Welcome to the September 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!

Unless Congress acts, federal funding for the Children's Health Insurance Program (known as Child Health Plan Plus, or CHP+, in Colorado) ends September 30, 2017. 

At this time, there are no changes to CHP+ eligibility or the CHP+ program;  however, the Department is beginning to plan for the necessary actions that will need to be taken if Congress does not continue funding.

 

Current law allows states to spend unspent federal dollars collected before October 1, 2017. The Department estimates that Colorado can use these funds for health care for CHP+ members until sometime in the first quarter of calendar year 2018. For more information, please visit Colorado.gov/HCPF/future-child-health-plan-plus-chp. 

 

If you have questions about the CHP+ program please send them to [email protected].

As of November 1, 2017, Health First Colorado members will no longer receive Prior Authorization Request (PAR) approval letters in the mail.  The letters are not necessary for approval, or to receive the approved medication. These letters only serve as confirmation of what was already approved.  Due to the delay in mailings, members often already have received the medications before they receive the letter.  

Members can request a paper copy of their PAR approval letters if they contact the Health First Colorado Member Contact Center at 1-800-221-3943/State Relay 711.

 

The Department will continue to send PAR denial letters to members.

Health First Colorado will notify members by mail when they have met their co-pay maximum for the month, beginning in October. The head of household will receive a letter showing the household has reached the monthly limit, and how the limit was calculated. 

 

Once a member has paid 5% of their monthly household income on co-pays in a month, no one in the household has to pay anymore co-pays for the rest of that month. Health First Colorado members should make sure their information is up to date so they receive this and other important Department correspondence.

 

For more information, visit HealthFirstColorado.com/copay.

The Department recognizes some providers have had difficulties submitting claims during the transition to the new claims payment system, the Colorado interChange.  In an effort to ensure providers are appropriately paid for services to our members, the Department is extending the temporary timely filing extension for an additional six (6) months.

Effective May 12, 2017, the timely filing limit was extended to 240 calendar days.

Effective May 1, 2018, the limit will be changed back to 120 calendar days. 

On May 1, 2018, all claims with a date of service (DOS) prior to January 1, 2018, will be outside the timely filing limit of 120 days, and providers will need to submit additional documentation to request a timely filing extension.

Examples of additional documentation are:

Claims that are not able to be submitted within the 240-day guideline, but have one (1) of the above documents attached to the submission, will be reviewed by the fiscal agent.

Please Note:

Load Letters

Load letters are only applicable to member eligibility and are only issued if there was a delay in the member's eligibility approval. Load letters will not be issued for any other timely filing circumstance unrelated to member eligibility backdates.

Provider Enrollment Delays

Providers are advised to complete the enrollment process before rendering services to a member to ensure claims processing. However, in most cases, providers can be backdated 240 days from the date of the enrollment approval, as long as they are licensed and meet all other enrollment requirements through those dates. Providers can use the approval letter as a timely filing waiver to submit any claims after their approved effective date.

For more information, see the General Provider Information Billing Manual.

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The Department will no longer offer the Family Support loan fund. The Family Support loan fund provided eligible families with short term, low interest loans to support a dependent family member with a developmental disability in the home. 

House Bill 17-1078 was enacted effective July 1, 2017 to repeal Colorado Revised Statutes 25.5-10-401- 403 which authorized the Family Support loan fund. 

Effective July 1, 2017, Colorado Revised Statutes 25.5-10-305.5 authorized  the creation of The Family Support Services Fund. The Family Support Services Fund will consist of money transferred from the Family Support loan fund prior to the  repeal  and  any  payments collected on outstanding loans. The Family Support Service Fund will be utilized to cover any additional expenses the Department has due to terminating the Family Support loan fund and for Family Support Services.

 

The Department will continue to accept payments on current outstanding loans until the loans are paid in full. There will be no change to the terms or condition of outstanding loans as long as the loan is in good standing. Loans that are greater than 30 days in arrears may be referred to collections.

For more information, contact Sheila Peil.

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