Tracking #2006-01235

I:/0608241.rtf
[I:/06082401.doc]

(12 CCR 2512-2)

Instructions: [Insert before line 986704.]
Revision of Section 12.540 and addition of Section 12.541 were final adoption following publication at the 1/5/2007 State Board meeting, with an effective date of 3/1/2007 (Rule-making# 06-8-24-1). Statement of Basis and Purpose and specific statutory authority for these revisions were incorporated by reference into the rule. These materials are available for review by the public during normal working hours at the Colorado Department of Human Services, Office of Performance Improvement, Boards and Commissions Office, State Board Administration.
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Instructions: [Replace lines 987076 through 987093.]
12.540  SERVICES [Rev. eff. 3/1/07]
Contractors  shall  provide program services.  Contractors may sub-contract with service providers, with the approval of the Department.
All program participants who receive program services shall receive care coordination services.
A.  Additional client services may be provided as program funds permit. Program services may include, but are not limited to:
1.  Community residential services;
2.  Structured day program services;
3.  Psychological and mental health services for the individual with the traumatic brain injury and the individual's family;
4.  Prevocational services;
5.  Supported employment;
6.  Companion services;
7.  Respite care;
8.  Occupational therapy;
9.  Speech and language therapy;
10.  Cognitive rehabilitation;
11.  Physical rehabilitation; and,
12.  One-time home modifications.
B.  Program services shall not include institutionalization, hospitalization, or medications.
C.  Program services shall only be provided, as necessary, for a period of one year from the date services begin.
Effective March 1, 2007, a program participant may only receive program services for a total of one year during his or her lifetime, except that:
1.  Any services received prior to March 1, 2007, shall not count against the lifetime service limit; and, 
2.  A program participant who is receiving program services as of March 1, 2007, may complete his or her current year of services and those services shall not count against the lifetime service limit. The participant may subsequently apply for one more year of services.
D.  Contractors shall provide program services. Contractors may sub-contract with service providers, with approval of the department.
The contractor providing care coordination services shall cooperatively develop a written transition plan with each program participant prior to the time the participant reaches his or her lifetime service limit. The transition plan shall identify the participant’s needs for further services and support, and the resources that are available in participant’s community to assist in meeting his or her identified needs.
12.541  Case Closure  [Eff. 3/1/07]
Care coordination agencies shall establish and publish written guidelines for closing cases. These guidelines shall respect and accommodate the cognitive and behavioral challenges following traumatic brain injury. Program participants shall be treated sensitively and fairly in any case closure discussions and decisions.
A.  The Traumatic Brain Injury Board shall approve the written guidelines for closing cases. 
B.  A case may be closed when a program participant: 
1.  Has met his or her goals and elects to discontinue services;
2.  Has moved out of state;
3.  Cannot be located by the care coordination agency after at least six attempts have been made over a period of at least two months;
4.  Has been institutionalized under circumstances which preclude delivery of services for at least six months;
5.  Has been non-cooperative with, or abusive of, the care coordination agency staff and/or service providers to the extent that services cannot be delivered; or, 
6.  Has died.
In the absence of one of the above criteria, a case may not be closed solely because a program participant exhibits behavior that is caused by his or her traumatic brain injury, such as forgetting scheduled appointments or difficulties communicating with the care coordinator.
C.  When a case is closed, the program participant shall be provided written notification of this action, and of his or her appeal rights and the process of how to appeal.