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Upcoming Events and Helpful Resources
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| 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.
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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.
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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.
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Welcome to the January 2018 edition of At a Glance!
Thank you for your interest!
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Child Health Plan Plus Will Continue
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Member Letters
The Department is notifying CHP+ members that the program will continue. CHP+ members will begin receiving letters the week of January 29, 2018.
Sample Letters:
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Department Mails IRS Form 1095-B to Health First Colorado and Child Health Plan Plus Members
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The Department began mailing 1095-B tax forms to nearly all Health First Colorado and all CHP+ members on January 11, 2018 through January 20, 2018.
IRS Tax Form 1095-B is a federal tax document that includes information about the months during 2017 in which Health First Colorado and CHP+ members were enrolled in qualifying health coverage.
Members are not required to include the 1095-B form with their tax return, but they should keep it with their tax records to verify coverage.
The Department will begin mailing corrected 1095-B forms, as needed, in February 2018.
For more information, see our frequently asked questions regarding the 1095-B Form.
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2018 Social Security Cost of Living Adjustments Agency Letter
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Monthly Social Security and Supplemental Security Income benefits will increase due to a Cost of Living Adjustment (COLA) of 2 percent in 2018. The purpose of the COLA is to ensure that the purchasing power of Social Security and Supplemental Security Income (SSI) benefits is not eroded by inflation. It is based on the percentage increase in the Consumer Price Index for Urban Wage Earners and Clerical Workers from the third quarter of the last year a COLA was determined to the third quarter of the current year.
The 300 percent income limit, home equity maximum, minimum monthly maintenance needs allowance maximum, and the community spouse resource allowance will increase. The Medicare Part B premium will also increase.
Beginning January 1, 2018, the Medicare Nursing Facility Co-Insurance Rate and the Income Trust Gross Income Limits and Average Nursing Facility Private Pay Rates will change. Additionally, the Personal Needs Allowance (PNA) base amount for residents of Nursing and Intermediate Care Facilities will increase by 3 percent, setting the 2018 PNA Base Amount at $84.41.
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Asset Verification Program
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On December 17, 2017 the Department implemented the Asset Verification Program (AVP). The AVP is an electronic data source that will verify certain liquid assets such as checking and savings accounts and will be deemed a valid verification of these types of assets.
Section 1940 of the Social Security Act set forth the requirement that all states implement a federally mandated electronic interface that will verify assets held in depository institutions, such as checking and savings accounts. This applies only to Non-Modified Adjusted Gross Income (MAGI) programs for individuals who have a disability and/or are age 65 and older, who have an asset test.
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Implementation of the Ordering, Prescribing, and Rendering Provider Enrollment Requirement
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Effective January 1, 2018, the Department
is
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 customer service at 1-800-221-3943 or use our Find a Provider tool to find a provider enrolled with Colorado Medicaid.
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In accordance with
state law, the Department has made changes to some the Health First Colorado (Colorado's Medicaid Program) co-pay amounts.
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.
Effective January 1, 2018:
- Outpatient hospital visit co-pay increased from $3 to $4
- Non-emergency ER visit co-pay increased from $3 to $6
- Generic drug co-pay increased from $1 to $3 per prescription for both new and refill prescriptions (Note: Some prescriptions never have a co-pay, including prescriptions to help Health First Colorado members quit smoking.)
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Partnerships to Improve Population Health
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January 10, 2018, marked the first day of the second session of the 71st General Assembly. Per the state Constitution, the Colorado legislature is in session no more than 120 days, adjourning this year on May 9, 2018.
Department Legislation
The Department has five bills on its legislative agenda this session, including:
- Redesign of Children's Habilitation Residential Program (CHRP) Waiver
- Conflict-free Case Management (CFCM) for Single-Entry Points
- Cost Savings through Transition Services & Community Living
- Align Managed Care Statute with Federal Regulations
- Remove Outdated Waiver References from Statute--introduced as SB18-093, this bill will remove references to the Persons Living with AIDS Waiver from statute and will begin going through the committee process next week.
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Delivery Systems Innovation
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| Accountable Care Collaborative Phase II Update |
Regional Accountable Entity Contract Awards
In November 2017, the Department announced the awards for the seven Regional Accountable Entity (RAE) contracts. The Department has made available the proposals and contact information from each of the awarded entities on
CO.gov/HCPF/ACCPhase2.
Next Steps
The Department continues to prepare for the implementation of the next phase of the Accountable Care Collaborative (ACC) and will be immediately focusing on contract negotiations with the new Regional Accountable Entities vendors, finalizing the 1915(b) waiver with the Centers for Medicare & Medicaid Services (CMS), managing system updates, and performing a variety of implementation activities.
The Department is also working to provide key communications about the program over the next few months. Some of the topics we will address include:
- Overview of ACC Phase II
- Provider Contracting
- Attribution Process
- Behavioral Health Services in Primary Care
- Performance Measurement
Below is a high-level timeline of the Department's activities.
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New! Personalized Health First Colorado Member Handbooks
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Personalized member handbooks are now available through PEAK.
These new member handbooks will show specific benefits for each member of the household, based on their eligibility category.
Members must have a PEAK account to access their personalized handbooks. They can create an account at
CO.gov/PEAK. Anyone with
technical questions about PEAK can call 1-800-250-7741.
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Improving Disability Competent Care
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Better understand the barriers persons with disabilities face when accessing primary care, and learn easy, tax-advantaged ways to improve your practice. Hear from members about the value and practice of delivering Disability Competent Care (DCC), or take your practice to the next level and complete the
Colorado Disability Competent Care self-assessment tool.
Providing Disability-Competent Care can benefit your practice in many ways:
- Listening to patients' needs and building trust can lead to cost savings over time, as patients' health needs are better met.
- Certain improvements are eligible for tax write-offs and other financial incentives.
- Providing DCC can reduce the likelihood of litigation, since the Americans with Disabilities Act (ADA) requires that providers maintain equal access.
- Learning DCC will help you be a better clinician.
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Providers: Please Update Your Information for the Provider Search Tool
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The new Health First Colorado Provider Web Portal makes it easy to keep provider contact information up to date. Providers who want to make changes to their listing on the Department's provider search tool, which members use to find a provider, must make those changes through the provider portal.
For detailed instructions on how to make these updates, refer to this Quick Guide.
Please note these updates require manual review and will not be effective immediately. Email addresses and provider search tool updates are made monthly.
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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).
CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-800-221-3943 (State Relay: 711).
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At a Glance
