to Section 25.5-6-106, C.R.S.
"Service Plan Authorization Limit" (SPAL) means an annual upper payment limit of total funds available to purchase services to meet the client’s ongoing needs. Purchase of services not subject to the SPAL are in accordance with the Colorado Department of Health Care Policy and Financing rules in Section 8.500.102, B (10 CCR 2505-10). A specific limit is assigned to each of the six support levels in the HCBS- SLS waiver. The SPAL is determined by the Department based on the annual appropriation for the HCBS- SLS waiver, the number of clients in each level, and projected utilization. "Spending Limitation" means an annual maximum limit of funds available to purchase services to meet the client’s needs under the HCBS-CES waiver.
"State Department" means the Colorado Department of Human Services. "Supportive services" means medication, appointment, and money management; accessing resources; and telephoning.
3.742 Program Overview [Rev. eff. 7/1/12]
A. The Special Populations Home Care Allowance (SP-HCA) program was established to allow dual eligibility for a SP-HCA program grant for specific clients enrolled in Home and Community Based Services (HCBS) Supportive Living Services (SLS) or HCBS- Children’s Extensive Support (CES) waivers meeting eligibility criteria established within these rules.
B. The SP-HCA grant shall be used for the purpose of securing non-skilled services for a client in his/her home, based on the SEP's functional assessment. Skilled personal care is not a paid service under the SP-HCA grant. (See HCPF rules, Section 8.489.30 (10 CCR 2505- 10) for the definition of skilled personal care).
C. The SP-HCA grant shall be paid to the designated care provider and shall not be used to meet ordinary household expenses, including but not limited to, shelter costs, utilities, food, toiletries, clothing, or home furnishings.
D. SP-HCA is a non-entitlement program that can only be combined with HCBS-SLS and HCBS- CES. No other long-term care program, such as other Home and Community Based Services waivers, Home Care Allowance (HCA), or Adult Foster Care (AFC), may be combined with SP-HCA.
E. Eligibility for the SP-HCA program shall be based on:
1. Basic requirements for public assistance benefits, including residency, citizenship, and lawful presence, as outlined in Section 3.100 et seq., and 3.200, et seq.;
2. Financial need;
3. The client’s functional capacity score;
4. The client’s need for paid care score;
5. The client’s receipt of Home Care Allowance (HCA) between September 1, 2011 and December 31, 2011; and, 6. The client’s receipt of and relationship to his/her HCBS-SLS SPAL or HCBS-CES Spending Limitation maximum between September 1, 2011 and December 31, 2011, as outlined in Section 3.743, A-B.
F. Authorized grants under SP-HCA are subject to the client’s ongoing eligibility and to available appropriations.
G. The SP-HCA program sunsets and shall no longer be available after June 30, 2017.
3.743 Application Process and Eligibility Determination [Rev. eff. 7/1/12]
A. Persons identified as potential clients for a SP-HCA grant minimally shall have been:
1. Approved for Supplemental Security Income (SSI) benefits and been receiving at least a one dollar ($1.00) SSI payment at least one month between September 2011 and December 2011; or, 2. Eligible for a Home Care Allowance (HCA) grant under criteria for the Old Age Pension (OAP) or Aid to the Needy Disabled/Aid to the Blind – State Only (AND/AB-SO) programs as outlined in Sections 3.300, et seq. and 3.400, et seq., at least one month between September 2011 and December 2011; and, 3. Receiving a Home Care Allowance (HCA) grant at least one month between September 2011 and December 2011; and, 4. Receiving HCBS-SLS or HCBS-CES services at least one month between September 2011 and December 2011; and, 5. One thousand dollars ($1,000) or less from the maximum SPAL or Spending Limitation for his/her functional level of need within the HCBS-SLS or HCBS-CES waiver between September 2011 and December 2011.
B. Persons identified by the State Department as potential clients by meeting the criteria outlined in Section 3.743, A, through a review of the Colorado Benefits Management System (CBMS), the data system for the Division for Developmental Disabilities, and review of the Single Entry Point (SEP) case file shall be provided a one-time-only opportunity to apply for SP-HCA.
1. The application process to determine eligibility for the SP-HCA grant shall be initiated no later than the effective date of the rules for the SP-HCA grant program.
2. An application packet for SP-HCA shall be sent to the identified clients. The application packet shall include:
C. Clients wishing to apply for an SP-HCA grant shall return the application packet and all supporting documentation so it arrives in the State Department office no later than June 1, 2012.
1. Applications may be returned via email, fax, or mail service.
2. Clients whose application is received in the State Department office after June 1, 2012 shall be determined permanently ineligible for SP-HCA. An appeal of this decision must be filed no later than thirty (30) calendar days after the denial.
D. Each application that was returned timely shall be reviewed within forty five (45) calendar days of receipt of the application to determine eligibility and grant award, to include:
1. Completeness of the application.
2. Financial eligibility determination.
3. Functional eligibility determination.
4. SP-HCA special eligibility criteria.
E. All eligible clients shall be approved for an SP-HCA program grant.
1. The SP-HCA program approval shall be retroactive to January 2012 for all months that the client is eligible.
2. The client’s grant amount shall be based on the SP-HCA tier of payment as determined by the functional assessment conducted by the SEP.
3. Grants shall be for one full month and shall not be prorated based on a partial month of services.
F. Notice shall be provided to the client of approval for or denial of an SP-HCA grant no later than ten (10) working days after completing the eligibility determination.
1. The notice shall contain the eligibility result and appropriate rule citations; and, 2. The date when the grant will be effective, if approved; or, 3. The date and reason for denial and the appeal process, if denied.
G. The initial payment shall be processed within ten (10) working days of approval. Subsequent monthly payments shall be processed no later than the fifth working day of the month.
1. The client or authorized representative shall report any changes related to income, resources, functional assessment, HCBS waiver status, or any other change that might affect eligibility to the State Department or SEP within five (5) working days of the change.
2. Failure to report a change shall be grounds for discontinuation from the program and any payments made after the change shall be subject to recovery and/or fraud investigation and possible prosecution, as outlined in Section 3.800 et seq.
H. The SP-HCA authorized grant amount in each tier is determined by the State Department and is subject to change at any time to ensure the expenditures do not exceed the available appropriation for SP-HCA and/or HCA. An appeal shall not be granted.
I. Hardship exceptions outlined in Sections 3.140.173, 3.210.3, 3.622.2, 3.622.3, 3.705.11, 3.810.73, and 3.810.76 shall not apply to SP-HCA grants.
3.744 FUNCTIONAL ASSESSMENT, CARE PLAN, AND PROVIDER AGREEMENT [Em. eff. 2/1/13;
Rev. eff. 5/1/13] 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 client’s functional eligibility and shall be completed using the same process and scoring guidelines as for the Home Care Allowance program, as outlined in Section 3.720.2, B, Section 3.720.3, and Section 3.720.31, A through E.
1. 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.
2. The grant standards shall equal the grant standards for the Home Care Allowance (HCA) program.
a. The SP-HCA program shall be managed within available appropriations and the SP- HCA grant may be reduced below the HCA grant level if necessary to stay within the appropriation. No appeal shall be granted if grants are reduced to stay within available appropriations.
b. The SP-HCA grant is not taxable income to the client.
c. 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.
C. The SEP shall develop a care plan on a State Department approved form for all clients who meet the functional capacity requirements for a SP-HCA grant.
1. The care plan shall be completed and shall be signed by all parties no later than ten (10) working days from the date of the functional assessment.
2. The care plan shall include, but not be limited to, the following tasks:
a. The identification and documentation of care plan goals and client choices;
b. The identification and documentation of services, including type, duration, and frequency;
c. The formalization of the care plan provider agreement, including appropriate signatures, in accordance with program requirements;
d. The explanation of complaint procedures to the client as listed on the care plan document;
e. The explanation of appeals process to the client, if necessary.
3. The care plan shall ensure that there is prudent purchase of services.
a. There shall be no service duplication between the client’s HCBS services and approved SP-HCA services and those services that can be received through other paid or unpaid service providers or sources.
b. When services are available to the client at no cost from family, friends, volunteers, or others, these services shall be utilized before the purchase of services.
c. When public dollars must be used to purchase services, the case manager shall encourage the client to select the lowest cost provider of service when quality of service is comparable.
d. The SEP shall meet the client's needs, with consideration of the client's choices, using the most cost effective methods available.
4. The SEP shall assist the client in locating a care provider, if needed.
a. The SEP shall negotiate with the client or authorized representative and the care provider to arrive at the total number of paid care hours to be provided monthly.
b. The client or authorized representative and the provider shall sign the state prescribed provider agreement and each party shall receive a copy of the agreement.
c. SP-HCA payments shall be made directly to the client or authorized representative who is responsible for paying the provider monthly for the agreed upon services.
D. The SEP shall notify the client in writing of the outcome of the functional assessment no later than ten (10) working days from the date of the functional assessment. The notice shall contain:
1. The functional eligibility result and appropriate rule citations.
2. The authorized grant amount, if the functional assessment determines the client has a functional need for paid care:
a. The authorized grant amount shall be the tier grant standard based on the client’s overall functional capacity and need for paid care score; or, b. An amount less than the tier grant standard based on the client’s overall functional capacity score if the care provider has agreed to provide all services outlined in the care plan for the lesser amount.
3. The reason for denial and the appeal process, if denied.
E. Upon completion of the functional assessment, care plan, and provider agreement, the SEP shall email or fax the State Department all documentation within one (1) working day of finalizing the care plan agreement.
F. The SEP shall monitor the provision of services by the care provider to ensure that the care plan is implemented, the care provider is providing services as agreed, the client’s services are appropriate, and to identify any changes in functional need.
1. A review of the client’s current assessment shall be conducted every six (6) months in conjunction with the HCBS required visit. The review shall be conducted by telephone or home visit.
2. A review via telephone or home visit earlier than six (6) months shall be conducted when the SEP, in its professional opinion, believes the client’s needs may have changed, and/or the client is not receiving or paying for appropriate care as established in the care plan agreement, and/or the client reports concerns regarding the provision of services.
3. A client or authorized representative’s refusal to allow a review via telephone or home visit is grounds for discontinuation from the SP-HCA grant program, as outlined in Section 3.746, D.
G. The SEP shall perform all other duties for the SP-HCA program as is required for the HCA program, outlined in Section 3.720.
3.745 Ongoing Determination of Eligibility [Rev. eff. 7/1/12]
A. Ongoing review of the client’s eligibility beginning February 2012 and thereafter shall be conducted by in coordination with the SEP, Division for Developmental Disabilities, and State Department. To remain eligible for a SP-HCA grant, the client shall continually:
1. Be approved for Supplemental Security Income (SSI) benefits and be receiving at least a one dollar ($1.00) SSI monthly payment; or, meet all eligibility criteria for the Old Age Pension (OAP) or Aid to the Needy Disabled/Aid to the Blind – State Only (AND/AB-SO) programs; and, 2. Be receiving HCBS-SLS or HCBS-CES services and SP-HCA; and, 3. Remain one thousand dollars ($1,000) or less from the maximum SPAL or Spending Limitation for his/her functional level of need within the HCBS-SLS or HCBS-CES waiver; and, 4. Meet the SP-HCA eligible Functional Capacity Score and Need for Paid Care Score as outlined in Section 3.744.
B. Annual reassessment and redetermination shall be conducted.
1. A new functional assessment shall be conducted by the SEP, as outlined in Section 3.744.
2. A new financial and SP-HCA eligibility determination shall be conducted, as outlined in Section 3.743.
3. The client or authorized representative shall compete and timely return the redetermination application and any other required documentation required to process the redetermination.
4. Notice of continued eligibility and grant amount shall be provided, if the client is determined eligible for SP-HCA.
D. If during ongoing review or at the time of annual redetermination the client is no longer eligible for SP-HCA, notice of discontinuation and appeal rights shall be provided within ten (10) working days.
1. The notice shall include the reason for the discontinuation, the appropriate rule citations, and information on the appeal process.
2. The appeal process shall be as outlined in Section 3.850, with the following exceptions:
3.746 Denials and Discontinuations [Em. eff. 11/9/12; Permanent rev. eff. 3/2/13] A. A client shall meet all eligibility requirements outlined in Section 3.743, D, 1-4, each month to continue to be eligible for the SP-HCA program.
B. Clients shall be denied or discontinued from the SP-HCA program if he/she is determined ineligible. The client shall be informed of the adverse action and appeal rights in accordance with rules under Section 3.745.
C. Clients that are denied and/or are discontinued from the SP-HCA program are permanently disqualified from the program and shall not be eligible to apply for or be approved for benefits in subsequent months or years.
1. To ease the eligibility process for the SP-HCA program, the following provisions shall apply:
2. Clients originally approved for the SP-HCA program and then subsequently discontinued from SP-HCA pursuant to Section 3.746, D, on or after July 1, 2013, will be permanently discontinued from receiving SP-HCA benefits.
D. The SEP and/or CCB shall notify the State Department when the agency has knowledge that any of the following occurs. The State Department shall notify the client of discontinuation from SP-HCA when it has information from the SEP, CCB, program data systems, or any other source that any of the following has occurred:
1. The client no longer receives services under the HCBS-SLS or HCBS-CES waiver.
2. The client’s needs change and his/her level of service need is no longer within $1,000 of the SPAL or Spending Limitation for HCBS-SLS or HCBS-CES.
3. The client no longer meets financial eligibility criteria, as outlined in Section 3.743, D, 2.
4. The client no longer meets the functional capacity and need for paid care scores necessary to be approved for SP-HCA.
5. The client has not received services for thirty (30) or more consecutive days.
6. The client or authorized representative has refused to schedule an appointment with the SEP, CCB, or State Department or refuses to allow for a home visit, an initial assessment, six-month review, reassessment, or other review.
7. The client or authorized representative has failed to keep two (2) scheduled appointments.
8. The client or authorized representative refuses to sign the application, the care plan, or other documents and forms required to receive services or in any other way refuses to cooperate with the requirements of the SP-HCA program.
9. The client or authorized representative refuses to use the SP-HCA grant to pay for services, uses the grant for services not identified in the care plan and provider agreement, or uses the grant to purchase household expenses including, but not limited to, shelter costs, utilities, food, toiletries, clothing, home furnishings or other items not authorized by the SP-HCA care plan.
10. The client is a resident of a nursing facility, hospital, alternative care facility, group home, licensed or unlicensed long-term care facility, or other institution.
11. The client enters a hospital or other long-term care facility for treatment or rehabilitation that continues for thirty (30) or more consecutive days.
12. The client cannot be safely served given the type and/or amount of services available. To support a denial or discontinuation for safety reasons related to service limitations, the SEP shall document the limitations and evidence of safety concerns, when available, including, but not limited to:
13. The level of service need is not cost effective under the SP-HCA program. To support a denial or discontinuation due to cost effectiveness the SEP shall document the level of service need and more cost effective alternatives.
14. The client has moved out of the state or country or has or been out of the state or country for more than thirty (30) consecutive days. Discontinuation shall be effective the day after the date of the move or on day thirty one (31) of the absence from the state or country.
15. The client or authorized representative requests withdrawal from the program.
16. The client or authorized representative has failed to report a change in circumstances that potentially affects eligibility for SP-HCA, as outlined in Section 3.743, G.
17. The client has died. Discontinuation shall be effective the day after the client’s death. No notice of discontinuation shall be sent.
E. The notice of adverse action shall include the reason for denial or discontinuation, the appropriate rule cite, and appeal rights.
F. In the event of denial or discontinuation, the SEP shall:
1. Provide appropriate referrals to other community resources, as needed, within one
2. Notify all providers on the care plan within one (1) working day of discontinuation.
3. Notify the State Department within one (1) working day of discontinuation.
4. Attend the appeal hearing to defend the denial or discontinuation.
3.750 LOW-INCOME ENERGY ASSISTANCE PROGRAMS
3.750.1 AUTHORITY
3.750.11 Low-Income Home Energy Assistance Act [Rev. eff. 11/1/84]
Programs authorized under the Low-Income Home Energy Assistance Act include a Basic Program and a Crisis Intervention Program.
3.750.12 Intent of the Basic Program [Rev. eff. 9/15/12]
The Basic Program is intended to help meet winter home heating costs of households composed of low-income families and individuals.
3.750.13 (None) [Rev. eff. 9/15/12]
3.750.14 (None) [Rev. eff. 2/1/12]
3.750.15 Funding [Rev. eff. 9/1/11]
This program is federally and privately funded and is subject to availability of funds. If funds are increased, decreased or become unavailable, the services provided herein shall be increased, decreased or terminated accordingly.
3.751 GENERAL PROVISIONS
3.751.1 Definitions [Rev. eff. 9/15/12]
"Applicant": The person who completes and signs the basic LEAP application form. This is also the only household member who is required to provide proof of lawful presence as defined in these rules. "Bulk Fuel": Bulk fuel is an energy source for home heating which may be purchased in quantity from a fuel supplier and stored by the household to be used as needed. Normally, bulk fuel includes wood, propane, kerosene, coal and fuel oil.
"Completed Application": A basic LEAP application shall be considered to be a completed application when:
A. The applicant has provided an adequate response to all application questions which are necessary to determine eligibility and payment level;
B. The applicant has provided all required verification. A Social Security Number (SSN) for each household member or proof of application for a SSN must be provided. A SSN is required to determine eligibility. If no SSN is provided for a household member, that member will not be included in the household, but the member’s income will be counted;
C. The application is signed;
D. The applicant has provided proof of lawful presence in the United States (see Section 3.140.11).
"Date of Application": For purposes of the Low-Income Energy Assistance Programs, the date of application shall be the date an application form that contains a legible name and address is received by the county department.
"Disabled or Handicapped": For purposes of the Low-Income Energy Assistance Programs, the term disabled or handicapped means persons who receive vocational rehabilitation assistance; Social Security disability, SSI, AB, AND, veterans disability payments, or who provide a physician's statement which indicates incapacity to engage in substantial gainful employment. This definition may be different for other public assistance programs.
"Elderly": For the purposes of these rules, the term elderly means aged 60 or over. "Eligibility Period": There shall be one eligibility period for the Basic Low-Income Energy Assistance Programs from November 1st through April 30th. If April 30th for a particular calendar year falls on a holiday or weekend, then the eligibility period shall be extended until midnight the next business day. This program is contingent upon the continued availability of funds in accordance with Sections 3.750.15 and 3.758.48.
"Emergency Applicant": This is a household which has had heat service discontinued or is threatened with discontinuance, or is out of fuel or will run out of fuel within fourteen calendar days. Applications for households in these situations shall be processed expeditiously and the emergency addressed within fourteen calendar days of notification of the emergency by the applicant to the county department. "Estimated Home Heating Costs": The amount of the heating costs incurred during the previous heating season for the applicant's address at the time of application to be used as an estimate, or projection, of the anticipated heating costs for the current heating season (November 1st through April 30th). Such estimated heating costs shall not include payment arrearages, investigative charges, reconnection fees, or other such charges not related to residential fuel prices and consumption levels. "Heat Related Arrearage": Any past due amounts for the primary heating fuel and/or supportive fuel. "Home Heating Costs": Charges related directly to the primary heating fuel used in a residential dwelling. "Household":The term "household" shall mean any individual or group of individuals who are living together as one economic unit for whom primary heating fuel is customarily purchased in common or who make undesignated payments for heat in the form of rent. Any individual considered as part of an approved household cannot subsequently be considered as part of another household during the same eligibility period. Each person living at a residence must be counted as either a member of the applicant's household or a member of a separate household.
The maximum number of household members shall be fifteen (15). The maximum number of separate households shall be nine (9).
The following cannot be classified as separate households:
A. Husband and wife living together;
B. Unemancipated minor(s) under the age of 18 and living in the same dwelling as the parent or guardian.
C. Supplemental Security Income (SSI) recipients in shared households receiving reduced benefits.
"Non-Bulk Fuel": Non-bulk or metered fuel is an energy source for home heating which is provided by a utility company and is regulated and metered by the utility company. Normally, non bulk fuel includes natural gas and electricity.
"Non-Traditional Dwelling": A non-traditional dwelling means a structure that provides housing that is not affixed to a permanent physical address, including, but not limited to, cars, vans, buses, tents and lean- tos.
"Point in Time": Point in time indicates that eligibility is determined by accounting for the circumstances of the household on the date of the application, regardless of any changes thereafter. "Poverty Level": The term poverty level as used in these rules describes federal guidelines updated annually by the U.S. Department of Health and Human Services. The guidelines, printed in the Federal Register, establish minimum subsistence income levels by household size. "Primary Heating Fuel": The primary heating fuel is the main type of fuel used to provide heat within the dwelling. When heat (such as natural gas and/or electric) is included in the rent, this may be reflected as "utilities" included in rent.
"Primary Heating Source": The primary heating system that provides heat to the dwelling such as a furnace, wood burning stove or boiler. Temporary or portable heating sources are not considered a primary heating source.
"Program Year": The term program year means from November 1st through April 30th for the Basic Program. If April 30th for a particular calendar year falls on a holiday or weekend, then the eligibility periods shall be extended until midnight the next business day. This program is contingent upon the continued availability of funds in accordance with Sections 3.750.15 and 3.758.48. "Public Assistance Income": For purposes of verifying income under the Low-Income Energy Assistance Programs, the term public assistance income shall mean income received from the following types of Department of Human Services programs:
A. Colorado Works;
B. OAP (Old Age Pension, both the SSI-supplement and State-only groups);
C. AND (Aid to the Needy Disabled, both the SSI-supplement and State-only groups);
D. AB (Aid to the Blind, both the SSI-supplement and State-only groups);
E. NCRA (Non-Categorical Refugee Assistance);
F. SSDI (Social Security Disability Insurance) for clients on another state program, such as a Medicaid waiver or buy in program.
"Subsidized Housing": Subsidized housing means housing in which a tenant receives a governmental or other subsidy (e.g., assistance provided by a church) and the amount of rent paid is based on the amount of the tenant's income.
"Supportive Fuel": Supportive fuel is an energy source needed to operate the primary heating system in a residential setting, such as electricity as a supportive fuel required to operate a natural gas furnace. "Traditional Dwelling": Traditional dwelling means a structure that provides a housing or residential environment that is affixed to a permanent physical address. "Vendor": A vendor is an individual, a group of individuals, or a company who is regularly in the business of selling fuel (bulk or non bulk) to customers for residential home heating purposes.
3.751.2 (None)
3.751.3 NON DISCRIMINATION POLICIES/RIGHT AND OPPORTUNITY TO APPLY
3.751.31 Non-Discrimination [Rev. eff. 9/15/12]
Non-discrimination policies as outlined in this rule manual shall apply to all households applying for the Basic Program .
3.751.32 Opportunity to Apply [Rev. eff. 11/1/84]
All persons shall be provided an opportunity to file an application form on the date of initial contact with the county department during the application period.
3.751.33 Interpreters [Rev. eff. 9/1/11]
An interpreter shall be available to assist persons known to the Department to be non-English speaking in completing application forms and to provide information between the applicant and the county department.
3.751.34 Program Information [Rev. eff. 11/1/84]
Public Assistance and food stamp households shall be notified during the certification and recertification procedures of the availability of the Low Income Energy Assistance Programs and the eligibility criteria for receiving such assistance.
3.751.35 Authorized Representative [Rev. eff. 11/1/84]
An authorized representative may apply on behalf of an applicant household when the applicant household is unable to apply on its own behalf.
3.751.4 NOTICE AND HEARINGS
3.751.41 Timely and Adequate Notice [Rev. eff. 9/15/12]
The requirements for providing timely and adequate notice of proposed actions and opportunity for hearings and appeals are as provided in the chapter on "Administrative Procedures" in this rule manual except as specifically provided in the rules governing the Basic Program.
3.751.42 Denials [Rev. eff. 9/15/12]
Notices of denial shall advise the applicant of the reason for the denial, the regulation citation relied on by the county department, and appeal rights and procedures. For advance payments of the Basic Program, notices of denial shall advise the applicants of their right to a forthwith hearing.
3.751.43 Request for a State Level Fair Hearing [Rev. eff. 9/15/12]
County departments shall notify the State LEAP office in writing within seven (7) days upon receipt of a request for a State level fair hearing by an applicant on Basic Program. See Sections
3.850.1 – 3.850.56 of this rule manual.
3.751.5 RECOVERY AND FRAUD PROCEDURES
3.751.51 Recoveries [Rev. eff. 9/15/12]
County departments must institute recoveries to ensure that Basic Program benefits do not exceed the maximum amounts described in these rules. Recovery procedures shall be the same as in adult program rules as described in the "Administrative Procedures" Chapter or as otherwise specified in these rules. (Note: Sections 3.810.13, 3.810.14, and 3.810.32 do not apply to LEAP.)
3.751.52 Determination of Recovery of Overpayment [Rev. eff. 10/1/01]
When overpayments, made directly to the client, have been verified by the county department, a determination as to whether recovery is appropriate shall be made within fifteen (15) calendar days after receipt of reports issued by the State Department designed to assist county departments in identifying and correcting such payments.
3.751.53 Definition of Overpayment [Rev. eff. 9/15/12]
Overpayment of Basic Program benefits shall mean a household has received benefits in excess of the amount due that household based on eligibility and payment determination in accordance with these rules.
3.751.54 Establishment of Recovery [Rev. eff. 11/1/08]
Recoveries shall be established for households that have received program benefits and are subsequently determined to be ineligible or which received benefit amounts greater than the household was entitled to for the eligibility period.
3.751.55 Recovery Procedures [Rev. eff. 12/1/07]
Recovery proceedings shall be handled in accordance with the procedures described in the "Administrative Procedures" chapter of this rule manual when applicable. (Note: Sections
3.810.73 through 3.810.75 do not apply to LEAP.)
3.751.6 REPORTING AND MONITORING
3.751.61 Reporting
All recoveries shall be reported to the State Department at the conclusion of the program year.
3.751.62 Reports and Fiscal Information [Rev. eff. 11/1/98]
County departments shall provide the State Department with reports and fiscal information as deemed necessary by the State Department.
3.751.63 Monitoring [Rev. eff. 11/1/98]
The State Department shall have responsibility for monitoring programs administered by the county departments based on a monitoring plan developed by the State Department. Such plan shall include provisions for programmatic and local reviews and methods for corrective actions.
3.751.7 REIMBURSEMENT AND SANCTIONS
3.751.71 Reimbursements [Rev. eff. 9/15/12]
Subject to allocations as determined by the State Department, county departments shall be reimbursed up to 100% for all allowable costs incurred for the operation of the Basic Program, outreach, and other administrative costs.
3.751.72 Sanctions [Rev. eff. 9/15/12]
County departments which fail to follow the rules of the Basic Program shall be subject to administrative sanctions as determined by the State Department (see 11 CCR 2508-1).
3.752 LOW-INCOME ENERGY ASSISTANCE PROGRAMS: BASIC PROGRAM
3.752.1 APPLICATION PERIOD [Rev. eff. 9/15/12]
To apply for LEAP, the general public shall submit a written State prescribed application form (IML-4) during the period of November 1st through April 30th. If April 30th for a particular calendar year falls on a holiday or weekend, then the eligibility periods shall be extended until midnight the next business day. These programs are contingent upon the continued availability of funds in accordance with Sections 3.750.15 and 3.758.48. The county department shall accept all application forms that are received or postmarked during the application period. Facsimile copies of completed application forms shall be accepted as valid. Preference shall be given to application forms received from public assistance households (such as Colorado Works, OAP, AND, AB, and NCRA). Such applications received prior to November 1st shall be accepted and may be processed; however, eligibility shall not be effective until November 1st. Application forms received or postmarked after the closing date shall be denied. Eligibility will be determined based on the applicant's circumstances on the date the application is received by the county department. Although applications may be accepted and processed earlier, the effective date of application shall not be before November 1st.
3.752.2 PROGRAM ELIGIBILITY REQUIREMENTS
3.752.21 [Rev. eff. 10/1/09]
To be determined eligible for a Basic Program payment, households must, at time of application, be vulnerable to the rising costs of home heating, and meet income and other requirements of the program as defined in these regulations.
The following factors shall be considered as of the date of application: Colorado state residency, U.S. citizenship/alien status, lawful presence, income, vulnerability, fuel type, household composition, shared living arrangements, and estimated home heating costs.
3.752.22 Income and Household Size Criteria [Rev. eff. 9/15/12]
A. For purposes of determining a household's eligibility, income shall be the countable gross income in any four (4) weeks of the eight (8) weeks prior to application, which best represents the applicant’s current income situation.
B. Determining Monthly Income If a household member is paid less than monthly, the county department shall determine gross monthly income by:
1. Weekly/Bi-Weekly Income
2. Semi-Monthly Income Adding gross semi-monthly income amounts to obtain total monthly income.
3. Partial Month Income
C. All applicant households whose countable income for the eligibility period is up to 185% of the poverty level, shall meet the income requirements for the Basic Program. The State Department shall adjust the income limits annually based on funds available and the federal poverty guidelines published in the Federal Register applicable at the time of application; no later editions or amendments are included. By September 1st of each year, that information shall be made available to the county departments through an agency letter. The federal poverty guidelines may be examined by contacting the Colorado Department of Human Services, Director of the Low-Income Energy Assistance Program, 1120 Lincoln Street, Suite 1007, Denver, Colorado 80203; at a state publications depository library; or on the federal web site at: http://aspe.hhs.gov/poverty.
D. Income shall be treated in accordance with the rules as contained in the Resources and Income chapter of this staff manual pertaining to the adult programs.
E. Households which have been denied basic benefits and have had changes in circumstances may reapply.
3.752.23 Income Exclusions [Rev. eff. 9/15/12]
The following exclusions and income calculation procedures shall be applied to household gross income:
A. Payments or benefits excluded as defined in the General Resource and Income Exemption Section of the "Resources and Income" chapter in this staff manual at Section 3.200.4, except that the following sections do not apply: 3.200.32; 3.240.16, B-F; 3.240.41; 3.250.14; 3.250.15.
B. All financial aid monies, including educational loans, scholarships, and grants as defined in Section 3.250.4 in this staff manual.
C. Earned income of children under the age of 18 who are residing with a parent or guardian.
D. Reimbursement received for expenses incurred in connection with employment from an employer.
E. Reimbursement for past or future expenses, to the extent they do not exceed actual expenses, and do not represent gain or benefit to the household.
F. Payments made on behalf of the household directly to others.
G. Payment received as foster care income. Foster children are not considered household members.
H. Home care allowance, if paid to a non-household member.
I. State/county diversion payments.
J. Reverse mortgages.
K. Subsidized housing utility allowances.
L. G.I. Bill educational allowances, including housing and food allowances.
3.752.24 Resources [Rev. eff. 10/1/01]
There is no resource criteria for the Low-Income Energy Assistance Program. The value of the household’s resources shall not be considered for the purpose of determining eligibility for assistance.
3.752.25 Vulnerability [Rev. eff. 10/1/09]
A. A household shall be vulnerable in order to qualify for Basic Program benefits. Vulnerability shall mean the household must be affected by the rising costs of home heating as defined below:
1. The household is paying home heating costs directly to a vendor and is subject to home heating cost increases; or, 2. The household is living in non-subsidized housing and is paying home heating costs either in the form of rent or as a separate charge in addition to rent; or, 3. The household resides in subsidized housing as defined in the "Definitions" Section of these rules; and, 1) the unit has an individual check meter which identifies specific heating usage of that unit and the household is subject to a surcharge or increased cost for home heating, or 2) the tenant is subject to a heating surcharge assessed by means other than an individual check meter. Such surcharges may include percentage fees assessed to the tenant for home heating. Under no circumstances shall rental costs be assumed to be subject to change due to an increase in home heating costs unless otherwise verified in writing by the county department.
4. The applicant household in a residence where more than one household resides shall be considered vulnerable if the applicant household contributes toward the total expenses of the residence. These expenses include, but are not limited to, shelter and utilities.
5. The applicant household must live in a traditional dwelling.
B. Households in the following living arrangements shall not be considered to be vulnerable:
1. Institutional group care facilities, public or private, such as nursing homes, foster care homes, group homes, alcoholic treatment centers, or other such living arrangements where the provider is liable for the costs of shelter and home heating, in part or in full, on behalf of such individuals;
2. Correctional facilities;
3. Dormitory, fraternity or sorority house;
4. Subsidized housing as defined in the "Definitions" section of these rules which does not have an individual check meter for heat for each unit or which cannot provide other evidence of responsibility for paying home heating surcharges.
5. Any applicant, or applicant household who is considered homeless or resides in non- traditional dwellings.
Vulnerability shall be verified for all applicant households as defined in these rules.
3.752.26 Residency Requirements [Rev. eff. 9/1/11]
Applicant households must meet the state residency requirements as contained in this rule manual. The household must reside at the address for which it applied to receive LEAP benefits.
3.752.27 Citizenship - Lawful Presence Requirements [Rev. eff. 9/1/11]
The applicant must meet the lawful presence in the United States requirements as contained in Section 3.140 of this rule manual to be considered a household member, except that there is no requirement regarding length of residency in the United States. An applicant who does not meet lawful presence requirements or a household member who does not meet citizenship requirements shall not be included as a household member; however, all countable income of this individual shall be counted as part of the household's total income. The household’s application shall not be denied due to lack of documentation regarding citizenship or lawful presence requirements if there are other household members who meet the citizenship requirements (i.e., minors born in the United States).
3.752.28 Mandatory Weatherization [Rev. eff. 9/1/11]
Households approved to receive a LEAP benefit must agree to have their dwelling weatherized if contacted by a state-authorized weatherization agency. Failure to permit or complete weatherization may result in denial of LEAP benefits for the following year.
A. Exemptions 1. Households containing a member(s) whose mental or physical health could be exacerbated by weatherization shall be exempt.
2. A household whose landlord refuses to allow weatherization shall not have benefits denied.
3. The local weatherization agency shall fully document the circumstances permitting the exemption.
B. Households Who Refuse Weatherization 1. Households who refuse or terminate weatherization before completion shall not be approved for LEAP benefits for the following year and a LEAP denial hold shall be placed on the household at that address by the State LEAP office. The hold can only be removed by the State LEAP office.
2. If the household has moved to another address that has been weatherized, the household may be approved for a LEAP benefit if otherwise eligible. If the new dwelling is not already weatherized, weatherization must be completed before approved for LEAP.
3. If a denied household subsequently allows the dwelling to be weatherized or weatherization completed, the household must reapply and, as long as other eligibility criteria are met, may be approved for LEAP benefits after notification from the local weatherization agency that the weatherization is completed.
C. State Weatherization Office Responsibilities 1. Assure that standards, as delineated in Sections A and B above, are applied uniformly and equitably.
2. Notify the state LEAP office by September 30th of all households who refuse weatherization.
3. Notify households who refuse weatherization, by first-class mail, that their refusal may result in denial of LEAP benefits for the following year.
4. Weatherization shall be completed as soon as possible on dwellings where the household previously refused or didn't complete weatherization and subsequently allows the dwelling to be weatherized.
3.753 (None)
3.754 REASONS FOR DENIAL OF ASSISTANCE
3.754.1 FACTORS FOR DENIAL [Rev. eff. 9/15/12]
Any of the following factors shall be the basis for the denial of an applicant household:* A. Excess income; 3.752.22 (04).
B. Not vulnerable to rising home heating costs; 3.752.25 (03).
C. A household not meeting citizenship/lawful presence requirements; 3.752.27 (13).
D. A household is a duplicate household or was previously approved as part of another household; 3.751.1, "Household" (06).
E. The household has voluntarily withdrawn its application; 3.756.18 (09).
F. The household has received Basic Program benefits from another county; 3.756.17 (10).
G. The household has failed to provide complete application information or required verification;
3.756.12 (11).
H. The household is not a resident of Colorado; 3.752.26 (07).
I. The household failed to sign the application form; 3.751.1, "Completed Application", C (21).
J. The household filed an application outside of the application period; 3.752.1 (14).
K. Unable to locate; 3.756.19 (25).
L. Refused weatherization services from a state weatherization agency; 3.752.28 (26).
M. The applicant failed to provide valid identification; 3.140.11, B, 1 (05).
N. The applicant failed to provide an affidavit; 3.140.11, B, 2 (08).
O. The applicant failed to provide valid identification; 3.140.11, B, 1, and the applicant failed to provide an affidavit; 3.140.11, B, 2 (18).
P. Non-traditional dwelling; 3.751.1 (23).
Q. The household does not reside at the address for which it applied to receive benefits;
3.752.26 (24).
R. LEAP can only assist with the primary heating fuel for the primary heating source; 3.751.1 (22).
S. The applicant household refused a bulk fuel delivery, thereby relinquishing the benefit;
3.751.54 (28).
(*Note: The rule citation is shown followed by the denial reasons which are to be used when coding the worksheet and data entering into the computer system.)
3.755 VERIFICATION POLICIES AND CASE RECORD DOCUMENTATION
3.755.1 GENERAL
3.755.11 [Rev. eff. 9/1/11]
Income, estimated home heating costs, and vulnerability shall be verified in determining initial eligibility and/or payment amount. If a household applied during the prior LEAP program year and there are no changes in the applicant, address and fuel provider, vulnerability and lawful presence (provided that IDs are valid in accordance with Section 3.140) may be copied from the prior year case file and provided in the current case file.
3.755.12 [Rev. eff. 10/1/00]
If the county obtains information which would affect the initial determination of an applicant household's eligibility or payment level and which is different than information provided by the applicant, the county shall inform the applicant and provide an opportunity for response or explanation. Eligibility shall be determined by using the correct information. In these cases, an applicant who meets eligibility criteria shall not be denied because the applicant provided information that was different than information subsequently obtained by the county. Information used to determine eligibility and benefit level shall be documented. However, in appropriate cases, the counties may institute fraud proceedings.
3.755.13 [Rev. eff. 9/1/11]
The case record shall contain at a minimum:
A. The application and any other supplemental forms the applicant is required to submit;
B. Documentation of all verification as required in these rules;
C. Written explanation on a report of contact sheet or other such document of any discrepancy between information contained on the application and information in the LEAP system;
D. Calculations used to compute income, documentation of the source of estimated home heating costs and any other written notations on a report of contact sheet or other similar document necessary to provide a clear and adequate record of action taken on the case. The eligibility workers shall date and initial each entry.
E. Copies of all written notices, including hand-written letters, sent to the applicant household requesting missing information and/or verification necessary to determine eligibility and/or payment level.
F. Complete documentation in emergency or expedited cases including when, to whom, and how a vendor contact is made.
3.755.2 VERIFYING INCOME
3.755.21 Adequate Verification of Income [Rev. eff. 9/1/11]
The case record shall contain adequate verification of income. Adequate verification is defined as any of the following:
A. Unearned income, such as pensions or retirement income, veteran's benefits, workman's compensation, unemployment or supplemental security income shall be verified in writing, such as an award letter or cost of living adjustment (COLA) letter, issued after the last general increase for that type of assistance, which shows the gross amount before any deductions. Acceptable verification includes documentation from federal/state/system inquiries (i.e., a copy of applicable CBMS screens). Copies of bank deposits or checks shall not be adequate verification of gross income.
B. Verification of child support income shall include at a minimum:
1. Verification through the Automated Child Support Enforcement System (ACSES); or, 2. Verification through the Family Support Registry (FSR); or, 3. Copies of checks, money orders or other document(s) including written statements or affidavits from the non-custodial parent that documents the income paid directly to the custodial parent.
4. An exception shall be made in cases of domestic violence defined in Section 3.602.1 of this manual. Client declaration shall be sufficient in such cases.
C. Social Security income may be verified by an award letter, issued by the social security administration, after the last general increase. Acceptable verification includes documentation from federal/state/system inquiries (i.e., a copy of applicable CBMS screens). Gross social security income includes income before any deductions for Medicare or other medical insurance. Copies of bank deposit or checks shall not be adequate verification of gross social security income.
D. Earned income shall be verified for at least four (4) weeks of the 8 weeks prior to the application date and shall consist of pay stubs or statements from employers which state the period worked, pay frequency and the actual gross income earned, as long as that income is reflective of income at the time of application.
E. Public assistance income shall be verified through the most current active county records. The Low-Income Energy Assistance Program case record must specifically reference the source document of the income information via federal and/or state system inquiries (i.e., a copy of applicable CBMS screens).
F. Verification of income other than public assistance income of applicant households may be obtained through the most current active county records. The Low-Income Energy Assistance Program case record must specifically reference the source document of the income verification (i.e., source document name and/or number and document date).
G. Verification may be obtained by telephone, provided that the case record contains complete information on the name and title of the person contacted, the name of the employer or agency, the period of employment and the actual gross income received, earned or unearned.
H. In verifying zero income, the county shall examine income of all adult members of the household by one or more of the following methods:
1. Obtain a reasonable explanation in writing from the household on how they meet living expenses;
2. Verify eligibility for unemployment benefits or verify final date of employment with last employer;
3. Colorado Benefits Management System (CBMS).
I. Verification of self-employment income shall include, at a minimum:
1. Profit and loss statements, i.e., self-employment ledger; and, 2. Receipts for business-related expenses are required to be considered as deductions.
3.755.3 (None)
3.755.4 VULNERABILITY
3.755.41 Evidence of Vulnerability [Rev. eff. 10/1/09]
All households shall be required to provide evidence of vulnerability for the primary heating fuel for the residence at the time of application. Evidence shall consist of items, such as a copy of the current or most recent fuel bill which the household is responsible for paying or a copy of the current or previous month’s rent receipt if heat is included in rent. In instances where a rent receipt is used to provide proof of vulnerability, the rent receipt must specifically notate that heat and/or utilities are included in rent. A lease or rent statement from the applicant's landlord is required if the rent receipt is not specific. The county may use prior year's fuel bill if the information supplied matches the current application/information. If historical information is being used to verify vulnerability, a notation must be made in the case record. If the fuel bill that is submitted as evidence of vulnerability is in the name of a person other than the applicant household, the case record shall contain a notation that explains the discrepancy in names. A disconnect notice from the heating fuel provider, that does not show primary heating fuel consumption, is not adequate evidence of vulnerability.
3.755.42 Subsidized Housing Rent Documentation [Rev. eff. 9/1/11]
Applicant households, living in subsidized housing units, where home heating costs are paid as part of rent, shall be required to provide a copy of a rental agreement or other documentation specifying that the household is subject to rent increases or heating surcharges when home heating usage exceeds the amount of the household's heating allowance, within the current LEAP program year.
3.755.43 Wood Permits [Rev. eff. 6/1/09]
Applicants who cut their own wood shall be required to provide a copy of their wood cutting permit. If a permit is not available, the applicants must provide a written and signed statement that they cut their own wood, plus documented proof that they cut it on their own land or that they have permission from the landowner.
3.755.5 ESTIMATED HOME HEATING COSTS
3.755.51 Verification [Rev. eff. 11/1/06]
County departments shall obtain verification of estimated home heating costs. Verification shall consist of evidence provided by fuel vendor or applicant for the residence at the time of application.
If the county changes the estimated home heating costs (EHHC) originally provided by the fuel vendor, the county must obtain written verification of this change from the fuel vendor. The written verification from the vendor shall be placed in the case record.
3.755.6 OTHER FACTORS AFFECTING ELIGIBILITY AND PAYMENT AMOUNTS [Rev. eff. 9/1/11] Other factors affecting eligibility and payment amounts of an applicant household may be verified if determined necessary.
3.756 PROCEDURES FOR PROCESSING APPLICATIONS AND NOTIFYING APPLICANT
HOUSEHOLDS
3.756.1 PROCEDURES
3.756.11 Application [Rev. eff. 9/1/11]
Basic Program applicants shall submit a completed application form as defined in the "Definitions" section of these rules to the county department in order to be considered for Basic Program benefits. The county department shall not require office interviews for purposes of determining eligibility.
3.756.12 Application Processing [Rev. eff. 12/1/07]
The county department shall be required to date stamp all application forms, verification, and information upon receipt. Beginning November 1st, all applications must be entered into the LEAP database in a pending status within fifteen (15) business days from the date the applications received in the county LEAP office. All applications received within the eligibility period must be added and either approved or denied no later than June 19th. The county department shall be required to review for duplicate applications. The county department shall determine if an application is complete as defined in the "Definitions" section of these rules. If an application is not complete, the county department shall notify the applicant household, in writing through a LEAP system-generated letter, of information or verification necessary to determine eligibility and/or payment level. The applicant household shall be provided two (2) calendar weeks from the date the notice is postmarked to provide the requested information and/or verification. Clients who fail to submit the required verification shall be denied. However, the county department shall extend the period upon a showing of good cause for the applicant's failure to provide the necessary information or verification within the two (2) week period. The term "good cause" as used above is defined as conditions outside the control of the individual such as sudden illness, hospitalization, fire, theft, acts of God, and natural disasters.
3.756.13 Lost Applications [Rev. 11/1/96]
If a household reports to the county that it has mailed or otherwise made application for basic benefits and the county department cannot locate the application for the household, such application shall be deemed "lost". The procedures for handling "lost" applications shall be prescribed by the State Department. The client must notify the county of the lost application no later than 30 calendar days after the end of the application period.
3.756.14 Determination of Eligibility [Rev. eff. 11/1/93]
A county department shall have up to fifty (50) calendar days from the date of application as defined in the "Definitions" section of these rules to determine eligibility.
3.756.15 Notification of Approval or Denial [Rev. eff. 10/1/01]
Upon determination of eligibility, the household shall be notified in writing of approval or denial in accordance with the notice requirements in these rules.
3.756.16 County of Residence [Rev. eff. 10/1/09]
The county of residence for applicant households shall be the county where the applicant household is residing as of the date of application. An application received from a non-resident of the county shall be forwarded to the county of residence within five (5) working days. Processing time begins upon receipt of the application by the county of residence. The county forwarding the application shall, simultaneously, notify the applicant household, in writing, of the name, address, and phone number of the county to which the application was forwarded.
3.756.17 Relocation [Rev. eff. 11/1/94]
If an approved household moves from one county to another within Colorado, the original county of residence in which eligibility was determined, shall remain responsible for processing that case throughout the program year. The new county of residence shall provide assistance to the case processing county as requested. If an applicant then applies in the new county of residence, the application shall be denied, and the applicant notified that benefits will be paid by the original county.
3.756.18 Withdrawn Application [Rev. eff. 11/1/08]
An applicant who voluntarily withdraws his/her application in writing prior to eligibility being determined shall be denied. The applicant must notify the county in writing that they are voluntarily withdrawing their application.
3.756.19 Unlocated Applicant [Rev. eff. 10/1/09]
An applicant who cannot be located prior to eligibility being determined shall be denied. The county must attempt to locate the applicant by mailing a forwardable letter to the last known address. If the applicant does not respond within fifteen (15) business days, the application shall be denied.
3.756.2 ADVANCE PAYMENT OF THE BASIC PROGRAM BENEFIT (applicable only when a signed Vendor Agreement has not been secured) [Rev. eff. 9/15/12] A. A shut-off notice or other documentation of intent to terminate heating services by the heating supplier or landlord or that termination of service has occurred; or, B. For households that use bulk fuel, a written declaration by the household that the fuel supply has been or will be depleted within the next two weeks and the specific amount needed to maintain heat in the home until payroll runs.
C. Eviction notice, and a written statement from the landlord that the client will not be evicted for thirty (30) days if request for advance of the payment is accepted. For purposes of advance payment, notices of denial shall advise the applicants of the reason for denial, appeal rights and procedures including, but not limited to, a hearing.
3.757 PROCEDURE FOR REPORTING ELIGIBILITY AND PAYMENT INFORMATION
3.757.11 [Rev. eff. 9/1/11]
The county will be required to correct any inaccuracies as they may result in an erroneous payment amount and/or incorrect eligibility determination. Information reported on the household's income, family size, estimated home heating costs, subsidized housing heat allowance, and number of separate households is the basis for the amount of LEAP benefit.
3.757.12 [Rev. eff. 9/1/11]
County departments shall enter completed applications into the LEAP automated system as eligibility is determined.
3.758 PAYMENT POLICIES
3.758.1 GENERAL
3.758.11 (None) [Rev. eff. 2/1/12]
3.758.12 [Rev. eff. 11/1/84]
The Basic Program is designed to help low-income households meet home heating costs. Payments to eligible households shall vary according to the following factors:
A. Poverty level (income and family size)
B. Estimated home heating costs
3.758.13 [Rev. eff. 11/1/96]
Payments to eligible households which share living arrangements will vary according to the same payment factors, except that the estimated home heating costs will be divided by the total number of households sharing the living arrangement.
3.758.2 (None)
3.758.3 CHANGES IN HOUSEHOLD COMPOSITION AFFECTING ISSUANCE OF PAYMENT
3.758.31 [Rev. eff. 11/1/95]
If, prior to payment, an eligible household's circumstances change, which involves separation or divorce of a marriage or common law arrangement, and the household includes dependent children, the Basic Program payment(s) shall be provided to the parent or guardian who resides with and has the responsibility for the care of the dependent children. If the household does not include dependent children, the Basic Program payment(s) shall be paid to the person listed as applicant.
3.758.32 Death of Payee Affecting Issuance of Payment [Rev. eff. 9/1/11]
When the payee for a Basic Program benefit dies, any payment to which the payee was entitled shall be kept available according to the following rules:
A. The surviving spouse or other household member shall be entitled to the Basic Program payee's benefit provided that the surviving spouse or other household member was included as part of the Basic Program payee's household upon Basic Program eligibility determination.
B. In the case of a single member household client payment, the payment will expunge after three hundred sixty-five (365) days. In the case of a single member household vendor payment, the vendor will follow the process outlined in the vendor agreement.
3.758.4 PAYMENT METHODS
3.758.41 Basic Program Payment
For an approved household which pays home heating costs directly to a fuel vendor, payment shall be made as a vendor payment, provided a written vendor agreement has been secured. The State Department shall be required to provide vendors servicing their county with an opportunity to sign the state prescribed vendor agreement. County departments shall provide vendors with applications, brochures, envelopes, and other outreach material. In cases where a written vendor agreement has not been secured, payment shall be issued directly to the eligible household. For an approved household that pays home heating costs to a landlord, payment of the Basic Program payment shall be made directly to the eligible household. Under no circumstances shall a direct payment be made to a landlord.
3.758.42 - 3.758.45 (None)
3.758.46 Vendor Payment Procedures
A. When a direct vendor payment is made, the county department shall be required:
1. To notify each household of the amount and month such assistance is scheduled to be paid on its behalf, 2. To notify the household of the vendor to be paid on the household's behalf, 3. To contact the vendor to explain the vendor payment process, when applicable.
4. To notify each eligible household in writing of the eligible household's responsibilities to continue to pay toward the household's heating costs. Such notification shall advise the household that the Basic Program payment is not intended to totally pay a household's heating costs.
5. To notify the vendor in writing of each household's eligibility and projected payment amount.
B. Prior to any Basic Program payment being made directly to a fuel vendor on behalf of an eligible household, the following terms of agreement shall be obtained from the fuel vendor in writing and notice of the same shall be included with the Basic Program payment in accordance with a State prescribed form. Any revision or modification of the assurances below, necessitated by unique circumstances, shall be submitted in writing to the State Department for approval prior to execution of the vendor agreement.
C. Refer to the State approved vendor agreement for specific requirements, conditions and procedures. This agreement is available on the Colorado Department of Human Services web site.
3.758.47 Methodology for Calculating Basic Program Benefits [Rev. eff. 9/1/11]
The payment amount for an eligible basic program household shall be determined in accordance with the following method:
Step A. Determine Estimated Home Heating Costs (EHHC)
The county department shall determine estimated home heating costs for November 1st through April 30th for the household's current residence at the time of application. The methodology for calculating estimated home heating costs is outlined below. The county department shall determine the applicant household's estimated home heating costs as follows:
1. An applicant household's estimated home heating cost shall consist of the total actual home heating costs for the primary heating fuel for November 1st through April 30th, of the prior year's heating season. Vendors serving applicant households shall be required to supply actual home heating costs for November 1st through April 30th of the prior year's heating season.
2. For any applicant whose home heating costs for the prior year's heating season are not available or determined by the county department to be invalid, the county department shall use the flat rate amount. The State Department shall adjust the flat rate amounts annually based on the average actual home heating costs found in the LEAP system by dwelling type for the prior year’s heating season and make that information available by September 1of each year to the county departments through an Agency Letter.
3. The State Department shall adjust the standard rates for heat in rent annually based on the flat rate amounts adjustment and make that information available by September 1 of each year to the county departments through an Agency Letter. Step B. Initial Statewide Adjustment The state LEAP office will adjust benefit levels at the beginning of each LEAP program year based upon the projected number of leap applications to be received and the estimated level of funding. Annually, this calculation determines the percentage of the estimated home heating costs (EHHC) of the applicant household to be adjusted. Step C. Adjustment for electric heat Households using electric heat will have their electric usage costs reduced to the percentage amounts listed below.
HEAT PORTION OF TOTAL ELECTRIC EHHC House/mobile home 62% for heat Townhouse / duplex / 48% for heat triplex / fourplex Apartment, 43% for heat condominium, hotel, rooming house Cabin, RV, 5th wheel, 50% for heat camper Step D. Adjustment for Shared Living Arrangements The estimated home heating costs shall be adjusted if the household shares living arrangements with other households but is determined to be a separate household as defined in the "Definitions" section of these rules. If the household shares living arrangements with other households, the estimated home heating cost shall be divided by the number of separate households sharing the living arrangements, whether or not all households sharing the living arrangements are eligible for the basic program. Step E. Adjustment for Subsidized Housing Home Heating Allowance The State Department shall adjust the amount of estimated home heating cost remaining after Step B if the household resides in subsidized housing (as defined in the "Definitions" section of these rules). A flat rate rental cost allowance for heating ($30 per month or $180 per heating season) shall be deducted from the remaining amount of estimated home heating costs. If the household does not live in subsidized housing, the amount remaining after Step B shall be the estimated home heating cost. Step F. Determine Basic Program Amount The State Department shall determine a benefit amount for each eligible household by subtracting the applicable adjustments listed above, in Steps B-E from the household’s estimated home heating costs (EHHC) determined in Step A, 1-3. Any eligible household will receive at least the minimum, up to and including, the maximum benefit amount established by the Department for the LEAP program year.
3.758.48 Adjustments [Rev. eff. 9/1/11]
The State Department will provide the county departments advance written notice of any statewide benefit level adjustments.
Any statewide adjustment to the LEAP benefit level cannot be appealed. The benefit amount in a prior LEAP program year is not indicative of a current LEAP program year benefit amount and benefit levels may vary from program year to program year depending on funding and the applicant pool.
3.758.49 Forfeiture of Benefit [Eff. 11/1/98]
If the benefit is not properly claimed within the current federal fiscal year for the period of intended use, the household will forfeit the remaining benefit.
3.759 OUTREACH AND REFERRAL
3.759.1 COUNTY DEPARTMENTS
3.759.11 Operation [Rev. eff. 11/1/83]
The county department has responsibility for the operation of a county wide outreach program. The outreach program shall be operated in accordance with guidelines contained in this section. The county may opt to contract with other agencies to perform all or part of the required outreach activities. Counties must assure that outreach includes:
A. Coordination with other agencies, organizations, and groups to facilitate the participation of potentially eligible persons with emphasis on most vulnerable (e.g., elderly, disabled, home bound, non-English speaking);
B. Access to Basic Program information and application forms. Outreach staff must identify locations in the county, such as community action programs, social security offices, low income housing sites, etc., for distribution of information, taking of applications, etc., through these sites. In addition, the county must have sufficient telephone lines to ensure access to information without requiring office visits;
C. An effective county wide information and referral system involving local agencies and organizations;
D. A referral system to weatherization and other energy conservation programs in the county;
E. Special efforts to meet the needs of target groups (e.g., home visits for home bound, outstationing of outreach staff, etc.). County departments shall assist disabled and elderly (as defined in the “Definitions” section of these rules) applicants in completing applications and securing the required verification;
F. Regular communications with cooperating agencies to identify concerns, problems, etc.;
G. Encourage utility companies to refer their customers to the county departments.
3.759.12 Outreach Plan [Rev. eff. 11/1/03]
The county department shall develop an outreach plan which describes specific activities the county will perform to carry out the specific responsibilities outlined in 3.759.11, above. The plan shall be available for public inspection at the county department.
3.759.13 Reporting Requirements
County departments shall comply with outreach reporting requirements as prescribed by the State Department. Failure to comply may result in the recovery of outreach funds.
3.759.2 OUTREACH ACTIVITIES
3.759.21
Outreach materials shall be distributed to various community agencies targeting groups such as elderly, persons with disabilities, veterans, migrant seasonal workers, renters, Native Americans, and non-English or limited English speaking communities.
3.759.3 (None) [Rev. eff. 2/1/12]
3.759.4 WEATHERIZATION REFERRAL
3.759.41 [Rev. eff. 11/1/83]
Eligible households shall be referred for participation in weatherization, energy conservation and other related assistance upon the household's request.
3.760 (NONE) [Rev. eff. 9/15/12]
3.770 ALLOCATION FOR ADMINISTRATION AND OUTREACH [Rev. eff. 11/1/96]
The county may transfer funds from Program Code 4510 Administration to Program Code4520 Outreach. The county may not transfer funds from Program Code 4520 Outreach to Program Code 4510 Administration.
The county is to budget its allocation of funds for Program Code 4510 Administration and Program Code 4520 Outreach to cover all expenditures which may be incurred from October 1 to the following September 30. The county department shall not be reimbursed for expenditures in excess of the county's allocation of Program Code 4510 and Program Code 4520 funds. The county's allocation of Program Code 4510 Administration funds will not be increased unless the State Department allocates additional funds to all counties or unless the county meets the following criteria:
A. The county submits a written letter of request which includes the county's original budget plan for expenditure of its allocation of administrative funds, a description of expenditures to date for administrative costs, a budget of anticipated costs for the remainder of the program, and a narrative justification of actual and anticipated expenditures for the program.
B. The request for additional funds must be justified on the basis of one or both of the following factors:
1. That the county incurred or expects to incur extraordinary costs which were or are beyond county control and were or will be necessary to implement the program:
2. That the county's caseload in relation to its allocation of administrative funds was significantly greater than the caseload of other similar sized counties in relation to their allocation of administrative funds.
The county's allocation of Program Code 4520 Outreach funds shall not be increased unless the county submits a request for additional outreach funds, which explains and justifies the need for such funds or unless the state department allocates additional funds to all counties.
_________________________________________________________________________ Editor’s Notes Primary sections of 9 CCR 2503-1 have been recodified effective 09/15/2012. See list below. Versions and rule history prior to 09/15/2012 can be found in 9 CCR 2503-1. Prior versions can be accessed from the History link located above the rule text.
Rule section 3.000 – 3.100, et seq. has been recodified as 9 CCR 2503-1, GENERAL RULES. Rule section 3.200, et seq. has been recodified as 9 CCR 2503-2, GENERAL FINANCIAL ELIGIBILITY CRITERIA.
Rule section 3.300, et seq. has been recodified as 9 CCR 2503-3, OLD AGE PENSION. Rule section 3.400, et seq. has been recodified as 9 CCR 2503-4, AID TO THE NEEDY DISABLED AND AID TO THE BLIND.
Rule section 3.500, et seq. has been recodified as 9 CCR 2503-5, (Reserved for Future Use). Rule section 3.600, et seq. has been recodified as 9 CCR 2503-6, COLORADO WORKS PROGRAM.
Rule section 3.700, et seq. has been recodified as 9 CCR 2503-7, OTHER ASSISTANCE PROGRAMS.
Rule section 3.800, et seq. has been recodified as 9 CCR 2503-8, ADMINISTRATIVE PROCEDURES.
Rule section 3.900, et seq. has been recodified as 9 CCR 2503-9, COLORADO CHILD CARE ASSISTANCE PROGRAM.
History Sections 3.750.12 – 13, 3.751.1, 3.751.31, 3.751.41 – 43, 3.751.51, 3.751.53, 3.751.71 – 72, 3.752.1, 3.752.22 – 23, 3.754.1, 3.756.2 eff. 09/15/2012. Section 3.760 – 3.760.53 repealed eff. 09/15/2012.
Sections 3.744.F – G, 3.746.A – F, emer. rules eff. 11/09/2012. Sections 3.720, 3.721.22, 3.744.A – B emer. rules eff. 02/01/2013. Sections 3.744.F – G, 3.746. A – F eff. 03/02/2013.
Sections 3.720 – 3.720.32, 3.721.22, 3.744.A – B eff. 05/01/2013.