Admission and Retention Policy

Facilities may not admit or retain residents who are consistently, uncontrollably incontinent, unless the resident or staff are able to prevent it from becoming a health hazard; are totally bedridden with limited potential for improvement; are in need of 24- hour nursing or medical service; are in need of restraints; have a communicable disease; or have an acute substance abuse problem.

A facility may keep residents who become bedridden if:

(1) a physician describes the services needed to meet specified health needs;
(2) a licensed home health agency or hospice service ensures that physical, mental, and psychological needs are met; and
(3) adequate staff are trained in the needs of bedridden residents.

Residents may be allowed to receive hospice care if they are long-term residents, the facility can continue to meet the needs of the other residents, and staff are trained to provide hospice care that is not outside their scope of practice. Individuals requiring hospice care upon application for residency must not be admitted.

Residents must not be admitted to a secured environment unless legal authority for admitting them has been established. However, a resident may be voluntarily admitted or may remain in a secured environment if his or her egress is not restricted and his or her needs can be met by the facility as determined by an assessment.

Alternative care facilities (facilities with a Medicaid contract). These facilities may not admit, or retain past 30 days, any resident who:

(1) needs skilled services on more than an intermittent basis;
(2) is incapable of self-administering medication, and the facility does not administer medications;
(3) is consistently unwilling to take prescribed medication;
(4) is diagnosed with a substance abuse disorder and refuses appropriate treatment; (5) has an acute physical illness that cannot be managed through medications or prescribed therapy;
(6) has an uncontrolled seizure disorder;
(7) exhibits specified disruptive behaviors; or
(8) has physical limitations that require tray food service on a continuous basis.

Medication Provisions

The rules specify how drugs that are used to affect or modify behavior may be administered and how staff may assist residents who use oxygen. Staff may assist with medications used on an as-needed (PRN) basis if the resident is capable of requesting the medication and a licensed medical professional has documented instructions for appropriate use.

A “qualified medication administration person” (QMAP) is an employee who has passed a Department-approved medication training course given by a licensed nurse, physician, physician’s assistant, or pharmacist, and/or has passed an approved competency test for assisting with medications. QMAPs may administer prescribed and non-prescribed medications but may not prepare, draw, or administer medication in a syringe for injection into the blood stream or skin, including insulin pen type devices.

The Department maintains a current list of persons certified as QMAPs. Facility managers must keep a copy of the QMAP certificate in employee records. A QMAP must complete a competency evaluation every 5 years.

ALRs are encouraged to develop and disclose policies and procedures for residents’ use of medical marijuana. Alternative care facilities may not have policies for medical marijuana use because they receive federal funds.

Public Financing

The state provides services in ALRs–which are called alternative care facilities– under two Medicaid 1915(c) waiver programs that serve older adults, adults with physical disabilities, adults with HIV/AIDs, and people with mental illness: the Home and Community-Based Services Waiver for Community Mental Health Supports and the Elderly, Blind, and Disabled Waiver.

Room and Board Policy

In 2015, room and board charges for Medicaid beneficiaries residing in alternate care facilities are capped at $675 a month and residents are permitted to retain a personal needs allowance (PNA) of the difference between the cap and their income. For federal Supplemental Security Income (SSI) beneficiaries, the difference is $58.

In 2011, the state paid an optional state supplement of $551 to SSI recipients residing in ALFs.

In 2009, family supplementation was allowed to pay for items not covered by the Medicaid waiver program.

Information Sources

Ann Kokish
Colorado Health Care Association
Dee Reda
Colorado Department of Health

Michele Craig
Colorado Department of Health Care Policy and Financing

Caitlin Phillips
Alternative Care Facility Specialist
Long-Term Services and Supports Division Department of Health Care Policy and Financing