Rules and Regulation Development
We collaborate with state officials to streamline rules and regulations, creating a clear framework that guides program development rather than hindering it.
We have extensive experience reviewing, analyzing, and writing rules and regulations and can help states develop regulations that make it easier to operate programs and help to level the playing field. This experience includes assisting the Colorado Department of Health Care Policy and Financing (HCPF) completely overhaul their rules for their HCBS waivers. The new structure integrates and organizes the rules by their intended audience: a rights and responsibilities section targeted towards participants; a section on case management requirements and activities guiding the work of the case management agencies; and a provider and service qualifications section aimed at direct service providers.
While rules and regulations are intended to guide how programs work, program participants, providers, advocates and state and local staff often find them to be opaque and unclear. This is understandable given that regulations are typically developed incrementally with new regulatory text being layered on top of existing text. New providers struggle to figure out how to comply with regulations, state staff take years to develop a comprehensive understanding of the regulations, and participants have more challenge advocating for specific changes.
We pay special attention to how to apply rules within larger system automation efforts. States’ efforts to automate assessment and case management activities typically start by identifying specific business rules that are incorporated into systems requirements. These business rules are often driven by the published rules and regulations. Automation efforts often go wrong when the systems requirements require a lot of custom coding (customization) of systems which increase costs, delays timelines, and leads to automation that is more fragile. We encourage states to balance the desire to automate rules with the realities of how automation efforts work. In some cases, this involves rethinking rules to reflect the capabilities and limitations of these automated systems.
