Streamlining Assessments with a Third-Party Nurse Assessor
The core of this new initiative is the introduction of a third-party nurse assessor. This independent professional will conduct comprehensive assessments, eliminating potential conflicts of interest and ensuring objectivity in determining the appropriate level of care. The nurse assessor will also educate members on available service options, empowering them to make informed decisions about their care. This single, holistic assessment will replace multiple assessments previously required for different service modalities like Private Duty Nursing (PDN) and Long-Term Home Health (LTHH), reducing redundancy and improving efficiency.
The Skilled Care Acuity Assessment: A Standardized Tool
Central to the new process is the Skilled Care Acuity Assessment, a clinically reliable and validated tool designed to determine the appropriate level and duration of care for individuals requiring skilled services. The third-party nurse assessor will utilize a digitized version of this tool, ensuring consistency and accuracy in assessments across the state. This standardized approach addresses the need for a uniform and dependable method of evaluating skilled care needs, a need identified by HCPF and its stakeholders.
Development of the Acuity Tool
The development of this acuity tool has been a multi-year process. Following a budget request in FY 2019-20 (R-9) for a Long-Term Home Health/Private Duty Nursing Acuity Tool, HCPF conducted an environmental scan of other states’ approaches. Unable to find a suitable existing tool, HCPF determined the need to build a new assessment from scratch. Funding from the American Rescue Plan Act (ARPA) through Initiative 6.01 (October 2021 – September 2024) finally enabled the development and implementation of this critical tool.
Implementation and Alignment with LTHH PAR Requirements
The rollout of the new acuity tool and third-party nurse assessor program is scheduled for July 1, 2025. This implementation will coincide with the reinstatement of Long-Term Home Health (LTHH) Prior Authorization Requests (PAR) requirements. This coordinated approach ensures a comprehensive and integrated system for accessing and managing skilled care services in Colorado.
Conclusion: Improving Access to Quality Long-Term Care
The implementation of the acuity tool for long term care represents a significant step towards ensuring individuals receive the appropriate level of skilled care services. By utilizing a standardized assessment tool and independent nurse assessors, Colorado aims to improve efficiency, transparency, and member experience within the long-term care system. This new program promises to enhance the delivery of skilled care services and empower individuals to make informed choices about their healthcare needs.
