Right to An Assessment

Section: Case Management Agency (CMA)
Created: 02/25/2024
Revised:
Effective: 03/01/2024

Policy

It is the policy of Weld County CMA (WCCMA) to ensure that all Members and Individuals receive fair, respectful, and dignified treatment during the intake, screening, and assessment processes for Long-Term Support Services (LTSS) programs. In accordance with federal mandates and state regulations, WCCMA will conduct Level of Care Screens and Assessments upon request by a Member or Individual, regardless of preliminary eligibility determinations by staff.

Scope

This policy applies to all WCCMA staff.

Contract Section(s)

Not applicable.

Relevant Rule(s)

8.7201.K.1.e: Case Management Agencies shall complete a Level of Care Screen when it is requested by the Member or Individual in accordance with Member rights, even if Case Management Agency staff does not believe the Individual will be deemed eligible.

8.7001.C.1.k. Members and other Individuals have the right to request that an Assessment be completed even if the intake Case Management Agency staff determines otherwise. If an Assessment is requested, the Case Management Agency must complete it.

Procedures

  1. Training and Open Communication

    Primary Procedure: Staff training emphasizes the importance of person-centered approaches, ensuring that all communication is open, supportive, and encourages applicants to freely request information, assessments, referrals, and LTSS services and supports. Training covers:

    • The rights of Members and Individuals to request a Level of Care Screen and Assessment.
    • Techniques for maintaining a welcoming and easeful communication atmosphere.
    • The significance of offering dignity, compassion, and respect from the initial contact.
  2. Request and Assessment Process

    Assessment Upon Request: Regardless of initial screening outcomes that suggest a Member may not qualify for LTSS programs based on Level of Care or Target criteria, WCCMA staff shall:

    • Explain the right to request an assessment despite the phone screen's outcome.
    • Perform the requested Assessment impartially, without any attempt to influence the Individual's decision or deter them from exercising their right to this process and access to the program, regardless of the initial screening outcome.
    • Clearly inform all of program applicants of their appeal rights and WCCMA's complaint procedure, both verbally and in writing, irrespective of the outcome of the state's assessment for LTSS program eligibility.

Complaint Procedure

WCCMA has established a comprehensive complaint procedure to address any violations of access requirements by WCCMA staff. This procedure provides clear steps and methods for Members to file complaints, ensuring accountability and continuous improvement in service delivery. The complaint procedure includes:

  • Contact Information: Detailed contact information for filing complaints, including phone numbers, email addresses, and postal addresses.
  • Step-by-Step Guide: A clear, step-by-step process for filing a complaint, including whom to contact first, how to describe the issue, and what information to provide.
  • Resolution Process: An outline of the process WCCMA will follow to investigate and resolve complaints, including timelines and communication with the complainant.
  • Confidentiality: Assurance that all complaints will be handled with confidentiality and respect for the privacy of all parties involved.

Training

  • Mandatory Training: All employees, whether new hires or current staff, must complete mandatory training within 120 days of their employment start date. Supervisors oversee this process, ensuring no staff Member undertakes independent work until they have fulfilled all mandatory training requirements
  • Ongoing Education: Refresher training sessions are scheduled as per contractual obligations and on an as-needed basis.

Compliance Monitoring

  • Feedback Mechanism: The complaint procedure offers a feedback mechanism for Members, family members, legal guardians, and others to report concerns and failures to preserve rights. It includes a complaint escalation plan with contact information for the Health Care Policy and Financing (HCPF).
  • Corrective Action: In cases of non-compliance, immediate corrective action will be taken to address and rectify the issue.

Policy Review

This policy will be updated as needed based on feedback and changes to contractual and regulatory requirements.

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