The Colorado Department of Health Care Policy & Financing on Nov. 6 held a virtual stakeholder meeting to gather feedback on proposed regulatory language that would redefine Individual Residential Services and Supports (IRSS) into two setting types — a “staffed home,” in which staff do not reside with the member, and a “host home,” in which the primary caregiver does live with the member. Cassandra Keller, Community Options Benefits Section Manager at HCPF, said the department is seeking comments only on the proposed definition and that the broader rate alignment effort is moving forward and is not reversible.

Why this matters: HCPF staff said the change aims to clarify billing and reimbursement between settings with different operational costs and to contribute to closing a roughly $1,000,000,000 fiscal shortfall cited by the department. HCPF told stakeholders it will keep negotiated individualized rates for members assessed as SIS (Supports Intensity Scale) level 7, but parents and providers warned that the rule language as written could reduce funds available to family caregivers, create coverage gaps for people with high support needs and raise legal concerns about choice and integration under Olmstead guidance.

HCPF’s proposal and staff explanation
Cassandra Keller and Victoria Rogers, HCPF residential benefits specialist, presented draft regulatory language that distinguishes staffed homes — where residential habilitation is provided primarily by employer/contractor staff who do not live in the residence — from host homes, where the primary caregiver resides with the member. Keller said the department’s intent is to make clear when a higher per‑diem staffed IRSS rate applies versus a host‑home rate, and to reduce billing confusion that HCPF staff said has arisen from inconsistent communication.

Keller told participants that HCPF had received 69 survey responses so far and that staff will revise the draft definition based on stakeholder feedback, publish the changes and convene another stakeholder meeting on Nov. 20 to review revisions. She said negotiated level‑7 rates will remain in place and that the rate alignment itself will proceed.

Concerns raised by parents and providers
Speakers who identified themselves as family caregivers, parents of people with intellectual and developmental disabilities, and representatives of provider agencies expressed several recurring concerns:
- Reduced pay and minimum wage risk: Multiple parents said the proposed staffed‑home reimbursements would not cover paying staff at local minimum wage for 24‑hour coverage. “A staffed home at the current IRSS rate would not even pay anywhere near minimum wage for 24 hours,” said Pat Chamberlain, a family caregiver. Participants also asked why Denver rates differ from non‑Denver rates; HCPF staff said the Denver difference reflects Denver’s higher local minimum wage.
- Loss of choice and Olmstead implications: Nicole Villas, who identified herself as a family caregiver, argued the proposal “violates the Olmstead final settings” and could force people into less‑integrated placements or institutional care if family caregivers’ funding is reduced.
- Gaps for high‑need members and hybrid arrangements: Parents of members with SIS level‑6 and level‑7 needs described 24‑hour line‑of‑sight care they provide and said many cases are hybrid — combining family caregiving with intermittent in‑home staff. “People don’t fit in nice pretty boxes,” said Megan Bowser, a commenter. Participants asked how HCPF will classify and reimburse hybrid situations and whether there should be a third tier.
- Process and documentation concerns: Julie Ryskin of the Colorado Cross Disability Coalition criticized the stakeholder process and survey format as insufficient for substantive input. Several speakers noted that HCPF has used multiple draft definitions in different documents and asked that the department align and publish a single clear proposed rule text.

HCPF responses and next steps
Keller and Rogers repeatedly said they welcomed feedback on the draft definition language and will revise the rule text based on comments entered via HCPF’s IRSS survey and the stakeholder meeting. Keller reiterated that the rate alignment effort itself will proceed and that negotiated SIS level‑7 reimbursement will not be eliminated. HCPF staff provided one data point requested by participants: “We have approximately around 4,000 individuals who reside in host homes,” Keller said.

Several staff replies addressed specific questions: the department said staffed and host home distinctions would remain across the same six support levels (with Denver and non‑Denver differentials) and that negotiated individualized rates (for example, SIS level‑7 negotiated rates) will continue. HCPF staff also said agencies operating staffed homes would be expected to maintain backup staff to cover absences and offered to clarify the policy materials and flow charts that participants found confusing.

What participants asked HCPF to change
Participants asked HCPF to:
- Remove language that appears to exclude family caregivers from host‑home definitions when draft text uses “unrelated” or a 75% occupancy test.
- Clarify how hybrid care arrangements would be assessed and reimbursed, or add a middle tier for hybrid cases.
- Publish consistent draft rule language and a survey format that allows substantive written comments.
- Consider reassessing SIS levels for some family caregivers (for example, approving more SIS level‑7 assessments) to allow negotiated higher reimbursement in cases of very high need.

No formal vote or regulatory decision was taken at the meeting. HCPF said it will compile survey results and stakeholder feedback, publish a revised definition ahead of the next meeting and discuss further on Nov. 20 from 11 a.m. to 12 p.m.

Ending
HCPF staff closed by encouraging attendees to submit written comments through the IRSS survey and to send specific questions to the agency’s HCBS questions inbox. The department said it will publish the revised draft definition and a summary of public feedback before the next stakeholder meeting on Nov. 20.