Imagine! The Future

As many of our stakeholders already know, Imagine! will be undergoing some significant changes in the near future due to the State of Colorado’s implementation of Case Management Redesign (CMRD).

The changes brought on by CMRD will have ripple effects across the entire Imagine! organization. Our goal throughout the process is to minimize disruptions in services and to ensure that we do all we can to continue our mission of creating a world of opportunity for all abilities.

To help us meet that goal, we pledge to share all the information we can about the process to help prepare all members of the Imagine! family – clients, families, employees, donors, and community members – for the new world of IDD services coming to our state.

To that end, this web page will serve as the central repository for information about the future of Imagine!. On this page, we will share success stories and victories and let you know what we’re excited about, while also acknowledging what we don’t know and what challenges we are facing. You are encouraged to bookmark the page and visit often.

You can also use this page to submit questions to Imagine!’s leadership about CMRD and other changes at Imagine! using the comment form at the bottom of this page. Comments and questions can be submitted anonymously if you prefer. Click here to jump to the form.

Change doesn’t need to be bad or scary. Together, we will come out on the other end of these changes stronger and more committed than ever to supporting the potential of all.


HCPF is hosting meetings bi-weekly with stakeholders to go through the rule changes they have proposed line by line.

  • Meeting calendar is available on HCPF Department website.
  • The purpose of the meetings is for the Department to update rules and regulations pertaining to HCBS waivers and non-waiver programs to come into alignment with new Case Management Redesign (CMRD) statute, policy, and language. Rule updates are required to clean up areas in existing rule and waivers that are repetitious, obsolete, or difficult to follow and understand. CMRD also implements changes to the rule structure. The vision behind the structure change is to make the HCBS rules easier to find, read and understand for all stakeholders.
  • Rules must be in effect no later than Nov. 1, 2023, at which point the first cohort of new Case Management Agencies under CMRD will transition
  • This is the new rule structure:

Have Questions? Click here to fill out the form and let us know!

We’ve answered a new question on our FAQ page:

There are so many acronyms around here. Is there a list somewhere that explains some of these, especially for those of us who are new to CMRD?

Yes, we have a link to a comprehensive list of acronyms here.

In addition, The State of Colorado’s Office of Community Living (OCL) has created this Acronym Glossary.

Have Questions? Click here to fill out the form and let us know!

Imagine! CEO, Dr. Kathryn Arbour, hosted a Leadership Town Hall today for Imagine! supervisors. Below are some bullet points on what to expect around CMRD for the next 2-3 months at Imagine!:

For Case Management work:

  • Focus on design and structure of the new Case Management Agency (CMA) (formed by joining case management operations, processes, histories, expertise of Adult Care Management, Inc. (ACMI) and Imagine!)
  • Complete financial feasibility studies with information currently available; adjust as new information regarding rates is released
  • Identify new name for CMA Prepare to respond to the CMA RFP by deadline (March 2023)

For Program Approved Service Agency (PASA) work:

  • Continue to learn about direct services at other Community Centered Boards (CCBs) and how they are considering the future
  • Continue to strengthen our current services offerings and mix

Have Questions? Click here to fill out the form and let us know!

The Colorado Department of Healthcare Policy and Financing is hosting a meeting tomorrow, Nov. 30, for CMRD Stakeholder Engagement. Information below.

CMRD Policy Updates

Case Management Redesign refers to several initiatives that will help make accessing long-term services and supports easier by changing case management agencies to serve all HCBS waivers so people have one place to go, making sure there are the right number of case management agencies in Colorado, and increasing the quality of case management services.

This is a statewide public meeting to provide updates to stakeholders on all aspects of CMRD and policy updates.

All interested stakeholders are welcome.

Nov. 30, 2022 9 - 11:30 a.m.

Join Online Meeting

ID: 873 9014 4539, Passcode: 597847 Join via Phone: 1-877-5257 (Toll-free)

CMRD Rule Revision Stakeholder Feedback Meeting Series

The Department will update rules and regulations pertaining to Home and Community-Based Services (HCBS) waivers and non-waiver programs to come into alignment with the new CMRD statute, policy and language. Rule updates are required to clean up areas in existing rule and waivers that are repetitious, obsolete or difficult to follow and understand. CMRD also implements changes to the rule structure. The vision behind the structure change is to make the HCBS rules easier to find, read and understand for all stakeholders. Rules must be in effect no later than Nov. 1, 2023, at which point the first cohort of new Case Management Agencies under CMRD will transition.

The Department wants to hear from stakeholders about each of the rule revision topics listed below to ask questions and receive feedback based on your knowledge and experience with navigating HCBS rules. The goal is to make these rule revisions work for all HCBS stakeholders. The Department will post the section of rule or waiver to be discussed on the CMRD webpage one week prior to each meeting. Stakeholder engagement, feedback and Department responses will be tracked through listening logs posted on the CMRD webpage.

Case Management Redesign (CMRD) Rule Revision Stakeholder Feedback Meeting Series Topics:

  • HCBS Waiver Program Eligibility Rules, Part 2
  • Case Manager Requirements
  • Case Manager Requirements & Client Rights and Responsibilities
  • Follow-Up Session for Case Management Rules
  • HCBS Benefits and Services Rules, Part 1
  • HCBS Benefits and Services Rules, Part 2
  • HCBS Benefits and Services Rules, Part 3
  • HCBS Provider Requirement Rules
  • Wrap-Up, Follow-Up and Next Steps

The meeting access information for all the CMRD meetings is the same:

Join via Zoom

Meeting ID: 873 9014 4539, Passcode: 597847

Join via Phone: 877 853 5257 (Toll-free)

Note: The 2022 meetings are posted on the OCL Stakeholder Engagement Calendar. You can copy them from the calendar to your individual calendar from there. The 2023 meetings below will be posted on the OCL calendar before the end of December 2022.

Have Questions? Click here to fill out the form and let us know!

Today we are excited to announce that, with the approval of our respective Boards of Directors, Imagine! and ACMI have signed a Letter of Intent to “…to join their case management expertise, experience, staff, operations, processes and certain assets to form a new case management agency serving Boulder, Broomfield, and Gilpin Counties for all disability waivers in a manner and timeline as defined by HCPF” in preparation for applying for the competitive bid to be released by the Colorado Department of Health Policy & Financing (HCPF) in order to serve as the Case Management Agency (CMA) for our catchment area.

This is an exciting development which we believe will strengthen both of our abilities to continue to build upon our combined 90-plus years of serving our communities. Stay tuned!

Have Questions? Click here to fill out the form and let us know!

We’ve answered some more questions for our FAQ page:

 

What happens to the Imagine! Foundation? Will they serve the CCB or the PASA?

It is likely all fundraising activities will be associated with the PASA in the Imagine! world post-CMRD implementation, although there are many considerations yet to be made. At the moment, our attorney is reviewing all of our legal entities, including the Foundation, reading through Articles of Incorporation and Bylaws to understand any particular legal considerations that must be taken into account as we plan the future. Stay tuned as we learn more and continue to study the possibilities.

 

Will Imagine! Case Management staff be able to view responses to the RFP?

We are deferring on responding to this question for the moment since we are still learning about the RFP process. We understand it to be a very competitive and proprietary process so undoubtedly there will be a level of care in sharing some of the specific responses pre-submission. There will be a collaborative process in preparing and vetting our responses to ensure accuracy, of course, but what that looks like right now is hard to define. Stay tuned for more information regarding all things RFP as we learn more.

 

When can Imagine! program managers begin meeting with the leadership team at ACMI?

The process is soon to include Case Management leadership from both agencies who will help define the work ahead and levels of engagement likely prior to submission of the RFP. Timelines for submission, post submission, and pre-implementation (assuming we win the RFP award) will be drawn up over the coming weeks and will include plans for engagement and ongoing communication.

Have Questions? Click here to fill out the form and let us know!

On November 4, Imagine! CEO Dr. Kathryn Arbour sent the following email to Imagine! staff members.

Hello,

As we focus on providing as much support for Imagine!’s direct services staff and clients as possible, and with the prospect of significant changes ahead driven by the conflict-free case management redesign (CMRD) mandate , I am happy to share news with you today about some promotions and related organizational changes. Our goals with these changes are to provide support to staff and continuity to our much needed client services for today AND to tackle and address any changes that may lay ahead for us and other CCBs and PASAs over the next year or so. Keeping our clients at the heart of all our work now and in the future will continue to be our best compass for navigating change!

To that end, we have created a single role, Chief Services Officer, to provide leadership across all direct service areas. Laurel Rochester, currently Imagine!’s Director of Residential, Therapeutic and Nursing Services, will take on this critical role in an interim capacity for several months. I am so grateful to Laurel for her willingness to provide the stability and array of talents we need at this time. We will post and hire for this new position, launching our search for a long-term Chief Services Officer soon.

To support Imagine!’s direct services programs and the Chief Services Officer, we have restructured to have three Assistant Directors. Kristin Halvorson will now be an Assistant Director overseeing Therapeutic Services, Family Recruited Employment and our School Age Services program. Brodie Schulze will now be the Assistant Director of Community Services, Employment Services and the Social Enterprise program. Both have provided excellent oversight, stability and support to staff most impacted by many recent changes. I offer sincere appreciation to them both on behalf of our organization for having shown such commitment to staff and clients.

We will be posting for the role of Assistant Director of Residential and Nursing Services shortly. As always, we encourage qualified internal candidates to apply for this position.

As with all organizational changes, we will invest time and talent to make transitions as smooth as possible. We also invite conversation, questions, and ideas as the process of the transition unfolds over the next few months. 

Thank you as always for the passion and commitment you bring every day to your work!

Warmly,

Kathryn

Have Questions? Click here to fill out the form and let us know!

On October 26, 2022, Barb Wilkins-Crowder, Executive Director of Adult Care Management, Inc. (ACMI), sent the following message to her staff members. The message is about how ACMI and Imagine! are engaging in the … “processes of creating formal agreements and establishing some initial designs about how we might bring our two agencies together as the new, post CMRD, single case management agency (CMA).” We thank Barb for letting us share her message here. For more information on this, see also Dr. Kathryn Arbour’s message to Imagine! employees in the October 26 update below.

Dear ACMI Team, The competitive bid cycle for our contract with HCPF is not new to many of you. In Colorado’s Single-Entry Point system, only 3-4 agencies have ever had to competitively bid on contracts. The majority have been assigned their work as branches of local, county governments (DHHS, Public Health, or County Nursing agencies). As a stand-alone, nonprofit agency, ACMI has had to bid for our contract every time RFPs have been published. Overall ACMI has written RFP responses about 8 - 10 times since its founding in 1986, and Barb has been part of the team writing those bids 5 – 6 times. Since our first bid to serve the Boulder, Clear Creek, and Gilpin area in 1994, we bid to add Broomfield County in 2001 and have successfully rebid to serve all 4 of those counties 4 times.

In the CCB (community-centered boards) world, the IDD waiver case management has been assigned to those agencies providing the CCB functions. The coverage area for some CCBs has mirrored that of the SEP, for others it has been different. The CCB in our area, Imagine!, has served the IDD community since 1963.

HCPF intends to issue an RFP in early 2023. The significant difference in this bid cycle is that due to Colorado’s case management redesign (CMRD) initiative: 1) counties have been reapportioned into new catchment areas; 2) all catchment areas will be rebid to award the work to a single case management agency in each area; and, 3) the winning CMA will serve all populations enrolled in all of Colorado’s long-term care Medicaid waivers. The area ACMI currently serves will be reduced in size as Clear Creek County has been reassigned to the catchment area with Jefferson and Summit counties.

That was all background to help me explain ACMI’s planned response to this RFP cycle. Given that ACMI and Imagine! both have extensive expertise, experience, and passion for providing high quality case management in our area, the Executive Leadership and Boards of Directors of both agencies have decided to combine our strengths and we are planning for a joint RFP response to ensure the most seamless transition to the CMRD-required, sole CMA, for our clients, our staffs, and our communities. We are in the processes of creating formal agreements and establishing some initial designs about how we might bring our two agencies together as the new, post CMRD, single case management agency (CMA).

Please know that the new CMA will be built on the expertise, experience and passion of the case managers, case aides, support staff, supervisors, administrators, and boards of both agencies. Winning the RFP bid comes first, then the transitions into a single agency will happen between the summer of 2023 and summer of 2024. The goal, as ACMI and Imagine! build this new agency, will always be to minimize disruptions to our clients, retain the expertise of our valued staff and stay true to our mission of supporting independence and choice for all disabilities.

You will have lots of opportunity to give input and hear about the plans as they are developed. For today, it is business as usual for everyone at both ACMI and Imagine!. We all have a dedication to this work and together we will continue to provide high quality case management even as we chart our way through these changes in Colorado’s long-term care system.

On we go,

Barb Wilkins-Crowder

Have Questions? Click here to fill out the form and let us know!

On October 26, Imagine! CEO Kathryn Arbour sent the email message below to Imagine! employees.

Hi, Everyone.

I am pleased to provide you with another important update regarding the statewide Case Management Redesign process (CMRD) currently underway. As we have explained previously, it has been the ongoing intent of Imagine! to apply for the competitive bid to be released by the Colorado Department of Health Policy & Financing (HCPF) in order to serve as the Case Management Agency (CMA) for our catchment area.

As we continue to explore the various approaches our organization can take as we consider the “conflict free case management” mandate, we have opened and pursued conversations with the case management organization currently servicing the five Medicaid waivers not served by Imagine! for Boulder and Broomfield counties. ACMI, located in Lafayette, has been the Single-Entry Point (SEP) awarded the contract for these Medicaid waivers in Colorado for over 30 years, and specifically in our catchment area for just over 25 years. Because ACMI and Imagine! currently are responsible for critical components of what will constitute the new case management agency (CMA) which will result from this process, it makes sense for our two organizations to come together to explore the ways we can join our expertise, experience and passion for ensuring clients have access to all the services they need to achieve their possibilities and potential. Our shared goal, as Imagine! and ACMI build this new agency, will always be to minimize disruptions to our clients, retain the expertise of our valued staff and stay true to our mission of creating a world of opportunities for all abilities.

A reminder that the current catchment area will expand to include Gilpin county in the future, which means the number of clients needing care coordination/case management and services will grow.

Our companies’ Boards of Directors have authorized me and the Executive Director of ACMI to sign initial agreements outlining our intentions to share information, including confidential and proprietary information, about each of our businesses, and to begin including key employees in assessing the feasibility of working together and establishing some initial designs about what joining forces might look like.

Imagine! will work closely with ACMI over these next two months to find a path for a joint submission to the RFP once it is released in January 2023.

We are excited and honored to be working alongside ACMI, an organization with a 30-year history of providing conflict-free case management to thousands of clients with disabilities throughout Colorado. As we clarify the opportunities for joining our organizations’ case management experience and expertise, we will update you and provide forums for more discussion.

For today, it is business as usual for everyone at Imagine!. We have critical work to do delivering case management expertise and an array of services to clients who rely on us to stay focused on them and their needs.

Thank you for your commitment to our important work and for all you do everyday.

Warmly,

Kathryn

Have Questions? Click here to fill out the form and let us know!

We have a couple new FAQs added to our FAQs:

How will the distribution of Mill Levy dollars look post-CMRD?

Boulder County controls how Mill Levy dollars are distributed. We are in discussion with the County, of course, about how their thinking is emerging regarding the future state of things with the changes being brought about separating case management agencies from PASAs. They do not have anything definitive regarding this topic, but commit to continue funding the IDD community with mill levy dollars. For mill levy funding for the calendar year 2023, we will be having the first of what is likely to be a few meetings with Boulder County in November regarding their priorities for the coming year and what format they are planning to use for our submission request. There have been no specific discussions on the various programs or positions currently funded partially by those mill levy dollars, only the overall topic.

Are there limits on how many regions an agency can bid on the RFP for?

The Colorado Department of Healthcare Policy and Financing (HCPF) has not specified a limit to how many “catchment areas” an entity can bid for. A reminder that HCPF has defined the new catchment areas for implementation of CMRD, and you can find the information memo released by HCPF and the map here. HCPF has further reiterated just in the past week that the bidding is “an open competitive process that will result in the Department selecting offerors ‘whose proposal is determined in writing to be the most advantageous to the state (C.R.S. §24-103-203(7)). HCPF said additionally that “this competitive process encourages proposals from all agency types and will result in the Department conducting a comprehensive, thorough, complete and impartial evaluation of each proposal received.”  

Have Questions? Click here to fill out the form and let us know!

On October 12, 2022, The Colorado Department of Healthcare Policy and Financing (HCPF) sent a message to CCBs, CEPs and private case management agencies, including Imagine!, saying the Department “has made the decision to pause the work being conducted by Health Management Associates (HMA) effective October 15, 2022 and will resume that work after the RFP proposal submission deadline has concluded on approximately March 1, 2023. The Department will be sending out additional communication regarding the current work underway with HMA in the coming weeks.”  There were no additional explanations offered in that communication.  What it means from a practical standpoint is that the work we had been doing with our transition coach on assignment from Heath Management Associates (HMA) is suspended until after the RFP submission period has passed.   We will keep you posted on any additional information from HCPF as it is made available.

Have Questions? Click here to fill out the form and let us know!

Recently, Imagine! CEO Kathryn Arbour sat down with members of our leadership team to discuss the future of Imagine! in light of CMRD. Below are some key takeaways from her presentation.

How does CMRD impact Imagine!?

Currently, Imagine! provides both service coordination (case management) and direct services. After July 2024, we will no longer be able to do this. There must be a complete separation.

Therefore, Imagine! has made the following decisions:

  • Imagine!’s Direct Services, which includes Residential Services, Employment Services, School Age Services, Adult Community Services, Mental and Behavioral Health Services, Imagine!'s Social Enterprise, and Family Recruited Employee Services, will take the name Imagine! and serve as a Program Approved Service Agency (PASA).
  • Imagine! will respond to the Request for Proposal (RFP) from Colorado to serve as the Case Management Agency (CMA) for our catchment area (catchment area is the geographical area of service).
  • If Imagine! is awarded the contract to serve as the CMA for our catchment area, the CMA will take on a new name and provide case management services to individuals who have intellectual or developmental disabilities (IDD) on the following waivers: Developmental Disabilities waiver, Supported Living Services waiver, Children’s Extensive Support waiver, as well as for individuals on the following waivers: Brain Injury waiver, Community Mental Health Supports waiver, Elderly, Blind and Disabled waiver, Spinal Cord Injury waiver, Children’s Home and Community Services waiver, and Children with Life Limiting Illness waiver.

If Imagine! is awarded the contract to serve as the CMA for our catchment area, our organization is likely to resemble the visualization below post-CMRD:

What steps is Imagine! taking in preparation for responding to the RFP to serve as the CMA?

Imagine! is currently (as of Oct. 11, 2022) engaging in due diligence for how best to respond to the RFP, including:

  • Exploring potential partnerships
  • Vetting viability of options through legal, financial, cultural lenses
  • Working with a transition coach and an attorney to explore viable organizational structures

Are there any details to share regarding where Imagine! Early Intervention (EI) services and coordination components will land with the future given the mandate to separate Case Management services from PASA services?

EI is under the direction of the Colorado Department of Early Childhood (CDEC -a newly created department in Colorado) and not Health Care Policy & Financing (HCPF) and Medicaid waivers, so how we plan for the future of EI is not dictated by the CMRD conflict-free mandate as defined in Colorado.

Additional resources:

The Colorado Department of Healthcare Policy and Financing has created a web page full of information and resources regarding CMRD

Check out this brief history of CMRD.

Have Questions? Click here to fill out the form and let us know!