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TopAt a Glance
December 29, 2017                                                                                      
In This Issue
Quick Links
In November 2017 there were 1,313,233 Coloradans enrolled in Health First Colorado (Colorado's Medicaid Program) and 76,175 enrolled in Child Health Plan Plus (CHP+).
Upcoming Events and Helpful Resources
Health First Colorado printed materials are available on our website
Health First Colorado videos for use in waiting rooms and other areas members visit are available for download on our website
New to PEAK or Need a Refresher?

The Intro to PEAK and Application Walk-Through recorded webinars are available anytime. For more information and trainings, visit the PEAK Outreach Initiative website.
Public Rule Review Opportunities

Anyone interested in a one-on-one discussion with Department staff about upcoming rules is invited to attend the Department's Public Rule Review Meeting. Information is available on the Public Rule Review Meetings web page. 

For more information, or to be added to the Medical Services Board email distribution list, please contact Chris Sykes.
Employment Opportunities

Applying for state government jobs is easy. Applications are electronic, you will receive updates, and you do not need to answer any written questions until it is determined that you meet the minimum qualifications. 

Check out the website for State of Colorado jobs including the Department of Health Care Policy and Financing jobs.
Welcome to the December 2017 edition of At a Glance!

At a Glance is a Department of Health Care Policy and Financing publication which provides information on major initiatives including policy changes and program updates. Please feel free to share At a Glance with your colleagues. Previous editions of At a Glance are available on our website.

Thank you for your interest!

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Breaking News

Co-pay Changes Begin January 1, 2018
In accordance with   state law , the Department has made  changes to some  the Health First Colorado (Colorad o's Medicaid Program) co-pay   amounts effective  January 1, 2018. Co-pays are a small amount of money Health First Colorado members must pay for their covered care or services.
 
Members who do not pay co-pays, such as children, pregnant women, qualifying former foster care youth, American Indians and Alaska Natives will not be affected.  

Starting January 1, 2018:
  • Outpatient hospital visit co-pay is increasing from $3 to $4  
  • Non-emergency ER visit co-pay is increasing from $3 to $6  
  • Generic drug co-pay is increasing from $1 to $3 per prescription for both new and refill prescriptions   (N ote:  Some prescriptions never have a co-pay, including prescriptions to help Health First Colorado members quit smoking. )    
For more information, visit  HealthFirstColorado.com/copay . Guidance  and resources  for providers and pharmacies can be found in  the  Department's Provider Bulletin  and at  CO.gov/HCPF/InterChange-Resources  

Implementation of the Ordering, Prescribing and Rendering Provider Enrollment Requirement    
Effective January 1, 2018, the Department will be enforcing 42 CFR 455.410(b) which provides that Medicaid must require all ordering or referring physicians (OPRs) or other professionals providing services be enrolled as providers, and  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 January 1, 2018 if the prescriber is not enrolled with Colorado Medicaid. Refills written prior to January 1, 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 January 1, 2018.

If a prescriber does not wish to enroll with Colorado Medicaid they should begin referring their patients to a prescriber who is enrolled. Patients needing new prescriptions for their medications written on or after January 1, 2018 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 January 1, 2018 claim denies- MD not enrolled, call DXC to enroll. 

Beginning January 1, 2018 the message will read: Prescriber not enrolled. Call DXC at 844-235-2387 to enroll.  

As always, members with questions or concerns can contact the Department at (303) 866-2993 or use our Find a Provider tool to find a provider enrolled with Colorado Medicaid.
Child Health Plan Plus (CHP+) Update   
At this time, there are no changes to CHP+ eligibility or benefits

We encourage you to bookmark CO.gov/HCPF/FutureCHP and check back often as we will regularly update this page. Also, we encourage you to subscribe to our Future of CHP+ updates

If you have questions about the CHP+ program please send them to HCPF_CHPPlusFuture@state.co.us .
Colorado interChange Update
Colorado interChange by the numbers (as of 12/18/2017)
  • 54,125 providers enrolled and growing every day
  • $6.3 billion paid to providers
  • Nearly 40 million claims processed
The Department recognizes some system issues remain, and as always, these are archived on our Known Issues and Updates web page , so we continue to develop resources for providers based on feedback from our provider stakeholders. 

Most recently, the Department conducted a live webinar about revalidation and used questions from the participants to update its revalidation FAQs . We also added FAQs to provide additional information about Timely Filing .
 
Provider organizations can begin requesting training from DXC's Field Representatives, but as always, specific and individual questions should be directed to the DXC Technology Provider Call Center: 1-844-235-2387.

Partnerships to Improve Population Health
Connect for Health Colorado Open Enrollment Ends January 12, 2018
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. 
 
Customers receiving financial help through Connect for Health Colorado will likely pay less in 2018 than in 2017. They will see the premium that they pay (full premium minus the Premium Tax Credit amount) go down by 20% on average in 2018. 

 
Open Enrollment ends January 12, 2018. 

For more information, visit ConnectforHealthCO.com.

Delivery Systems Innovation
Spinal Cord Injury Pilot Waiver Annual Report Published
The Colorado General Assembly authorized the Department to seek Federal approval from the Centers for Medicare and Medicaid Services (CMS) to implement a Home and Community Based Services (HCBS)-Spinal Cord Injury (SCI) waiver. The HCBS-SCI waiver is set to expire in 2020.

The SCI Waiver offers services that allow members to live in the community of their choice as well as to offer and evaluate the effectiveness of Complementary and Integrative Health Services (CIHS) for individuals with a spinal cord injury which consist of acupuncture, massage, and chiropractic.

Report Findings
As mandated by the General Assembly, the Department is conducting an external evaluation on the effectiveness of the waiver through 2020.  Each year, the Department receives an annual report with a final report due in 2020. The Department's 2017 SCI Waiver Annual Report Findings are available online

Key findings from the report:
  • The most commonly cited result of receiving CIHS was a decrease in pain; 81 percent of participant respondents said that they experienced pain on fewer days and 87 percent said their level of pain had decreased as a result of CIHS (page 38).
  • It is hypothesized that better pain management through CIHS will lead to a reduced need for pharmaceuticals to manage pain and depression.  Early data shows some support for this hypothesis (page 20).
The Department envisions adding further providers to our network of Complementary and Integrative Health Services and increasing the number of enrolled members. With increased enrollment and service utilization, more members may experience the benefits of CIHS while also providing the Department with valuable feedback through the independent evaluation process. The increased number of participants in the waiver will help to increase the quality and validity of the final evaluation findings being presented to the General Assembly in 2020.

If you are interested in participating in the waiver or becoming a participating provider, contact Lindsay Westlund.


Apply Now for State Innovation Model Third Cohort

Primary care practice representatives are encouraged to apply for the third and final cohort of the Colorado State Innovation Model (SIM) before January 19, 2018

 

SIM practices receive a comprehensive package of coaching, business supports, access to a data aggregation tool and achievement-based payments. They report on clinical quality measures, including screening for behavioral health, to help them intervene early and improve patient health. 

 

Learn more about the initiative, see a map of the practices that are engaged in this rewarding work and apply now.

      
Operational Excellence
Recent Updates to Colorado.gov/PEAK and the Colorado Benefits Management System
On December 17, 2017, several updates to Colorado.gov/PEAK and the Colorado Benefits Management System (CBMS) were implemented. 

For more information, check out the December 2017 Build Updates online.
Tools for Transformation
Alternative Payment Model for Primary Care Survey is Live 
The Department is moving forward with the implementation of the Alternative Payment Model for Primary Care (APM). The survey to select measures in the model is now open. A link to the survey is available on the Department's web page

The web page also has pre-survey instructions, links to resources including the APM Survival Guide, and a short video demonstrating how to use the APM model.  The survey will remain open through January 31, 2018.  

Nondiscrimination Policy
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.

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