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Helping you stay healthy Medical Resources Justifying Medical Necessity Seizure Protocol Blank Medication Schedule Justifying Medical Necessity ​ Please click here to download the PDF Clic aquí para descargar un modelo de la carta con guía en Español ​ ​ ​ Writing a Letter of Medical Necessity ​ Include the following information: Full name of child, names of parents (parents and child may have different names) Date of birth of child Insurance plan name (there may be more than one plan) Relevant diagnoses (codes are helpful only if they are accurate! Ask the doctor.) Item/service being requested Why the item/service is medically necessary (refer to the insurance plans’ definition) What positive/negative impacts the item/service will result in (include financial) Scope and duration of treatment Supplemental documents (pictures, letters from other providers, research articles, product information, Prior Authorization Request) Include funding streams NOT able to help (denial letters, help) Terms to use: medically necessary clinically based promoting independence preventing secondary disability cost-effective safety Terms to avoid: custodial rehabilitate developmental delay/disability speech delay (without a diagnosis such as aphasia) Caregiver convenience ​ Ask if your Letter of Medical Necessity answers the following: Is there a licensed provider stating in writing the item/service is medically necessary? Is this item/service not for care giver convenience? Is this item/service costs effective and if so have you explained how? Is this item/service considered standard medical practice? Have you explained how long and how often the item/service will be used. Is this item/service right for the need of individual? ​ The Responsibilities of Each Role ​ Care provider needs to: Know the process if the parent is not yet skilled Know pertinent benefits Know limitations and exclusions Know the appeals process Know terms and their definitions Distribute instructive materials to parents (empowerment) Write perfect letters of medical necessity Parent needs to: Become knowledgeable about the policy Supply information to providers Keep a paper trail of all communications Confront conflicting information Advocate’s role is to: Assist with the appeals process Guide providers and parents to resources Influence systems’ change ​ Example Letter: Full name of parent’s Insurance ID: Full name of Child: Date of Birth: Diagnosis codes: Dear Insurance person: Date: This letter is to communicate the medical need for a ________________________. My child____________________, has the medical diagnosis requiring this device/service. I have researched other devices but feel this is the best device for my child. Other devices don’t have the ability to tilt in space, the __name of device_________________ has this ability, allowing for multiple positions. Multiple positions are important as _name of child__________must be repositioned often to reduce spasticity. The positions also allow this device to grow with my child. Reducing the need for another device to be purchased in a few years. This device was recommended by a licensed therapist, see attached letter. Without this device my child will require additional therapies and costly surgeries in the future. I am sure you get letters asking for things every day. I am including a picture of __name of child____________ using this device, to assist you in understanding the importance having this device. If this device is not approved the child will – cost more money, lose mobility, lose community access. I do plan to go through the appeal process if this device is not funded. Your company’s definition of medical necessity is: I am communicating that this device for my child fits your definition for the above reason. Don’t hesitate to call or email if you need additional information, related to this decision. I look forward to hearing from you. Sincerely, Name, ID# Address Phone Email Attachments: Doctors, therapist or professional letter Picture Marketing material about device ​ Justifying medial necessity Seizure Protocol ​ ​ Click here to download the PDF in English Clic aquí para descargar PDF en Español Example of a Seizure Action Plan Name: DOB: Diagnosis: Emergency Contact: Phone: Name_______________'s MEDICAL History: MEDICATIONS: _______________________ HISTORY:____________________________ Patient, has a history of seizures, displayed by for Seconds/minutes. ​ NOTE: If has a seizure lasting longer than minutes: Call: parent: name: phone: Call 911 if seizure lasts longer than 5 minutes and no rescue medications are available. Seizure Protocol Blank Medication Schedule ​ Click here to download the Blank Medication Schedule Form in English Click aquí para descargar un modelo del horario de medicamentos en Español Blank Medicatin Schedule

let us help clarify Acronyms & Common Terms 300%ers –Persons whose income is up to three times the SSI payment limit. This optional eligibility category is eligible for Medicaid by virtue of need for long term care services. A & A –Aid and Attendance (VA Benefit) A/CSA –Alcohol/Controlled Substance Abuse AAA –Area Agency on Aging AABD –Aid to the Aged, Blind, and Disabled (Federal Term) AAMR — American Association on Mental Retardation AARP –American Association of Retired Persons AAS –Aging and Adult Services AASD –Aging and Adult Services Division AB –Aid to the Blind AB-T –Aid to the Blind- Treatment ACF –Alternative Care Facility ACSES –Automated Child Support Enforcement System Acute Care & EQRO –Adult Care & External Quality Review Organization ADA –Americans with Disabilities Act ADAD –Alcohol and Drug Abuse Division ADC –Adult Day Care ADL –Activities of Daily Living ADP –Automated Data Processing ADS –Adult Day Services AFC –Adult Foster Care. This is not a Medicaid program or service; however, many AFC eligible are also Medicaid eligible. This provides residential care with supervision for client medications, etc. While these services are not as extensive as those rendered in a nursing home, they do represent an important component of a “continuum” of long term care. It is funded through a 95% General Fund and a 5% local match. AFDC-A –Aid to Families with Dependent Children- Adults AFDC-C –Aid to Families with Dependent Children- Children AFDC-FC –Aid to Families with Dependent Children- Foster Care AFDC-I –Aid to Families with Dependent Children- Incapacitated Parent AFDC-U –Aid to Families with Dependent Children- Unemployed Father AG –Attorney General AIDS –Acquired Immune Deficiency Syndrome ALJ –Administrative Law Judge Allowed Charge –The Amount Medicare Will Consider for Payment for a Given Service or Supply AMPS –Automated Medicaid Payment System- Electronic Claims System Ancillary Services –Those Service and Supplies Provided to Patients on an As-Needed Basis AND-SSI –Aid to the Needy Disabled- SSI ANSI –American National Standards Institute AOA –Administration on Aging AP –Assistance Payments AP-700 –Financial and Medical Eligibility Reporting Form APD –Advance Planning Document APPLS –Automated Personnel Payroll Ledger APS –Adult Protective Services ASA –American Society of Aging ASC –Ambulatory Surgical Centers AT –Assistive technology Arc of Colorado —State organization that serves an advocacy group for persons with developmental disabilities for all ages AU –Administrative Unit Authorized Representative— An individual designated by the person receiving services Autism —A complex neurological disorder that appears disorders that appears during the first three years of life. BBA –Balanced Budget Amendment BC/BS –Blue Cross/Blue Shield of Colorado, Medicaid’s former Fiscal Agent BCA –Baby Care Adults BCC –Baby Care Children BC-KC –Baby Care – Kids Care Program BCR –Birthing Cost Recovery BENDEX –Beneficiary Data Exchange Beneficiary –One Who is Entitled to Receive Benefits Benefits –The Scope of Services Available to Beneficiaries BI –Brain Injury BIA –Bureau of Indian Affairs BIDS System –Colorado procurement information system BL –Black Lung BMS–Bureau of Medical Services (Obsolete- Now MS) BPR –Business Process Reengineering BUS –Benefits Utilization System CACTIS –Colorado Automated Client Tracking Information System CACCB —Colorado Association of Community Centered Boards CAFSS –Colorado Automated Food Stamp System CAHHA –Colorado Association of Home Health Agencies CAHPS –Consumer Assessment of Health Care Study CAHSA –Colorado Association of Homes and Services for the Aging CAP –Colorado Admissions Program CAPD –Continuous Ambulatory Peritoneal Dialysis CAPRA —Colorado Association of Private Resource Angencies CAPS –County Automated Payment System CARC –Colorado Association for Retarded Children Carve-Out –A Benefit or Service that is not Included Under an Otherwise Global Services Agreement, Such As a Medicaid HMO Contract Case Mix Demo –Pilot Effort Directed by HCFA to Test & Prove CM Using the MDS & RUG 3 as the Case Mix Reimbursement System for Medicare SNF Patients. KS, MS, ME, TX, NY, SD are the Participating States Case Management—Services provided by CCBs to assist in eligibility determination, IP development and the coordination of services. CAT Scans –Computerized Axial Tomography CBHP –Children’s Basic Health Plan CBLTC –Community Based Long Term Care CBMS –Colorado Benefits Management System CBP –Common Business Proces CBT –Computer-Based Training CCB –Community Centered Board (for DD) or Change Control Board CCHN –Colorado Community Health Network (Assoc. of FQHCs) CCI –Colorado Counties, Inc. CCOA –Colorado Commission on Aging CCPD –Continuous Cycling Peritoneal Dialysis CCR –Code of Colorado Regulations CCSO –Colorado Congress of Senior Organization CDAS –Consumer Direct Attendant Support CDBG –Community Development of Social Services CDE —Colorado Department of Education CDF –Colorado Drug Formulary CDHCPF –Colorado Department of Health Care Policy and Financing CDHS –Colorado Department of Human Services CDOLE –Colorado Department of Labor and Employment CDOR –Colorado Department of Revenue CDPHE –Colorado Department of Public Health and Environment CDSS –Colorado Department of Social Services or County Department of Social Services or County Department of Human Services CEDARS –Colorado Eligibility Disbursement and Reporting System CES —Children’s Extensive Support (Medicaid Waiver) CFMC –Colorado Foundation for Medical Care- HCPF ‘s PRO Contractor CFR –Code of Federal Regulations CGS –Colorado Gerontological Society CHAMPUS –Civilian Health and Medical Program of the Uniformed Services CHATS –Child Care Automated Tracking System CHFA –Colorado Housing Finance Authority Children’s HCBS –HCBS for children with physical disabilities CHINS –Children in Need of Supervision CHP+ –Children’s Health Plan Plus CHRS —Children’s Health and Rehabilitation Services CICP –Colorado Indigent Care Program CIDS 2000 –Client Information Data Subsystem for the 21st Century CIN –Colorado Information Network CLASS I –Refers to general nursing facilities CLASS II/IV –Refers to nursing facilities for physically and developmentally disabled individuals CLASS IV Nursing Homes –Regional Centers for persons with developmental disabilities (operated by CDHS) CLEAR –Colorado List of Emergency Assistance Recipients CM –Case Manager CMA –Case Management Agency CMER –Colorado Medicaid Eligibility Response CMI –Comparative Measure Index CMS — Center for Medicare and Medicaid Services CNS –County Nursing Service CO/EBTS –Colorado Electronics Benefits Transfer Service COBRA –Consolidated Omnibus Budget Reconciliation Act of 1985 COFRS –Colorado Financial Reporting System COIN –Client Oriented Information System (CDHS-HCPF eligibility database) Co-Insurance –The amount of the allowed charge the beneficiary is responsible for paying on assigned Medicare beneficiaries COLA –Cost of Living Adjustment COLO R/X –Colorado Drug Formulary Colorado Works –Colorado’s Welfare Reform Program (see: TANF) Comprehensive Services – a program that provides 24-hour supervision and other supports, training and habilitation based on an Individual Plan Consultec –Medicaid, CBHP, CICP, etc., fiscal agent beginning December 1st, 1998 CP —Cerebral Palsy CPAS –Claims Processing Assessment System CPT-6 –Current Procedural Terminology (Physician Reimbursement Guide) CQC –County Quality Control CRCP –Central Registry for Child Protection CRD –Chronic Renal Disease CRLS –Colorado Rural Legal Services CRS — Colorado Revised Statute regarding care and treatment of persons with developmental disabilities. CRSP –Colorado Refugee Service Programs CS –Federal SSI-Colorado Supplement CSBG –Community Services Block Grant CSE –Child Support Enforcement CSL –Colorado Senior Lobby CSPR –Control System for Proposed Rules (State Regulations) CSR --Continued Stay Review CSU –Child Support Unit CTRANS –County Transportation Refers to Non-Emergency or Non-Wheel Chair Transportation Services Customary Charge –The most common charge by a provider for a particular service to the majority of patients CW –Child Welfare CWEST –Child Welfare Eligibility and Services Tracking System CW-FC –Child Welfare – Foster Care CWS –Division of Child Welfare Services CY –Calendar Year CYF –Children, Youth, and Families Day Program– Part of the home and community based services for persons with developmental disabilities. This is the day program part of the waiver. DC –Day Care DD –Developmentally Disabled DDDS — Division of Developmental Disabilities Services DEFRA –Deficit Reduction Act DHMC –Denver Health Medical Center DHS –Colorado Department of Human Services DIDD– Division for Intellectual and Developmental Disabilities DIH –Department of Indian Health DLE –Colorado Department of Labor & Employment DMA –Division of Medical Assistance (obsolete now AAS) DME/MED EQUIP. –Durable Medical Equipment and Supplies DOH –Division of Housing DORA –Colorado Department of Regulatory Agencies DPHE –Colorado Department of Public Health and Environment DRG –Diagnosis Related Group DSH –Disproportionate Share Hospital DSS –Decision Support System DVR –Division of Vocations Rehabilitation DYC –Division of Youth Corrections EA –Emergency Assistance EBD –Elderly, Blind, and Disabled EBT/EFT –Electronic Benefit Funds Transfer EGHP –Employer Group Health Plan EI –Early Intervention EID –Employment Information Data EIS/DSS –Executive Information System/Decision Support System EJB –Enterprise Java Beans Eligible –This refers to one full time equivalent client for a defined period of time. Every person who is issued a MAC Is called an “eligible.” It does not refer to the number of clients who actually use a medical service. When a MAC is issued, the computer system assigns a prescribed span of time for which the person is eligible. If eligibility is not renewed at the end of the span, eligibility lapses. EMC –Electronic Media Claim EMS –Eligibility Management Systems EOMB –Explanation of Medicare Benefits EPM –Enterprise Project Manager EPSDT –Early and Periodic Screening, Diagnosis and Treatment (Preventive Health Care Program for Medicaid Clients Up to age 21) EQRO –External Quality Review Organization ERS –OYS Education Records System ESC –Employment Status Code EVV –Electronic Verification System F PLAN– Family Planning refers to services which are paid through the family planning clinics for which an annual capitation is paid for all family planning services eligible for one year FA –Fiscal Agent (Blue Cross/Blue Shield of Colorado)- Medicaid’s Fiscal Intermediary; operates the provider claim system and MMIS database FAMIS –Family Assistance Management Information Systems FC –Foster Care Children FCS-100 –Foster Care and Subsidized Adoption and Medicaid Eligibility Tracking FDA –Food and Drug Administration FDDI –Fiber Distributed Data Interface FFP –Federal Financial Participation FFS –Fee for Service (non-capitated health care payment system) FFY –Federal Fiscal Year FGP –Foster Grandparent Program FI –Fiscal Intermediary (Medicare) FIPS PUB –Federal Information Processing Standard Publication Fiscal Intermediary –An insurance company which manages medicare claims and provides audit-reimbursement services for HCFA to assure providers utilize program benefits appropriately FLOOR –Medicare statute for the minimum amount of time a claim must be held before payment/also minimum payment, etc. FNS –Food and Nutrition Services FPL –Federal Poverty Limit FQHC/Rural Clinic –Federally Qualified Health Clinic (or center )- health service facility for low income persons in a medically under served area FR –Federal Register (Publication of Federal Regulations) FRV –Fair Rental Value FS –Food Stamps FSP –Family Service Plan FSSP –Family Support Services Program FSJS –Food Stamp Job Search System FSR–Feasibility Study Report FTE –Full Time Equivalent FY –Fiscal Year (state) GA –General Assistance GB –Giga Bytes GGCC –General Government Computer Center GJTO –Governor’s Job Training Office GSS –(Colorado Department of) General Support Services GUI –Graphic User Interface HB –House Bill (introduced to the Colorado House in the General Assembly/Legislature) HB 97-1304, HB 97-1325 – Authorizing legislation for the Children’s Basic Health Plan (CBHP) HCA –Home Care Allowance HCBS –Home and Community Based Services HCBS-BI –HCBS (persons with brain injury) HCBS-CES –HCBS (Children’s Extensive Support) HCBS-CM –Home and Community Based Services for the Elderly, Blind, and Disabled Case Management HCBS-CMW –HCBS (Children’s Medical Waiver) HCBS-CS –Home and Community Based Services for the Elderly, Blind, and Disabled Client Services HCBS-DD–HCBS (Persons with Developmental Disabilities) HCBS-EBD–HCBS (Elderly, Blind, and Disabled) HCBS-MI–HCBS (Mentally Ill) HCBS-PLWA–HCBS (People Living with AIDS) HCBS-SLS–HCBS (Supported Living for persons with developmental disabilities) HCFA–Federal Health Care Financing Administration HCPCS–HCFA Common Procedure Coding System (Outpatient) HCPF (Medicaid)–Colorado Department of Health Care Policy & Financing Health Insurance Buy-In–Premium and coinsurance/deductible payments for private health insurance policies for medicaid clients when it can be shown to be cost effective HEDIS–Health Plan Employer Data and Information Set HEWI–Health, Environment, Welfare & Institutions HH–Home Health Care HH#–County Household # HHA–Home Health Aide or Home Health Agency HHS–Health and Human Services Federal agency HIBI–Health Insurance Buy-In Program HIM–Health Insurance Manual HIMS–Health Information Management System HIS–Indian Health Services HM–Home Maker HMO–Health Maintenance Organization Home Care Allowance –This is not a Medicaid program or service; however, most Home Care Allowance eligible are also Medicaid eligible. Services are for persons residing in their own homes and include personal care and supportive services. While these services are not medical in nature, they do represent an important component of a “continuum” of long term care. It is funded through 95% General Fund and 5% Local Match Home Mod--Home Modification HOSPICE–Hospice HRC–Human Resources Committee HSP–Hospital Specific Portion HTML–Hyper Text Markup Language HTTP–Hyper Text Transfer Protocol HUD–Housing and Urban Development HW–Hardware IADL–Independent Activity of Daily Living IAPD–Implementation Advance Planning Document ICD-9-CM–International Classification of Diseases, version 9, Clinical Modification ICF–Intermediate Care Facility ICF-IDD–Intermediate Care Facility for the Intellectually and Developmentally Disabled ICN–Internal Control Number IEVS–Income Eligibility Verification System IFF–Intrastate Funding (Allocation) Formula for QAA Funds IFSP(0-3)–Individualized Family Service Plan IM–Income Maintenance IMAP–Information Management Annual Plan IMC–Information Management Commission Inpatient–Inpatient Hospital Care Intermediary (F.I.)–An independent insurance company contracted by HCFA to administer payments for Medicare IP–Individualized Plan IPV–Intentional Program Violation IRFP–Implementation Request for Proposal ISP–Internet Service Provider IT–Information Technology ITS–Information Technology Services IV-A–Title IV-A, Social Security Act Federal AFDC regulations IV-D–Title IV-D, Social Security Act Federal Child Support Enforcement Program regulations IV-E–Title IV-E, Social Security Act, Generally refers to children eligible for TANF payments but the child is in foster care IVES–Income Eligibility Verification System JAD–Joint Application Development JAVA–A programming language JBC--Joint Budget Committee JDBC–Java Database Connectivity JHAC–Joint Commission of the Accreditation of Hospitals JOBS–Job Opportunity Basic Skills (Federal employment program) JTPA–Jobs Training Partnership Act Lab/X-ray–Laboratory and Radiology Services LAC–Lifetime Authorization Cards LAN–Local Area Network LEAP–Low-income Energy Assistance Program LGHP–Large Group Health Plan LOC–Level of Care or Line of Code LOP–Local Operational Plan LOS–Length of Stay LPN–Licensed Practical Nurse LSC–Legal Services Corporation LSD–Legal Services Developer LTC–Long Term Care LTHH–Long Term Home Health LTC-101–Long Term Care Assessment Form LTC-102–Monthly HCBS Non-Diversion/Termination Report Form LTC-103–HCBS Case Plan Form LTC-104–HCBS Case Plan Revision Form LTC-105–HCBS Prior Approval and Cost Containment Form LTC-106A–Client Payment Form for HCBS- 300% Non ACF Clients LTC-106B–Client Payment Form for HCBS- All ACF Clients LTC-107–HCBS Notice of Service Status/Eligibility Form LTC-108–HCBS Statement of Services (Claim Form) LTC-109–HCBS Form for Application of Individual Providers LTC-110 –HCBS Form for Monthly Listing of New Individual Providers, Re-certifications, De-certification LTC-111–HCBS Complaint Information Form LTCO–Long Term Care Ombudsman LVN–Licensed Vocational Nurse MA–Medical Assistance MAC–(Mutually exclusive meanings depending upon context): · Medical Authorization Card (Client’s Medicaid Card) · Medical Assistance Advisory Council · Maximum Allowable Cost MANE—Mistreatment, Abuse, Neglect and Exploitation MAPI–Messaging Application Program Interface MB–Mega Bytes – a measure of computer memory or file size MBE/WBE–Minority-owned Business Enterprise/Woman-owned Business Enterprise MC–Medicaid MCO–Managed Care Organization MCPI–Medical Consumer Price Index MCR or M18–Medicare MDS 2.0–Minimum Data Set for resident assessment MDS Automation Demonstration–Pilot effort directed by HCFA to test & prove automated MDS submission by nursing facilities MDS+–The NF Demonstration version of the MDS, Main, Mississippi & South Dakota us 12/1/90 b version. It meets the federally mandated requirements for primary resident care screening & assessment. Medicare–That portion of the Social Security Act which provides health care benefits to citizens over age 65 or under age 65 who are permanently disabled or suffering from chronic renal failure Medicare Part A–That part of medicare law providing for in-patient hospitalization, SNF care, NH benefits, & home health services to senior citizens Medicare Part B–A supplementary program to Part A providing for physicians’ services, outpatient hospital services, & other supplies. Waivers were granted in 1996 to enable use of RUGs 3 for routine costs. Medicare/TPL–Medicare/Third Party Liability Mental Health –This refers to the mental health care provided through the community MHASA–Mental Health Assessment & Services Agency MI–Medically Indigent MK or M19–Medicaid MMIS–Medicaid Management Information System MMQ–A Case Mix RAI developed by Hill haven & used by MA MOE–Maintenance of Effort – This is a federal mandate requiring states (and, where applicable counties) to spend at least 80% of the funding amounts expended in base year 1993. If the state pays 80% of the base year expenditures, then even if welfare rolls escalate in future years, the federal government will continue to supply its share of funds for the higher costs. This is intended to assure that states expend a proper amount of state funds relative to federal funds. MOU–Memorandum of Understanding MOW–Meals on Wheels MR–Mentally Retarded MRI–Magnetic Resonance Imaging MS–Medical Services MSA--Metro Statistical Area MSP–Medicare Secondary Payer MSR–Monthly Status Report MSW–Master’s of Social Work or Medical Social Work MTBD–Mean Time Between Defects MTBF–Mean Time Between Failures MTS–Medicare Transaction System MTTR–Mean Time To Restore MVS–IBM Mainframe Operating System MVS–Multiple Virtual Storage NAAAA–National Association of Area Agencies on Aging NASUA–National Association of State Units on Aging NASW–National Association of Social Workers NCANDS–National Child Abuse and Neglect Data Systems NCOA–National Council on Aging NCQA–National Commission on Quality Assurance NCSC–National Council of Senior Citizens ND–Non-Diversion NDS–Net ware Directory Services NF–Nursing Facility NFT--Nursing Home Transition Program NH–Nursing Home NOA–Notice Of Action NON-PPS–Non-Prospective Payment System NPE–Nutrition Program for the Elderly NRST–Non-Resident Specific (Nursing or Therapy Staff Times) NRTA–National Retired Teachers Association NT Windows–Windows New Technology Operating System NTS–Nonresident Tracking System OAA–Older Americans Act OAP/A–Old Age Pension/65 years or older OAP/B–Old Age Pension/60 to 64 years OAP/SO–Old Age Pension- State Only health and medical benefits OASDI–Old Age Survivors Disability Insurance OAVP–Older American Volunteer Programs OBRA–Omnibus Budget Reconciliation Act OCA–Older Coloradans Act OCYF–Office of Children, Youth, and Families ODBC–Open Database Connectivity OIB–Older Individuals who are Blind Program OIG–Office of Inspector General OIT–Office of Information Technology OLTC–Options for Long Term Care OLTP–Online Transaction Processing OMB–Office of Management and Budget OP–Outpatient Option/Mandate–Certain Medicaid services are mandated by federal law as a cost of participating in the federal Medicaid program and certain others are optional for the states. Option/Mandate–Certain Medicaid services are mandated by federal law as a cost of participating in the federal Medicaid program and certain others are optional for the state ORB–Object Request Broker ORD–Office of Research and Demonstrations OSPB–Office of State Planning and Budget (Governor’s Office) OT/PT/ST–Occupational Therapy/Physical Therapy/ Speech Therapy OTC –Over the Counter Drugs OUT–Outcome Tracking Unit Outpatient–Outpatient Hospital Services includes all hospital-based outpatient care ranging from emergency room to hospital based care Over 65–Inpatient Psychiatric Hospital Care for Persons over age 65. State owned and operated hospital care. OYS–Office of Youth Services PA–Public Assistance PA-1--Program Area One- Adult Self Sufficiency, Social Services Block Grant, Social Security Act PA-2--Program Area 2- Adult Protective Services, Social Services Block Grant, Social Security Act PAC–Political Action Committee, also Policy Advisory Committee to CDSS PACE–Programs of All Inclusive Care for the Elderly PAPD–Planning Advance Planning Document PAR–Prior Authorization Review PASA–Program Approved Service Agency PASARR–Pre Admission Screening and Annual Resident Reviews PC–Personal Care PCA–Personal Care Alternative PCBH–Personal Care Boarding Home PCD–Project Control Document PCP/PCPP–Primary Care Physician/Primary Care Physician Program PDCS–Prescription Drug Card System PDN–Private Duty Nursing PE–Presumptive Eligibility PERA–Public Employees’ Retirement Association PETI–Post Eligibility Treatment of Income PHN–Public Health Nurse PHP–Prepaid Health Plan Physician–Physician’s services are those ranging from family practice to specialty care. PI–Program Integrity PIN–Personal Identification Number PLWA–People Living With AIDS PMIP–Professional Medical Information Page PMR–Planning and Management Region PM–Program Manager PN–Personal Needs POC–Plan of Care POPs–Points of Presence POS–Point of Service- child based HMO or Point of Sale PPD–Per Patient Day PPHP–Pre Paid Health Plan PPO–Preferred Provider Organization PPS–Prospective Payment System PPV–Pneumococcal Pneumonia Vaccine Prescription Drug–Includes payment for all drugs provided through Medicaid including those dispensed in nursing home, but excluding those which are dispensed in the inpatient hospital setting PRO–Peer Review Organization PROC–Procedure PRO-DUR–Prospective Drug Utilization Review PSA–Planning and Service Area PSRO–Professional Standards Review Organization QA–Quality Assurance QC/QA/ME–Quality Control/Quality Assurance/Management Evaluation QDWI–Qualified Disabled & Working Individuals QMB–Qualified Medicare Beneficiary R/R/R–Re-determination/Re-certification/Reassessment RA–Remittance Advice RAD–Rapid Application Development RAE–Regional Accountable Entity RAI–Resident Assessment Instrument RAPs–Resident Assessment Protocols RAS–Remote Access Services RC–Regional Center RCCO–Regional Care Collaborative Organization RDBMS–Relational Database Management System Rebate- Prescription Drugs –Medicaid prescription drug optional benefit. In an effort to offset the additional costs related to the items above, manufacturers rebate Medicaid drug expenses for certain items. The rebates are not accounted for in MMIS data and are handled manually through accounting transactions. Residential Program–Part of the Home and Community Based Services for the Developmentally Disabled, is the residential care provided for under the waiver. RETRO-DUR–Retrospective Drug Utilization Review RFP–Request for Proposal RHC–Rural Health Clinic RN–Registered Nurse RO–Regional Office (HCFA) ROI–Return on Investment RPC–Remote Procedure Call RRB–Railroad Retirement Benefits RSDI–Retirement, Survivors, Disability Insurance RST–Resident Specific- Nursing or Therapy Staff Times RSVP–Retired Senior Volunteer Program RTC–Residential Treatment Center (Children with behavioral problems) RTD–Resubmission Turn-Around Document RTP–Return to Provider Form Used by BC/BS RUGs–Resource Utilization Groupings RUGs III–The most recent version of RUGs SACWIS–Statewide Automated Child Welfare Subsystems SAM–Employment First System SB–Senate Bill (introduced to the Senate in the Colorado General Assembly/Legislature) SB 5-– Medicaid Managed Care legislation SB 138–Obsolete term for the HCBS-EBD Program SB 38–Pilot Program that Preceded HCBS SB 42–Social Security Legislation directing Case Mix SBSS–State Board of Social Services SCP–Senior Companion Program SCSEP–Senior Community Service Employment Program SCW I, II, III–Social Case Worker under the Merit System SSDI—Social Security Disability Insurance SP–Service Plan (Developmental Disability System) Section S–Only MDS section allowed for unique state use & change Section T–Record Nursing Therapy Section U–Records Medication Information SEP–Single Entry Point SHEA–State Health Expenditure Account SIDMOD–State Identification Module SI–Supports Intensity Scale SISC–SSI Status Code SLMB–Special Low-Income Medicare Beneficiaries SLP–Service Level Plan SMIB–Supplementary Medical Insurance Benefits SMSA–Standard Metropolitan Statistical Area SN–Skilled Nursing SNA–Systems Network Architecture SNF–Skilled Nursing Facility SOW–Statement of Work SPA–Single Purpose Application SPAL–Service Plan Authorization Limit SPSS–Statistical Package for the Social Sciences SQL–Structured Query Language SS-4–County Department of Social Services Form to Notify Clients of Service Status/Eligibility SS-6–County Department of Social Services Case Plan Form SSA–Social Security Administration SSBG–Social Services Block Grant SSCN–Social Security Claim Number SSI–Supplemental Security Income SSI-CS–Supplemental Security Income- Colorado Supplement (OAP) SSL–Secure Socket Layer SSN–Social Security Number SSO–Single Sign-On SSO–Social Security Office SSS–Social Services Syndrome SSTABS–Social Service Technical & Business Staffs (Association) ST–Speech Therapist or Therapy ST. I.D. #–State Identification Number (Medicaid #) STAC–Specialized Transportation Association of Colorado STARS-Services, Tracking, Analysis & Reporting System STM–Staff Time Measurement (SNF) SUA–State Unit on Aging SURS–Surveillance Utilization Review Subsystem SW–Software TANF–Temporary Assistance to Needy Families TCM-DD–Targeted Case Management-Developmentally Disabled TCP/IP–Transmission Control Protocol/Internet Protocol TILES–A Case Mix RAI developed & discontinued by Texas Title XIX–Social Security Act- Medicaid Title XVIII–Social Security Act- Medicare Title XX–Refers to State Children’s Health Insurance Plan TP–Transaction Processing TPL–Third Party Liability TPR–Third Party Recovery TPR–Third Party Resources Transportation–Emergency Transportation TRIGGERS–MDS data which points to specific RAPS TTS–Title 4-E Tracking System UAT–User Acceptance Test UB92–Uniform Billing Form HCFA 1450 UCB–Unemployment Compensation Benefits ULTC-100–Uniform Long Term Care (client needs assessment tool form) Under 21 Psych.–Private Psychiatric Hospital Care for Persons under age 21 Undoc–Undocumented Immigrants Unknown–Refers to appeal or adjustment activity which is not necessarily specific to one single claim/eligible or for a client who no longer has an active eligibility span on the recipient eligibility file in the MMIS. UR–Utilization Review of medical providers URL–Universal Resource Locator USC–United States Code USD–Unified Software Distribution USDA–United States Department of Agriculture VA–Veterans Administration VISTA–Volunteers in Service to America Vol 10–CDSS Staff Policy Manual for State Policy on Older Americans Act Vol 7–CDSS Staff Policy Manual for Social Services Vol 8–CDSS Staff Policy Manual for Medicaid VR–Vocational Rehabilitation VRS –Voice Response System VSAM –Virtual Sequential Access Method WAN –Wide Area Network WC –Worker’s Compensation WIC –Women, Infants, and Children Wrap Around Service s–Medicaid services that are not covered by HMOs, but that are covered for Medicaid clients enrolled in HMOs by referral or direct access to fee-for-service Medicaid Providers. XML –Extensible Markup Language Y2K –Year 2000 YTD –Year To Date 100.2 –Level of Care Assessment for HCBS Waiver Programs ​

Find more help Agencies & Resource Organizations Colorado Agencies & Resources Disability-Specific Orgs Colorado Agencies and Resources Ability Connection Colorado www.abilityconnectioncolorado.org Contact: 303-691-9339 ​ Matching parents one on one with each other for support. They connect families of children and adults with special needs by either phone, computer or in person. ​ The Arc of Colorado : www.thearcofco.org Contact: 800-333-7690 ​ The Arc builds better lives for persons with intellectual and developmental disabilities and their families by improving connections to schools, work and the community. Can provide an advocate to assist families through the IEP process. ​ Assistive Technology Partners : Contact: 303-315-1284 ​ ATP assists persons with cognitive, sensory, and/or physical disabilities reach their highest potential at home, school, work and play through the addition of appropriate assistive technologies to their lives. ​ Child Find / Early Intervention Colorado https://cdec.colorado.gov/ Contact: 888-777-4041 ​ Colorado has a Child Find system for appropriately identifying infants and toddlers with developmental delays or disabilities, and timelines for making referrals to local early intervention programs at no cost to parents. ​ Community-Centered Boards (CCBs) ​ Colorado has 20 CCB organizations serving children and adults with developmental disabilities. They determine eligibility for community-based services and provide case management services. CCB’s also assist individuals with gaining access to Medicaid Waivers. Waiver programs provide additional Medicaid benefits to individuals with special needs. ​ Colorado Center on Law and Policy (CCLP) Contact: 303-573-5669 ​ The Colorado Center on Law and Policy (CCLP) works to promote justice, economic security, access to health care, and sound fiscal policies for the people or Colorado through advocacy, litigation, education, and research. ​ Colorado Health Care Policy & Financing (HCPF): Contact: 303-866-2993 ​ Provides access to cost-effective, quality health care services. The Department administers the Medicaid and Child Health Plan Plus programs as well as a variety of other programs for Colorado’s low-income families, the elderly, and persons with disabilities. ​ Colorado Home and Community Based Service Waivers (Medicaid): ​ Medicaid is a health care program for low income Coloradans. Applicants must meet eligibility criteria for one of the Medicaid Program categories in order to qualify for benefits. Major program categories include Aid to Families with Dependent Children/Medicaid Only, Colorado Works/TANF (Temporary Assistance for Needy Families), Baby Care/Kids Care, Aid to the Needy Disabled, Aid to the Blind, and Old Age Pension. ​ For more information on Medicaid Waivers: Choosing an HCBS Waiver for Children Children’s Waivers Choosing an HCBS Waiver for Adults Adult Waivers ​ Colorado Respite Coalition (CRC): Contact: 303-619-1437 ​ CRC is community partners who explore, connect, and support community organizations and individuals interested in creating a variety of respite programs. ​ Disability Law Colorado : Contact: 303-722-0300 ​ Specialize in civil rights and discrimination issues. They protect the human and legal rights of people with mental and physical disabilities throughout Colorado. ​ Easter Seals Colorado : Contact: 303-233-1666 ​ Easter Seals is dedicated to supporting people with disabilities and their families as they live, learn, work and play in their communities. ​ El Grupo VIDA : Contact: 303-335-9875 ​ Provides information, referrals, and support for Spanish speaking parents. Ombudsman (Medicaid): 877-435-7123 email: help123@maximus.com Ombudsman help solve problems with your health care issues (both physical and mental health) for Medicaid Managed Care patients. They also help with health care rights and with grievances and appeals. ​ ​ Health Care Program for Children with Special Needs (HCP): Contact: 303-692-2370 ​ HCP offers support for families with children with special needs and focuses on care coordination and providing specialty clinics throughout the state of Colorado. HCP services are available to children with special needs, regardless of insurance status or family income. ​ Healthy Communities, Colorado Department of Health Care Policy and Financing: Contact: 303-866-2267 ​ Healthy Communities combines aspects of the Early Periodic Screening Diagnostic and Treatment (EPSDT) outreach and administrative case management program and Child Health Plan Plus (CHP+) outreach into one model that better meets the needs of clients. This outreach and case management model takes into account that many families have one child enrolled in Medicaid while another is enrolled in CHP+. The distinction between Medicaid and CHP+ benefits and services isn’t always clear. Family Health Coordinators are available statewide to help Colorado Medicaid and CHP+ families through the Healthy Communities program. ​ CLICK HERE TO READ MORE ABOUT HEALTHY COMMUNITIES ​ JFK Partners : Contact: 303-742-5266 ​ JFK promotes the independence, inclusion, contribution, health and well-being of people with special needs, through consumer, community, and university partnerships. ​ PEAK Parent Center : Colorado’s Parent Training & Info Center (PTI): Contact: 800-284-0251 ​ Provides information about all types of disabilities, training on a variety of topics and technical assistance on your child’s IEP. ​ Show and Tell: Contact: 303-632-6840 ​ Show and Tell empowers low-income, culturally diverse families to be advocates for their children with disabilities to achieve success in their schools and communities. ​ Single Entry Point (SEP) : Single Entry Point (SEP) Agencies provide case management, care planning, and make referrals to other resources for clients with the following qualifying needs: elderly, blind and disabled, mental health, persons living with AIDS, brain injury, spinal cord injury, children with a life-limiting illness, children with a physical disability. Coloado Agencies & Resources Disabiliy spcific Org Disability-Specific Organizations Ability Connection Colorado : Contact: 303-691-9339 ​ Autism Society of Colorado : Contact: 866-733-0794 ​ Brain Injury Association of Colorado : Contact: 800-955-2443 ​ Colorado School for the Deaf and Blind : Contact: 719-578-2100 ​ EMPOWER Colorado : Contact: 866-213-4631 ​ EMPOWER offers support, education, advocacy and resources to families with children and youth who have social, emotional or mental health challenges. ​ Epilepsy Foundation of Colorado : Contact: 888-378-9779 ​ Federation of Families for Children’s Mental Health | Colorado Chapter: Contact: 888-569-7500 ​ Learning Disability Association of Colorado : Contact: 303-894-0992 ​ Mile High Down Syndrome Association : Contact: 303-797-1699 ​ NAMI (National Alliance for the Mentally Ill) Colorado : Contact: 888-566-6264 ​ National Organization for Rare Disorders : Contact: 800-999-6673 ​ Unique (Rare Chromosome Disorder Support Group)

A few extras Additional Resources Connect for Health Colorado Assistance ​ ​ Family Voices is an official Assistance Site for families and individuals applying for coverage through the marketplace (also called the exchange), specializing in assisting families of children and youth with special health care needs. ​ Please visit http://www.connectforhealthco.com/ to learn more about the tools and options available there before calling us for assistance. ​ Si Ud. habla español, aquí puede encontrar información sobre el sitio en su idioma: C4HCO en español . Entendemos que el sitio entero debería ser traducido al español el 1 de octubre. ​ The Colorado Alliance for Health Equity and Practice (CAHEP) has translated two informational flyers about Connect for Health Colorado into several languages to better serve the diverse population of Colorado. You can access CAHEP’s assistance site here. ​ English: Connect for Health CO Basic Info-English Colorado Medicaid & Connect for Health CO Arabic: FactSheet-CAHEP-Arabic Flyer-Medicaid-CAHEP-Arabic Questionaire-CAHEP-Arabic Bhutanese: C4HCo-Bhutanese-Facts-v3 C4HCo-Butanese-CAHEP-Comparison-v3 C4HCo-Bhutanese-CAHEP-SurveyForm-v3 Chinese: C4HCoFacts-Chinese-v2 C4HCo-ComparisonFlyer-Chinese-v2 French: Factsheet-French-CAHEP-v2 Medicaid-French-CAHEP-v2 Korean: Factsheet-Korean Flyer-2-Korean (Hyun Moon)-Final

Quick Guides Fast Facts Information Sheets Fast Facts: Health first Colorado (Medicaid), CHP+, & Children's buy-in income limits View Download Fast Facts: Resources: Colorado Educational and Disability Specific View Download Fast Facts: Resources: State, County, and Disability Organizations View Download

Medicaid Buy-in Medicaid Buy-In for Children with Disabilities ​ What is the Children’s Me dicaid Buy-In? The Health First Colorado Buy-In Program for Children with Disabilities allows families who make too much to qualify for Health First Colorado (Colorado’s Medicaid Program)and Child Health Plan Plus (CHP+) to “buy into” Health First Colorado coverage for their child with a disability by paying a monthly premium based on the family’s income. Who Qualifies? Children age 19 and under, with a qualifying disability per the Social Security Administration (SSA) A determination of disability by the SSA is accepted as proof of disability Children not certified through the SSA can still be determined disabled by the State by completing the Health First Colorado Disability application Family income must be below 300% of Federal Poverty Level (FPL), after income disregards are calculated The Children’s Buy-In may be an option for: Families of children with disabilities who are over income or resources for other Medicaid programs or CHP+; children on a waitlist for a children’s waiver (other than the C-HCBS waiver; contact us to learn more about this); children who do not qualify for waiver services; children who do not have health insurance or who need coverage as a wrap-around to other insurance. ​ ​ Learn More: Read the full overview and Frequently Asked Questions from the Department of Health Care Policy and Financing (HCPF). Visit HCPF’s page about the Children’s Buy-In for all the details. Apply: Download the Medicaid Application for Medical Assistance and the Medicaid Disability Application (both are required). ​ Apply online through the Program Eligibility and Application Kit (PEAK) . Note that you will also need to complete and submit the disability application, linked above, on paper rather than online.buy in premium chart

About Us Who we are Overviw Overview of Family Voices Colorado Family Voices Colorado is a grassroots organization run by parents of children with special healthcare needs. The support you receive is from someone who understands the many challenges of having a child with special health care needs in their life. ​ Every day we give parents the information and knowledge they need to navigate complex health care systems in order to get things like wheelchairs, oxygen, or a surgery for their children. With our help, parents are able to be the heroes their children are counting on! Parents also receive the information about other systems they should access based on their child’s diagnosis and needs. ​ Family Voices CO works at the policy level to ensure children with special health care needs have a voice. We listen to the challenges from the family perspective, tracking trends, in order to create systems change. We monitor policy activities to ensure families receive the services they need. ​ Colorado’s health care systems – both public and private –are difficult for families to navigate . Family Voices CO understands both the private and public health systems. They also understand how the systems can work together. ​ Through working with Family Voices CO, parents are supported and empowered , resulting in stronger families and an increased ability to advocate effectively on behalf of their children. ​ Families of children with special healthcare needs often access multiple systems. Consequently, they experience the system barriers more quickly. Family Voices CO collaborates with the systems working to reduce the barriers through policy work and systems change. Family Voices CO promotes improved decision-making, better outcomes and higher quality services for all. F2F Heah info Center What is a Family-to-Family Information Center? Family-to-Family Health Information Centers (F2Fs) are family-led centers funded by the Health Resources and Services Administration (HRSA). There is one F2F in each state, in the District of Columbia, in five U.S. territories, and there are three F2Fs serving tribal communities. ​ Family Voices Colorado is the Family-to-Family Health Information Center for the State of Colorado. ​ Each F2F is staffed by highly-skilled, knowledgeable family members who have first-hand experience and understanding of the challenges faced by families of Children and Youth with Special Health Care Needs (CYSHCN). These uniquely qualified staff provide critical support to families caring for CYSHCN, particularly families of children with complex needs and those from diverse communities. ​ F2Fs also assist providers, state and federal agencies, legislators, and other stakeholders to better understand and serve CYSHCN and their families. How do Family-to-Family Health Information Centers Help? How Do F2Fs Help Families? ​ Each F2F provides free, 1:1 assistance to families, helping them: ​ • Find appropriate care and services • Apply for Medicaid, CHIP, or private insurance • Get referrals to providers • Address insurance denials • Identify and access community support programs • Advocate to ensure effective and cost-efficient care • Connect with parent mentors How Do F2Fs Help Providers and Systems? ​ F2Fs also work with health care professionals, hospitals, and public agencies to help them better meet the needs of CYSHCN and their families. They most often request assistance for: • Obtaining help for a patient/family • Addressing changes to state policies and programs • Learning about family experiences • Partnering to improve services Family Voices Colorado... Provides public awareness of the challenges and barriers of children and youth with special health care needs and their families Meet the Staff Meet the Team Christy Blakely Executive Director Katiah Scisum Administrator Corinne DePersis Family Navigator Megan Bowser Deputy Director Jamie Stefanski Family Navigator Family Navigator Malai Bernard Brenda Delgado Bilingual Family Navigator Jerrica Thurston Family Navigator Kayleigh Sheble Family Navigator Advisory Boar Family Voices Colorado Board of Directors Cordelia (Corry) Robinson Rosenberg PhD, RN Treasurer Professor Pediatrics and Psychiatry Todd Blakely President Parent Member Attorney Jim Brennan Parent Member Film Maker Lance Wheeland Legislative Aide Justin Gutierrez Parent Member VP of Home Health Agency Benny Mudiar Parent Member Professor

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Medicaid waivers Home and Community-Based Services Waivers What are Medicaid Waivers? A Home and Community-Based Services (HCBS) waiver is an extra set of Health First Colorado (Colorado's Medicaid program) benefits that you could qualify for in certain cases. These benefits can help you remain in your home and community. ​ Learn More: General Info on HCBS Waivers Adult Waivers Children's Waivers Flowchart for choosing a Children's Waiver Children's Waivers (Spanish) Flowchart for choosing an Adult Waiver

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