Colorado Single Assessment (CSA) and Level of Care Determination

What the Colorado Single Assessment Replaces

Colorado is transitioning from multiple legacy evaluation tools to one unified instrument: the Colorado Single Assessment (CSA). Before the CSA, different waivers used different assessment tools — the Supports Intensity Scale (SIS) for developmental disability waivers, separate functional screens for other HCBS programs — creating inconsistencies in how support needs were measured and how service budgets were authorized.

The CSA creates a single comprehensive profile of a member's medical, functional, and support needs, used across all HCBS waiver programs administered by the Department of Health Care Policy and Financing (HCPF). Your Case Management Agency conducts the assessment.

The ISLA for New Members

Adults newly enrolling in waivers don't receive the full CSA immediately. Instead, HCPF uses the Interim Support Level Assessment (ISLA) — a subset of functional questions drawn from the CSA. The ISLA applies a new algorithm to assign a Support Level, which determines the individual's authorized service budget.

The Support Level is the number that matters. It dictates how many hours of services your family member can receive, what the annual service budget looks like, and which services can be authorized within the Person-Centered Support Plan (PCSP).

Members with established Support Levels derived from the legacy SIS remain at their current level unless a formal Support Level Review (SLR) is requested due to a change in condition. You don't need to worry about being reassessed under the new tool unless your CMA initiates it or you request a change.

The Developmental Disability Determination

For SLS or DD waiver enrollment, the individual needs a developmental disability (DD) determination. Other HCBS programs use their own applicable eligibility pathway. In Colorado, a developmental disability is defined as a disability that:

• Manifested before age 22
• Is attributable to an intellectual disability, cerebral palsy, epilepsy, autism, or another neurological condition closely related to intellectual disability
• Results in substantial functional limitations in three or more areas of major life activity (self-care, language, learning, mobility, self-direction, capacity for independent living, economic self-sufficiency)

The CMA conducts this determination. You'll need to provide documentation: psychological evaluations, adaptive behavior assessments (Vineland, ABAS), school records, and clinical history. The stronger and more recent the documentation, the smoother the determination goes.

Contact your CMA to begin this process at age 14 — it establishes your child's placement date on the DD waiver waiting list, and that date is calculated from the DD determination or the 14th birthday, whichever is later.

What Happens During the Level-of-Care Screen

For SLS or DD waiver applicants, your CMA completes a functional level-of-care screen to establish that the individual needs an institutional level of support. This is the eligibility gateway for both the SLS and DD waivers. The Community First Choice (CFC) state plan benefit also requires a level-of-care screen through its applicable pathway.

The screen evaluates functional needs across domains: self-care, communication, mobility, behavioral support, medical complexity, and supervision requirements. The goal is to determine whether the individual would, without community-based services, require placement in an intermediate care facility (ICF).

Most adults with developmental disabilities who have substantial functional limitations meet this threshold. The screen isn't designed to be restrictive — it's confirming that the person genuinely needs the services the waiver provides.

County Human Services and Medicaid Eligibility

Your county Department of Human Services handles the financial side of Medicaid eligibility, separate from the CMA's functional assessments. This includes:

• Processing the Health First Colorado (Medicaid) application through Colorado PEAK
• Verifying income and resource limits for the appropriate eligibility category
• Processing the WAwD (Medicaid Buy-In) enrollment for working adults
• Running the state-level disability determination through the HCPF disability vendor, if no federal SSA determination exists

The CMA determines functional eligibility and develops the service plan. The county determines financial eligibility and maintains the Medicaid enrollment. They're separate tracks that must both complete for waiver services to begin.

When Your Support Level Is Wrong

If the ISLA assigns a Support Level that doesn't reflect your family member's actual needs, you have the right to request a formal Support Level Review (SLR). This is a documented process, not an informal complaint:

1. Notify your CMA case manager that you're requesting an SLR, citing the specific areas where the assessed level doesn't match functional needs.
2. Provide updated documentation — recent medical records, behavioral assessments, or evidence of changed condition that supports a higher level.
3. The CMA submits the SLR to HCPF for review. The review evaluates whether the algorithm's output aligns with the documented support needs.

You can also request a state fair hearing if you disagree with the CMA's service plan or the support level determination. The hearing is an administrative process through HCPF where an independent hearing officer reviews the evidence.

Don't accept a support level that doesn't fit. The assigned level directly controls your family member's service budget. An incorrect assessment compounds over every year it remains uncorrected — the annual plan is built on it, and services that aren't authorized can't be delivered.

Pulling It All Together

The assessment and determination process has multiple moving parts — DD determination, functional screen, financial eligibility, ISLA, support level assignment — and each depends on documentation quality and CMA responsiveness.

The Colorado SSI at 18 & Adult Disability Benefits Guide includes a document inventory checklist and CMA intake tracker that organizes the specific forms, evaluations, and records needed for each step. Having the right documentation ready before your CMA appointment saves the most common delay: being sent home to gather records and losing your place in the intake queue.

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