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Upcoming Events and Helpful Resources
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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 March 2017 edition of At a Glance!
Thank you for your interest!
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New Income Guidelines Effective April 1, 2017
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New Supplemental Resources--Medicaid Expansion and Opioid Use
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New resources covering the Medicaid Expansion and Colorado's efforts to curb opioid abuse are now available
on our website. Please feel free to share these materials, which provide a more in-depth look at these important topics covered in our
Department Annual Report.
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Tell Us What You Think! Notice of Action Survey
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We want to hear from you!
The Departments of Health Care Policy & Financing and Human Services, Connect for Health Colorado and the Governor's Office of Information Technology are tackling the eligibility Notice of Action (NOA). Drawing on your feedback from last spring combined with two rounds of client interviews around the state, we have developed an updated draft NOA.
Together with Joining Vision and Action (JVA), we have created a survey to gather feedback on the Notice of Action. This brief and anonymous survey will take approximately 10 minutes to complete. We will use the data from the survey responses to improve the language and format of the Notice of Action.
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Per the state Constitution, the Colorado legislature is in session for no more than 120 days, adjourning this year on May 10, 2017.
HCPF Legislation
The Department's bills are still in the process of being introduced or working through the committee process at this time.
SB17-091, has been sent to Senate Appropriations and
HB17-1139 has been calendared for April 11.
- Implementation of conflict-free case management
- Reducing opioid overdoses by gaining access to the Prescription Drug Monitoring Program
- Contingency planning for changes to the CHIP funding
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Partnerships to Improve Population Health
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Primary Care Fund 2017-18 Grant Opportunity
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The Primary Care Fund grant opportunity provides an allocation of moneys to health care providers that make basic health care services available in an outpatient setting to residents of Colorado who are considered medically indigent.
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Delivery Systems Innovation
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Colorado State Innovation Model Update
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Last day to apply for SIM
Act now to apply for the Colorado State Innovation Model (SIM), a federal initiative that helps health care providers integrate behavioral and physical health and test alternative payment models. The application for cohort 2 closes at midnight today, March 31.
This recruitment process will add at least 150 practices to cohort 1, which includes 92 primary care practice sites and four bidirectional behavioral health homes that serve approximately 320,000 attributed patients.
Integrated health care has been shown to improve outcomes, reduce costs and enhance provider morale. The SIM initiative, which is funded by the Centers for Medicare & Medicaid Services (CMS), provides guidance and support to primary care practice sites that progress along an integrated care path continuum that might start with referrals to external behavioral health or primary care providers and could lead to co-location of professionals.
Continuous improvement
Colorado was one of 11 states selected for SIM model test awards funded by CMS, and it was the only state to focus on integrated care with public and private payers as its primary goal. The state will receive
$65 million from the
Center for Medicare and Medicaid Innovation
to implement and test its proposed model for health care innovation
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Health care innovators
Delivering integrated care necessitates process and staff changes, which is why SIM provides practice facilitators and clinical health information technology advisors, who provide guidance in addition to a menu of benefits outlined below. SIM also created a new workforce in the form of regional health connectors, who connect practices with community resources, and partners with local public health agencies to reduce stigma and help connect patients to the care they need.
Capitalizing on full health potential
During its four-year time frame, which ends in 2019, SIM will help 400 practice sites and four bidirectional health homes engage in this work to integrate behavioral and physical health in primary care settings.
SIM practices receive the following supports:
- Achievement-based payments of up to $13,000 for meeting key activities and milestones
- Small grants of up to $40,000 that help practices operationalize integration efforts
- Practice facilitators who visit the practice each month
- Clinical health information technology advisors who visit the practice each month
- Regional health connectors who identify and help practices tap into community resources
- Local public health agencies that address stigma associated with behavioral health issues and help create community resources
- Broadband access to expand telehealth and enhance health information technology infrastructure
- Business support that help sustain integration efforts
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Accountable Care Collaborative Enrollment Update
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As of March 2017, 1,022,445 Health First Colorado members were enrolled in the Accountable Care Collaborative.
This number includes 35,268 who are members of the Accountable Care Collaborative PRIME program on Colorado's western slope and 22,042 who are members of the ACC: Access KP Program in RCCO Region 3.
Approximately 739,142 Accountable Care Collaborative members are attributed to a medical home.
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Medicaid Managed Care Grievance and Appeal Rule Change
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The Department is currently in the process of modifying the Medicaid Managed Care Grievance and Appeal Rule (8.209) to come into compliance with Subpart F of the 2016 Centers for Medicare and Medicaid Services managed care final rule, effective July 1, 2017. This rule change reflects the changes made in the Department's Managed Care Entity (MCE) contracts for FY 2018. A highlight of the changes are below.
- Includes Prepaid Ambulatory Health Plans (PAHPs) as being required to follow the same procedures as MCOs and PIHPs
- Adds in a definition of Managed Care Organization (MCO) to align with federal and state definitions
- Changes "Action" to "Adverse Benefit Determination" to align with federal regulation
- Changes the timeline the member has to file an appeal from 30 calendar days to 60 calendar days after receiving a notice of Adverse Benefit Determination
- Changes the expedited appeal timeline from 3 business days to 72 hours
- Requires the member to exhaust the health plan level appeal process before requesting a State Fair Hearing
- Changes the timeline for a member to request a state fair hearing from 30 calendar days to 120 calendar days of receiving the health plan's notice of appeal determination
- Includes information for when a member may request a State Fair Hearing due to the health plan not adhering to notice and timing requirements
- Removes the timeline for when a member may file a grievance
- Removes the definition for "Timely Filing," as the term is not used anywhere in the rule, and moves the information to the appropriate section in the rule
If you would like to submit public comment to the Department regarding this rule change, please send comments to
Colleen McKinney
by April 4, 2017.
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Modernizing the Colorado Indigent Care Program
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The Department is proposing to modernize the Colorado Indigent Care Program (CICP) effective July 1, 2017. The proposed rule, #MSB 16-11-22-A:
- Simplifies administrative requirements for CICP providers and applicants;
- Offers flexibility in the financial determination process;
- Preserves a safety net of access to health care for qualified Coloradans up to 250% of the Federal Poverty Level;
- Creates a formal CICP advisory council that will be appointed by the Executive Director of the Department of Health Care Policy and Financing; and
- Incorporates quality performance metrics into the payment methodology for CICP stand-alone clinics.
The Medical Services Board will hold its initial hearing of this proposed rule on April 14, 2017. The rule will be heard in Conference Room 11 ABC at 303 E. 17th Ave., Denver, CO beginning at 9:00 a.m. Public testimony will be accepted.
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FAQs on Pend at Redetermination Change Now Available
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On March 19, 2017, the Department implemented a project in the Colorado Benefits Management System (CBMS) to automatically pend a case during a member's redetermination when certain information cannot be verified through an interface.
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Stakeholder Meeting on Upcoming Asset Verification System
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The Department is convening a stakeholder meeting to gather feedback on the upcoming Asset Verification System scheduled to be implemented in December 2017.
The system will be able to verify liquid assets held in financial institutions, such as bank accounts. This system will help streamline the eligibility determinations when an asset test is required for programs and waivers for individuals who are 65 and older, blind, or who have a disability.
The meeting will be held at HCPF's office at 303 E. 17th Ave., Denver, CO 80203 on Tuesday, April 18 from 1:00 to 2:00 p.m. in Conference Room 11AB. A webinar and conference line will be available for those who cannot not attend in person. RSVP now online.
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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
