County Connections Newsletter
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This newsletter is designed for the Department to inform county directors, management and staff about county performance, policy changes, process updates, upcoming due dates, and more.
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High-Impact Policy and Process Updates
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CBMS Transformation Update
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Phase 1 Application Initiation Tip Sheets
The CBMS Command Center has received several questions around issues with starting a new Application Initiation (AI) in CBMS in Salesforce.
Start a New Application Initiation
This includes two options to start a new Application Initiation in CBMS in Salesforce.
Application Initiation History
This includes how to see Recently Viewed Applicant Information in CBMS in Salesforce.
Moving forward, please use these updated
Tip Sheets
as a guide to start a new Application Initiation and view Application Initiation history.
October Road to Transformation Newsletter
The
Road to Transformation
is a monthly one page overview that previews one key feature of CBMS Transformation and discusses current activities. The newsletter is published the first week of each month. To view all issues of the
Road to Transformation
, click
here
.
Details:
This month features a Phase 1 Update, Phase 0 Recap an Update, and what should be on your radar.
The left-hand margin of the newsletter provides links that will help you to learn more about CBMS Transformation:
CBMS Transformation Post-Phase 1 Go-Live Survey
Now that we are live with CBMS Transformation Phase 1, which provided updated Home Page, Application Initiation (AI), and Clearance screens, we would like your feedback on how you felt with regards to your level of preparedness and confidence for Phase 1. We will use this feedback to improve and prepare for Phase 2.
Below, please find a link to a short survey that will take less than five minutes to complete. Your participation is important and greatly appreciated because it will help determine how we can improve in our efforts for Phase 2. Thank you in advance for taking the time to complete the survey and sharing your feedback by
Friday, October 26
th
. As a reminder, all survey results are completely anonymous.
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Member Attribution Update
Since the July 1 launch of the ACC Phase II, the Department has been working closely with providers, our contractors, and stakeholders to identify and tackle questions and issues related to implementation. These have ranged from payment, benefit, and attribution issues.
As anticipated prior to implementation, the most common issue identified has been related to member attribution to a primary care medical provider (PCMP) and Regional Accountable Entity (RAE). This is a challenge all health plans face, particularly when trying to attribute members to a specific practice. Department staff have been working hard for months to build and implement an attribution process that honors member choice and complies with federal regulation, while also connecting all members to a medical home.
There are a number of factors that have contributed to the challenges of this process, from recent changes in provider enrollment and billing practices to the shift from regional enrollment in a health plan based on member residence to a new model that use the PCMP as the driver of health plan enrollment. This last change was designed in collaboration with providers to reduce the administrative burden of contracting with multiple Health First Colorado health plans and should eventually result in stronger support for providers and improved coordination for members. That said, these factors have increased the complexity of the process and resulted in a number of attribution errors.
Addressing Attribution-related Issues
In order to address attribution-related issues, we started first with identifying and designing system-level solutions. The Department is now running four concurrent streams of work focused on attribution-related issues:
- Closely monitoring and managing system defects and enhancements, and their impacts,
- Executing manual fixes while systemic fixes/changes are being developed and implemented,
- Conducting reattribution of members to more accurately assign members to a PCMP based on their utilization history since July 1, and
- Identifying and analyzing PCMP panel issues with help from the RAEs and individual PCMPs.
Reattribution of Members
In Phase II, the Department plans to conduct a reattribution process to ensure PCMP attributions reflect the member's strongest PCMP relationship every 6 months. The Department will be utilizing the reattribution process more regularly at the beginning of the Phase II program to help ensure proper member attributions.
The reattribution process under ACC Phase II will prioritize attributions made when the member contacted Health First Colorado Enrollment if that contact was within the 18 month look-back. If the member contacted Health First Colorado Enrollment outside of the 18 month look-back, and the client has a stronger claims history with a different provider, the member will be reattributed to the new provider whom they have been seeing.
When a member is reattributed to a new PCMP, they will be notified via a letter from the Health First Colorado Enrollment. If this also triggers a change to the RAE assigned to the member this will be stated on the letter. If a member contacts Health First Colorado Enrollment and selects a new PCMP, they will not get a letter from Health First Colorado Enrollment.
PCMP Panel Analysis
The Department is working with the RAEs to identify, analyze and troubleshoot individual PCMP panel issues. We are taking the following steps:
- Working with the RAEs to compile a list of practices with issues in need of panel analysis,
- Identifying and pooling Department and vendor resources to dedicate to panel analysis,
- Prioritizing PCMP practices for analysis, and then
- Deploying resources to work systematically with the RAEs and individual practices to resolves issues.
At times, a member may be appropriately attributed to another PCMP. The panel analysis process may include identifying members not on a PCMP's panel. This may occur when:
- A member has chosen a new PCMP by contacting Health First Colorado Enrollment,
- A member has more claims utilization history with another PCMP,
- A member's provider was is not contracted as a PCMP at the time of attribution,
- A provider contracted with their RAE using the wrong practice site location or rendering provider number at the time of attribution,
- A member is currently not enrolled in Health First Colorado, and/or
A member is not eligible for enrollment in the ACC (for example, a member is enrolled in Child Health Plan Plus (CHP+) or Program All-Inclusive Care for the Elderly [PACE]).
Though time-consuming work, the Department and RAEs are committed to working through panel issues with PCMPs. We encourage PCMPs to contact their RAE to report the following issues:
- Maximum enrollment/panel size concerns, specifically if a PCMP is concerned about the number of members that have been geographically attributed to their practice site.
- Panel composition concerns, such as the attribution of populations the practice site does not see (for example, children attributed to a practice that does not see children).
- Members not attributed to a practice site that the practice has an established history or relationship with.
If PCMPs have difficulty contacting their RAE, issues can be submitted to the Department
using this form
.
Health First Colorado Enrollment
Health First Colorado Enrollment provides assistance directly to Health First Colorado members to change their assigned PCMP. The Department continues work closely with Health First Colorado Enrollment to ensure appropriate wait times to speak with an enrollment counselor. For more about Health First Colorado Enrollment,
see our Member FAQs
.
For more information on ACC Phase II, including resources for providers, stakeholders, counties, and Health First Colorado members, see
CO.gov/HCPF/ACCPhase2
.
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New Verification Check List
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On October 15, 2015, the Colorado Benefits Management System (CBMS) began sending the new Verification Checklist (VCL). The new VCL’s language and layout have been updated for improved readability. The Department worked in collaboration with the Colorado Department of Human Services, Connect for Health Colorado, and stakeholders throughout the process. The new VCL was also consumer tested in English and Spanish, and edited to incorporate feedback.
The Department has recorded a webinar, created a desk aid, and provided sample VCL letters in English and Spanish. The resources can be found on our
Eligibility Partners FAQ and Training page
by navigating to the ‘Member Correspondence’ tab.
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HCPF Department Updates - Informational
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Memos and Department Communications
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Policy Memos
–
PM 18-003
CBMS Limited Benefits for Incarcerated Individuals
Operational Memos –
OM 18-016
CDASS Allocation Increase Process for Single Entry Point Case Management Agencies
OM 18-017
Managed Care Entity Notification Policy
OM 18-018
Case Management Over Cost Containment Process for Consumer Directed Attendant Support Services
Informational Memos –
IM 18-036
Colorado Choice Transitions (CCT) Stakeholder Webinars
IM 18-037
Extension to Public Comment Period for CES Waiver Amendment
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Public Rule Review Meeting
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Public Rule Review meetings
are an opportunity for stakeholders to have one on one conversation with the Department's rule author regarding draft rules.
Public Rule Review meetings happen on the second Monday after the second Friday of each month. Stakeholders can attend in person or can e-mail feedback to the rule author before the rule goes to the Medical Services Board.
The Department’s regularly scheduled Public Rule Review Meeting will be held on Monday, October 22, 2018 at 9:00 a.m. at 303 East 17
th
Avenue, Conference Room 7A, Denver, CO.
This meeting is intended to provide you an opportunity to discuss with rule authors and Department staff proposed rules that will be presented to the MSB for adoption. Department staff will be available for one on one conversations. If no one has arrived by 9:15 – 9:20 a.m., the meeting will be closed.
This does not take the place of public testimony at the Medical Services Board meeting and anyone who wishes is invited to come to the MSB meeting to address the Board directly. The next scheduled meeting of the MSB is Friday, November 9 at 9:00 a.m. in the 11
th
floor conference room at 303 East 17
th
Avenue.
You can access information about the Public Rule Review Meeting by visiting our
web site
.
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FIXED LINKS - Provider County Analysis Reports
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The Department has produced two Provider County Analysis Reports:
These reports provide information on the amount of Health First Colorado and Child Health Plan
Plus
claims paid during those timeframes, the number of providers enrolled and billing based on category, and the total number of claims paid and claims denied.
These reports have replaced the COLD Provider Analysis Reports and are based on claims data from the Colorado interChange claims payment system. This data can be utilized to help determine the economic impact of Health First Colorado/Child Health Plan
Plus
within your county.
Some information about the reports:
- These reports list claims paid within county boundaries; they do not include claims paid for county residents outside of county boundaries.
- Example: a client is referred from a provider in Alamosa County to Children’s Hospital in Denver County. The claim would not be listed in Alamosa County’s claims amount because it was not within the county’s boundaries.
- Not all providers bill for services at all times. Thus, some categories may not include data because there were no recent claims.
- Providers have up to 365 days to submit a claim, so data may not reflect delayed claims submissions. The data is subject to change in the future based on the timeframe to submit claims.
- There is an “Other” county that is inclusive of claims paid outside of Colorado counties.
- These reports were based on COLD Reports, but interChange captures new/additional fields not available in the Medicaid Management Information System (MMIS), from which the COLD Reports were produced. The Department welcomes feedback and recommendations for improvement.
The Department has not yet determined a regular production schedule for these reports, but will have further information on the regular availability of them at a later date.
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County Grant & County Incentives Programs
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The Department has released guidance regarding implementation of the FY 2018-19 County Incentives Program:
- IM 18-032 FY 2018-19 County Incentives Webinar, Support Calls and FAQs
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Grant check ins for the second quarter will take place in December.
If your team has any grant questions prior to that time, please contact the County Team.
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Timeliness for September 2018
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Timeliness for all Medical Assistance
applications
was measured at
96.48 percent
. The Department and its county partners have registered 50 consecutive months above 95 percent timeliness.
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Timeliness for all Medical Assistance
redeterminations
was measured at
99.33 percent
. The Department and its county partners have registered 30 consecutive months above 95 percent timeliness.
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Connect for Health Colorado
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2019 Open Enrollment Dates and
link
to online store to access free materials
Official Open Enrollment Dates for 2019 are November 1, 2018 – January 15, 2019. Counties can order free materials from the
C4HCO online store
. C4HCO covers all of the costs including shipping. Users will create an account and then can choose materials such as brochures, posters, and application checklists. The link for the online store is:
https://c4hcostore.com/login
.
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2019 Plans and Prices
With rate increases lower than the state has seen in years, Connect for Health Colorado® customers who qualify for financial help are looking at an
average decrease
in their net (after tax credit) premium of 24% next year.
The Colorado Division of Insurance today issued final approval for individual health insurance plans that will increase by an average of 5.6% in 2019. The relatively small increase in monthly premiums and the return of all seven health insurance companies to the Connect for Health Colorado, the state’s health insurance Marketplace, are signs of a stabilizing market for Coloradans who buy their own health insurance coverage.
“I am happy that so many of our customers will be seeing premium decreases,” said Connect for Health Colorado CEO Kevin Patterson. “But I remind everyone that it is still important to look at all your options. Things change and the best value for your family in 2019 could be different than what it was in 2018. We have tools to evaluate the whole cost of coverage and compare offerings side-by-side. I urge everyone to use them when they renew or shop for new coverage in 2019.”
Analysis shows that three out of four of Coloradans who bought their health insurance with financial help through the Marketplacethis year will have an option for health insurance with a net premium (after financial help) less than $50 per month in 2019. Two out of three of the more than 100,000 Connect for Health Colorado customers who qualify for financial help will be able to find a bronze level plan for $0 net premium. Bronze level plans are the lowest premium tier but come with higher deductibles and other out of pocket costs than silver and gold level plans.
“The news is just as good for new customers coming to Connect for Health Colorado for 2019,” Patterson said. “Those who qualify for financial help will, on average, see their premiums reduced by 80%.”
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Department Contacts & Resources
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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).
For further information about this policy, to request free disability and/or language aids and services, or to file a discrimination complaint, contact:
504/ADA Coordinator
1570 Grant St
Denver, CO 80203
Phone: 303-866-6010, Fax: 303-866-2828, State Relay: 711
Civil rights complaints can also be filed with the U.S. Department of Health and Human Services Office for Civil Rights electronically through the
Office for Civil Rights Complaint Portal
or by mail, phone, or fax at:
1961 Stout Street Room 08-148
Denver, CO 80294
Telephone: 800-368-1019, Fax: 202-619-3818, TDD: 800-537-7697
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Colorado Dept. of Health Care Policy & Financing
(303) 866-2993 | 1570 Grant Street, Denver, CO 80203
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