Dear Case Manager,

The Alternative Care Facility (ACF) daily rate for Community Mental Health Supports (CMHS) clients increased by $0.72 beginning October 1, 2017, from $51.20 to $51.92. However, the increased rates were not paid from October through December, as the Department received a retroactive effective date from the Centers for Medicare & Medicaid Services (CMS).

We would like to thank you for your patience and cooperation as we work through the rate change. We acknowledge the time and frustration this issue has caused you. Below is a summation of the known Post Eligibility Treatment of Income (PETI)/ACF issues.

Ending the service line: 

As you know, we have asked for Prior Authorization Request (PAR) revisions to be completed, ending the line September 30, 2017, and beginning the new line October 1, 2017. We know that may not be possible for providers who have billed past September 30, 2017. We have informed provider agencies that they have the option to seek the higher reimbursement; if they do, they will need to coordinate with you to do so.

Note that claims for all impacted dates of service must be voided by providers in order for revisions to be performed. The following steps must take place to adjust the rate and PAR.

1)  Provider will contact the case manager by February 7, 2018, indicating they wish to receive the higher rate.

2)  Agree on the time period the case manager can complete the revision.

  • The provider will give the case manager about a week for the PAR revision to take place.

  • Given the number of revisions that will need to be completed, an agreed upon timeframe must be in place before this process begins. Example: “The Case Manager can complete the revision between February 12, 2018 and February 16, 2018.”

3)  The provider will void the claims, using the instructions from this Quick Guide .

4)  Case manager will complete the revision of both the PAR and PETI, reflecting the correct dates and new rates. A screenshot of the work completed shall be sent to the provider.

5)  Provider will rebill all impacted claims.

Categorical clients:

In order for providers to receive the higher rate, both the PAR and PETI must be revised. The system pulls the rate from the PETI, rather than the PAR. This means you must complete a revision of the PETI and PAR for all categorical clients.

Thank you in advance for all your efforts. 

Thank you,

Health First Colorado (Colorado's Medicaid Program)