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County Incentives Program
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| FY17-18 County Incentives Program |
Updates!
The County Incentives Program Guide and related documents can be found on the
County Administration website.
Collaboration Incentives Deliverables for Reporting Period 1 (July - December 2017) are due January 5, 2018
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Updates to the Approved Training List and the FAQs will occur before January 1, 2018.
As soon as these updates are complete, the County Relations team will send notice out to county contacts.
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FY 2017-18 County Grant Program
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Reminder!
For counties that have projects that were approved through the FY 2017-18 County Grant Program, your Quarterly Check In for the second quarter of 2017-18 will occur in December.
The Quarter 2 Check In Matrix is due one week from the county's scheduled conference call.
Quarter 3 check ins will be site visits. These visits will be scheduled in January and the site visits will take place in March.
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Quick Links and Resources
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Medicaid and CHP+ Rules and Guidance
Volume 8 - Rules - direct link to Secretary of State
HCPF Forms and Rules
HCPF Agency and Directors Letters
HCPF FAQs and Training
HCPF County Relations
CBMS Enhancement Sheets - Governor's Office of Information Technology (OIT)
Staff Development Center (SDC)
Training Calendar
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Welcome to the December 2017 edition of County Connections!
The content in this newsletter is designed to inform county directors, management and staff in areas such as county performance, process improvement, collaboration, policy updates, upcoming due dates and more.
Please feel free to share
County Connections
with your colleagues by selecting
forward this email
at the bottom of this page.
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Breaking News - Policy and Process Updates |
County Connections Survey
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The County Relations team wants to know how we can improve your experience with the monthly releases of
County Connections.
The survey will be open until
January 31, 2018.
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Co-Payment Increase for Health First Colorado Members Effective January 1, 2018
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In accordance with
SB17-267, the Department plans to change the following co-payment policies effective January 1, 2018 for Health First Colorado Members:
| Service |
Dates of service on and prior to December 31, 2017
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Dates of service on and after January 1, 2018
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| Outpatient hospital visit |
$3 |
$4 |
| Outpatient hospital non-emergent emergency room visit |
$3 |
$6 |
| Generic drug* |
$1 |
$3 |
*Changes apply to all new and refill prescriptions.
Providers can find additional information on the co-payment changes at CO.gov/HCPF/InterChange-Resources or in the December Special Provider Bulletin.
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Tobacco Cessation Medications Now Available Without a Co-pay
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Health First Colorado will no longer require a co-pay for tobacco cessation medications. A prior authorization request (PAR) must be submitted in most instances for over the counter and prescription medications.
Health First Colorado providers can prescribe any of the seven FDA-approved nicotine replacement therapy and non-nicotine containing medications, all of which are on the Medicaid formulary and available to any Health First Colorado member at participating local pharmacies:
- Nicotine patch, nicotine gum, nicotine lozenge,nicotine nasal spray, and nicotineinhaler.
- Bupropion SR tablets (generic of Zyban) andVarenicline Tartrate tablets (generic ofChantix). This product will be co-pay exempt when a diagnosis code for smoking cessation is on the incoming claim (ICD10 Disease Group=F17 ; ICD10 Code Z87.891, Z72.0).
Health First Colorado covers tobacco cessation counseling services for members who smoke or are at risk of smoking, also without co-pay.
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Future of Child Health Plan
Plus
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Child Health Plan Plus (CHP+) Update: Gov. Hickenlooper Request
As you may be aware, if Congress does not renew federal funding, CHP+ in Colorado will end on January 31, 2018. Congress can pass a law at any time to renew federal funding for CHP+, but there is no guarantee that they will.
As of today, there are no changes to CHP+ benefits, eligibility or enrollment.
On December 19, 2017, Gov. John Hickenlooper requested one-time, short-term funding from the Joint Budget Committee to extend funding of Colorado's Child Health Plan Plus (CHP+) through February 2018. Currently the CHP+ program has funding to last until January 31, 2018, if Congress does not act to renew federal funding by that time. The Joint Budget Committee has not yet acted on the Governor's request.
More information on the Governor's request.
Webinars Online Now
The Department, Connect for Health Colorado and Division of Insurance hosted two informational webinars in December with more than 500 participants. The purpose of the webinars was to provide policy and operational information to our partners regarding the possible end to CHP+. The recorded webinars and slides are now available online.
- December 12, 2017 Provider & CHP+ Managed Care Organization Slides.
- December 13, 2017 Stakeholder, Advocate, County and Eligibility Partner Slides
County CBMS users can get Training Incentive credits for watching the December 13, 2017 webinar. After watching the webinar, go to the Learning Management system and choose "Add External Training." E-mail the County Relations team at
[email protected]
if you need instructions.
The Department will update our current FAQs on
CO.gov/HCPF/FutureCHPwith questions from the webinar on a rolling basis.
FAQs Available Online Now
The Department has published frequently asked questions (FAQs) on
CO.gov/HCPF/FutureCHP. Below is a sampling of some of the FAQs:
- What will happen if Congress renews federal funding for CHP+ after members receive the termination notice in late December, but before the program ends on January 31, 2018? Will members need to reapply?
- Members with a February 1, 2018 renewal date, will start receiving redetermination (RRR) letters around December 1. Should they still respond with any changes or requested documents?
- When is the last day CHP+ members can submit a redetermination letter?
- Should eligibility sites still process applications, redeterminations, and changes for CHP+ members after January 31, 2018?
- Will the enrollment fee for CHP+ be prorated?
- Will the eligibility system (CBMS) automatically check to see if CHP+ members qualify for financial assistance to purchase private health insurance through Connect for Health Colorado?
Resources
- Talking Points for County and Eligibility Partner Staff and Member Facing Call Centers
- Outbound Call Talking Points for Outreach
- CHP+ Member and Applicant Frequently Asked Questions
- Social Media Posts
- Phone Hold Message
- Website, Member Portal or App Message
- ...and more!
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New Requirements for Prescription Payments
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Implementation of the Ordering, Prescribing and Rendering (OPR) Provider Enrollment Requirement
Effective January 1, 2018, the Department will be enforcing the following two rules:
- 42 CFR 455.410(b) which provides that Medicaid must require all ordering or referring physicians or other professionals providing services be enrolled as providers.
- 42 CFR 455.440, which provides that Medicaid must require all claims for the payment of items and services that were ordered, referred, and prescribed to include the National Provider Identifier (NPI) of the ordering, referring or prescribing physician or other professional.
The Department will not pay for new prescriptions written on or after 01/01/2018 if the prescriber is not enrolled with Colorado Medicaid. Refills written prior to 01/01/2018 by unenrolled prescribers will pay until the prescription expires or until there are no remaining refills. Prior Authorizations requested by unenrolled prescribers will not be processed by the call center beginning 01/01/18.
If a prescriber does not wish to enroll with Colorado Medicaid they should begin referring their patients to a prescriber that is enrolled. Patients needing new prescriptions for their medications written on or after 01/01/18 must be written by an enrolled prescriber for Colorado Medicaid to pay for and process the claims.
Pharmacy staff members can identify prescriptions filled by an unenrolled prescriber with a current message that is sent back on the pharmacy claim that says, "On 1/01/18 claim denies- MD not enrolled, call DXC to enroll". Beginning 01/01/18 the message will read, "Prescriber not enrolled. Call DXC at 844-235-2387 to enroll".
The Department has been identifying and making direct calls to these providers since October 2016, has sent many faxes to pharmacies about the implementation and has been noticing pharmacies via the claim message referenced above.
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October/November 2017 Caseload Changes
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The Department has received many questions about a significant drop in the Health First Colorado caseload in October and November 2017. For the most part, the drop in caseload is related to the March 2017 system updates that required the member to take an action to verify their income. Below are some contributing factors:
- Member did not respond to the income verification request at the time of their redetermination.
- Member's reported income did not match the IEVS reported income and member did not respond to request for verification.
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Reminder: Medicaid Eligibility Inbox
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| The Medicaid Inbox assists counties and partner agencies with policy questions related to general program eligibility. As a reminder, [email protected] is for internal use only for counties, MA sites, and related agencies. Please do not share this email address with clients. Thank you.
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Accountable Care Collaborative Phase II Update
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The next phase of the Accountable Care Collaborative (ACC) seeks to leverage the proven successes of Health First Colorado's (Colorado Medicaid's program) programs to enhance the member and provider experience. The goals of the next phase are to improve health and life outcomes of members while using state resources wisely. Learn more here.
The Department is pleased to announce the protest period associated with the Request for Proposal for the Regional Accountable Entities (RAEs) for the next iteration of the Accountable Care Collaborative (ACC) has ended. The entities listed below will be awarded contracts.
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Region
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Entity
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1
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Rocky Mountain Health Plans
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2
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Northeast Health Partners
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3
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Colorado Access
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4
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Health Colorado, Inc.
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5
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Colorado Access
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6
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CO Community Health Alliance
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7
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CO Community Health Alliance
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The Department has made available online the proposals from each of the awarded entities on CO.gov/HCPF/ACCPhase2.
The Department continues to prepare for the implementation of the next phase of the ACC and will be immediately focusing on contract negotiations with the new vendors. After the beginning of the new year, the Department will begin sharing more detailed information and plans to help providers and stakeholders prepare for the program transition. Below are the major implementation milestones.
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Colorado's Health IT Roadmap Update & Survey
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Colorado's Health IT Roadmap- a 16 month-long collaborative effort led by the Office of eHealth Innovation (OeHI) and steered by the eHealth Commission- has concluded its planning phase.
The Roadmap was developed with input from over 1,000 stakeholders from many Colorado communities, both rural and urban. Colorado's Health IT Roadmap has been reviewed and approved by both the Governor's Office and eHealth Commission, and now enters the implementation phase. View the Roadmap or request a printed copy of Colorado's Health IT Roadmap.
The Colorado Health IT Roadmap will provide strategic direction for the state of Colorado in ways that will most effectively support Colorado's Triple Aim - best care, best health, best value. The Roadmap identifies 16 initiatives which will help to advance the health information infrastructure of Colorado.
One of the Roadmap initiatives is to improve person identity matching to better coordinate and improve care, reduce costs, and improve data integrity. OeHI, through the Department of Health Care Policy and Financing (HCPF), released a draft Request for Proposal for a Master Patient Index for public comment at the beginning of November. We want to thank everyone for their valuable feedback. A summary of comments will be presented at an upcoming eHealth Commission meeting.
Take the Survey
Care Coordination has also been determined as a state-wide priority in the Colorado Health IT Roadmap. The initiative focuses on leveraging and aligning technology, projects and processes. To better understand the challenges around care coordination, the Office of eHealth Innovation is asking for your help in completing the Care Coordination survey.
Completing this brief 10-minute survey will provide valuable information to OeHI that will inform the planning and implementation of the Care Coordination Initiative.
OeHI continues to advance work in several other areas identified as priorities for the Roadmap, such as electronic clinical quality measures, a program management office, and a statewide master provider directory.
The eHealth Commission will continue to advise and guide the implementation of Colorado's Health IT Roadmap as our state continues to advance the health of all Coloradans.
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Colorado interChange Update
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The Department has been conducting increased provider outreach to better understand the issues affecting providers with the implementation of the Colorado interChange.
In response to those discussions and forums, we'd like share the following resources which address some of the most frequently mentioned topics. For providers who are wanting the most timely and up to date information, we suggest they subscribe to receive emails from the Department.
- Here's a link to our Read Your RA Quick Guide. We recognize this Quick Guide does not address all concerns with the RA so we are scheduling a webinar to better support billing staff with the new document. Additionally, the Department is working with DXC to reformat the RA to be more user-friendly.
- The Department will be publishing a webinar to address upcoming changes with co-payments. The webinar will clarify the changes and include instructions on how to check co-pay information in the Provider Web Portal
- The Department frequently communicates about the availability for interim payments to providers experiencing financial difficulties. More information is available in this FAQ document.
- The Department understands Timely Filing has been a topic of confusion for many providers. The Department published a clarifying article in the October 2017 edition of the Provider Bulletin. You can also find FAQs on this site under the Timely Filing FAQs heading.
- The Department and DXC have published a variety of resources, including step-by-step instructions with screenshots for frequent tasks and Provider Web Portal training videos, related to using the Provider Web Portal. In addition to these resources, DXC will be scheduling provider training sessions in the next few weeks. You'll find that schedule here.
The Department will continue to collect feedback from providers and use their input to adjust provider communications and develop training materials to address needs.
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Timeliness for November 2017
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Timeliness numbers for the month of November 2017 are in!
Timeliness for all Medical Assistance
applications for the month was measured at
98.76 percent.
The Department and its county partners have registered 41 consecutive months above 95 percent timeliness.
Timeliness for all Medical Assistance redeterminations for the month was measured at
99.10 percent.
The Department and its county partners have registered 22 consecutive months above 95 percent timeliness.
This could not have been accomplished without the hard work of our county partners. Many thanks!
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The following counties were
below the 95.00 percent benchmark for the month of November 2017.
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Applications
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Redeterminations
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| Adams County - 94.84% |
None! |
| Jackson County - 78.57% |
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| Kit Carson County - 91.43% |
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| La Plata County - 86.80% |
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Saguache County - 94.25%
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| San Juan County - 85.71% |
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| December and January RRR Pending Reports |
In December 2017, the Department noted that the RRR pending report after auto re-enrollment ran was high.
Reports were sent to the 10 largest counties to start working on these cases.
To increase timeliness for the current month and reduce the number of backlog cases that could be added to the following month, counties can pull and work the Detailed Timely Processing of Medical Applicant Redeterminations-Adhoc report.
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| Recent Updates to Colorado.gov/PEAK and the Colorado Benefits Management System (CBMS) |
| Transportation Services Benefits Collaborative Update |
The Department of Health Care Policy & Financing has scheduled a stakeholder meeting on January 8, 2018, to begin the Transportation Services Benefits Collaborative process.
The Benefits Collaborative process is the Department's formal, public, policy development process. The process is used to define coverage policy - what is covered and who can provide/receive covered services - in a manner that is transparent to, and inclusive of, all stakeholders, using evidence-based guidelines.
This effort will review and refine current Emergency Medical Transportation (EMT) and Non-Emergent Medical Transportation (NEMT) rules to ensure they accurately reflect coverage policy, and will also include discussion of possible content for inclusion in a new NEMT broker contract request for contract proposals (RFP).
The Benefits Collaborative process is open to anyone who indicates they wish to participate. You are encouraged to forward this invitation to anyone that may be interested.
Please indicate your interest in receiving future Transportation Services Benefits Collaborative emails, and
please RSVP if you plan to attend the January meeting
so that we can ensure adequate meeting space.
Transportation Services Benefits Collaborative Meeting
Monday, January 8, 2018
10:30am - Noon
Department of Health Care Policy and Financing
303 E. 17th Ave, Denver, Seventh Floor Conference Rooms 7A,B,&C
Meeting materials and call-in information will be sent to those who express interest in the coming weeks.
As always, feel free to reach out to us with questions/comments.
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From the Office of Community Living
Room and Board Charge and Personal Needs Allowance Amounts
Effective January 1, 2018, the maximum SSI monthly payment an individual may receive will increase by 2.0%. The new monthly maximum amount will be $750.00. The maximum amount a residential provider may charge a participant in HCBS-DDResidential Habilitation for Room and Board is $677.00 per month.
Read the communication brief
here.
HB 17-1343 Implement Conflict-Free Case Management
In 2017, the Colorado General Assembly passed HB17-1343 to implement Conflict Free Case Management (CFCM) for individuals with intellectual and developmental disabilities (IDD) in Colorado. Implementing CFCM per HB 17-1343 requires separation of case management from direct service provision for Community Centered Boards (CCBs).
Read the communication brief
here.
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In Summer 2017, Colorado launched four regional No Wrong Door (NWD) pilot sites to test a model for streamlining access to long-term services and supports.
To help inform future, statewide implementation of a NWD system, pilot sites were asked to share their lessons learned and milestones based on the first three months of pilot site operations. Lessons learned and milestones include focusing on more tangible solutions to: align partners, combine collective knowledge on an electronic platform, and coordinate overall agency operations while understanding that developing a more efficient way to work together takes time.
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From the Staff Development Center - Job Opening
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The SDC has an opening for a
Public Assistance Training Specialist. Please share this with anyone that may be interested in applying.
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From Connect for Health Colorado
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A Message from Connect for Health Colorado: Financial Help Still Available for 2018
Contrary to what you may have heard, financial help is still available for 2018. You may have heard that the current administration has decided to end Cost-Sharing Reduction payments. These payments are reimbursements to health insurance companies. It does NOT affect Cost-Sharing Reductions for our customers who receive them.
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Passionate about walking but not sure how to make your community more walkable? America Walks invites you to apply for a 2018 Walking College Fellowship to help you build a local walking movement and take your advocacy work to the next level.
The application process will be open Feb. 1 - 28 and there's an "Orientation to the Walking College" webinar on Feb. 8. America Walks is an inclusive organization and we seek applications from diverse individuals who are interested in getting more involved in the walking movement.
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The Colorado Department of Health Care Policy and Financing complies with applicable federal and state civil rights laws and does not discriminate on the basis of race, color, ethnic or national origin, ancestry, age, sex, gender, sexual orientation, gender identity and expression, religion, creed, political beliefs, or disability. Learn more about our Nondiscrimination Policy.
ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-800-221-3943 (State Relay: 711).
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1-800-221-3943 (State Relay: 711).
For further information about this policy, to request free disability and/or language aids and services, or to file a discrimination complaint, contact:
504/ADA Coordinator
1570 Grant St
Denver, CO 80203
Phone: 303-866-6010, Fax: 303-866-2828, State Relay: 711
Civil rights complaints can also be filed with the U.S. Department of Health and Human Services Office for Civil Rights electronically through the
Office for Civil Rights Complaint Portal
or by mail, phone, or fax at:
1961 Stout Street Room 08-148
Denver, CO 80294
Telephone: 800-368-1019, Fax: 202-619-3818, TDD: 800-537-7697
Complaint forms are available online
.
For more information, please visit our website at
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