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 Road to Transformation
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The left-hand margin of the newsletter provides links that will allow you to learn more about CBMS Transformation:
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ACC Phase II Update & New County Resources
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The next iteration of the Accountable Care Collaborative (ACC) began July 1, 2018. As a reminder, the Department has published resources and guidance for providers, members, and other interested parties on
CO.gov/HCPF/ACCPhase2
.
Updated Frequently Asked Question for Counties
The Department has updated our ACC Phase II frequently asked questions (FAQs) for counties based on questions and feedback from County Directors. The FAQs are posted on the
ACC Phase II website here
. The FAQs are not intended to be comprehensive and we encourage County Leadership to see all resources available on
CO.gov/HCPF/ACCPhase2
.
Member Attribution Update
Health First Colorado members began receiving letters indicating a member’s primary care provider, managed care plan and/or regional organization attribution and enrollment. Information about the letters can be found on our Member Messaging Resource Center on
CO.gov/HCPF/ACCPhase2
.
Through ongoing communications with our partners and contractors, the Department has identified a handful of issues that may have contributed to some members being attributed to the incorrect primary care medical provider (PCMP). We are working to address these issues at the individual and system level.
Health First Colorado members are encouraged to continue to contact the Health First Colorado Enrollment to change their primary care provider at 1-888-367-6557. State Relay: 711 for callers with hearing or speech disabilities. Call Monday to Friday, 8 a.m. to 5 p.m.
Foster Care Attribution Resources
All foster care children who are eligible for Health First Colorado will be assigned to a PCMP and regional organization. Members, including foster care children, will be automatically attributed to a PCMP in this way:
- Utilization: An ACC member that has a claims history with a PCMP over the last 18 months will be automatically attributed to that practice. Specifically, the member will be attributed to the practice location associated with the billing address on the claims.
- Family Connection: A member that has no history with a PCMP will be attributed to a practice where someone in their household has a history, if the practice is appropriate. For example, an adult will not be attributed to a pediatric practice.
- Proximity: If an ACC member cannot be attributed based on either utilization or family connection, the member will be attributed to the closest appropriate PCMP in the member’s region.
For more information on the attribution/assignment process for foster care children enrolled in Health First Colorado, see our
fact sheet
.
Member Communications
The Department has developed a Member Messaging Resource Center for our partners on
CO.gov/HCPF/ACCPhase2
. This resource center will provide you the latest information and messaging for Health First Colorado members related to the ACC. We will regularly add to the resource center, so check back often.
Transition of Care Policy
Per 42 CFR 438.62, the Department must have in effect a transition of care policy to ensure members with special health care needs have continued access to services during a transition from fee-for-service (FFS) or from one Managed Care Entity (MCE) to another MCE. For more information, see the Department's
Transition of Care Policy
on the
ACC Phase II page
or the
Regulatory Resource Center
.
What Home and Community Based Service Providers Need to Know
The implementation of ACC Phase II does not change the way Home and Community Based Service (HCBS) services are provided and how HCBS providers get paid. HCBS providers may continue rendering care and services to the Health First Colorado members they currently see. A member's attribution to a primary care provider does not prevent HCBS providers from rendering care and services. If a member would like to change their primary care provider, they should contact Health First Colorado Enrollment at 303-839-2120, 1-888-367-6557 (outside of Denver), Monday-Friday, 8:00 a.m. to 5:00 p.m.; State Relay: 711 for callers with hearing or speech disabilities.
Member Enrollment in Kaiser Permanente
Kaiser Permanente has changed its participation with Health First Colorado. As of July 1, 2018, Kaiser Permanente will no longer serve as a Medicaid Primary Care Medical Provider (PCMP) outside of the Denver and Boulder area. Kaiser Permanente has chosen to not contract as a PCMP with the following regional organizations: 1,2,4, and 7.
In late June, Kaiser Permanente sent letters to approximately 5,600 impacted Health First Colorado members enrolled with Kaiser Permanente notifying them of this change. The impacted Kaiser Permanente members were disenrolled from Kaiser Permanente effective June 30, 2018. Impacted members were assigned a new PCMP and regional organization following the Department's attribution methodology, see our
fact sheet
and
FAQs
for more information. Members will be notified of this assignment through a letter from Health First Colorado Enrollment.
Primary Care Medical Provider Panel Limits/Caps
Primary care medical providers (PCMPs) have the ability to set their own panel limit/cap on the number of Health First Colorado members that can be attributed to them, but are not required do so. PCPMs can maintain an open panel with no limit. If a PCMP chooses to have a panel limit/cap and reaches this limit, the PCMP will not receive any additional attributions, including claims history, geographic attributions or member choice.
Updated Member Handbooks Online Now
Health First Colorado member handbooks in English and Spanish have been updated to reflect the transition to regional organizations. Members can find the
handbooks on HealthFirstColorado.com
and can request a hard copy handbook by calling Health First Colorado Enrollment if they have any questions regarding their letter at 1-888-367-6557. State Relay: 711 for callers with hearing or speech disabilities. Call Monday to Friday, 8 a.m. to 5 p.m.
Common Member Questions
Can I enroll in regular Health First Colorado?
You are enrolled in regular Medicaid. From now on all Health First Colorado Members are assigned to a primary care provider and a
regional organization
. Members still have their choice of primary care provider. In addition, members may see Health First Colorado providers of their own choosing even though they are assigned to a primary care provider and regional organization.
If you want to change your primary care provider you can do so at any time by calling Health First Colorado Enrollment at 1-888-367-6557. For TDD/TTY, call 888-876-8864. Call Monday to Friday, 8 a.m. to 5 p.m. The call is free.
Why do I need to have a primary care provider?
Health First Colorado thinks it is important for all members to have a primary source of medical care to help a member understand and coordinate their health needs. All members of Health First Colorado are now required to have an assigned primary care provider and a
regional organization
. Members still have their choice of primary care provider. In addition, members may see Health First Colorado providers of their own choosing even though they are assigned to a primary care provider.
If you want to change your primary care provider you can do so at any time by calling Health First Colorado Enrollment at 1-888-367-6557. For TDD/TTY, call 888-876-8864. Call Monday to Friday, 8 a.m. to 5 p.m. The call is free.
Submitting Questions
At this time, we ask that members, providers and other interested parties start by contacting their RAE if they have questions. In addition, interested parties can submit their questions to the Department using this
form
.
The Department will not be able to respond directly to all inquiries but will direct questions to the appropriate entity while we work closely with the RAEs and other contractors to address critical issues. The Department will continue to use the questions submitted to tailor upcoming communications and resources.
Key Resources
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Annual Activities Report for Client Fraud Investigation
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The Department is required by law to report yearly Medicaid member fraud recoveries and overpayments to the state legislature. The report is due every year detailing fraud for the previous state fiscal year. Now that the state fiscal year is over, please remember to send in the completed form by
July 31, 2018.
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Retroactive Updates to Eligibility Spans
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Effective June 12, 2018, the Bridge will reflect retroactive updates to eligibility spans which include Home and Community Based Services (HCBS) member eligibility.
This update will help resolve member eligibility mismatches between the Colorado Benefits Management System (CBMS) and the Bridge, which will help with the finalization of HCBS Prior Authorization Requests (PARs). Case managers should check the Bridge to verify HCBS PARs can now be finalized.
Case managers should take the following steps to finalize any impacted Prior Authorizations (PAs):
- Review all PAs suspending for eligibility issues
- Check the “Current Benefit Plan” field to see if updates from CBMS changed member eligibility
- If eligibility issues have been corrected, select “Check Limits” and “Submit PPA”
- The next business day, verify the PA processed through the Colorado interChange and has a status of “Approved”
There could be instances where the data in CBMS does not match the data in the Bridge. If an eligibility does not appear in the Bridge after two business days, but has been confirmed as processed by the county technicians, please email
HCPF_BPA-CBMSMismatch@state.co.us
with the necessary CBMS screenshots documenting member eligibility.
Although this change will help resolve PA issues, case managers are still responsible for communicating with the county regarding members’ financial and functional eligibility.
As a reminder, providers must verify member eligibility for Health First Colorado (Colorado’s Medicaid Program) and Child Health Plan
Plus
(CHP+) prior to rendering services and submitting claims.
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HCPF Department Updates - Informational
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Memos and Department Communications
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Operational Memos –
Informational Memos –
Communication Briefs –
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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 MSB.
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Quarterly Update:
Conflict Free Case Management
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In 2017, the Colorado General Assembly passed HB17-1343 to implement Conflict-Free Case Management (CFCM) for individuals with intellectual and developmental disabilities in Colorado. Implementing CFCM per HB 17-1343 requires separation of case management from the provision of direct services from the same agency for the same individual.
Single Entry Point (SEP) Agencies HB 18-1288 did not pass the Senate committee and therefore did not become legislation. However, there are four SEP agencies providing both case management and direct services to the same individual. The Department is working with those SEPs to come into compliance with federal regulation.
Case Management Agency and Case Manager Qualifications
The Department is working to redesign case management for individuals enrolled in a Home and Community Based Services waiver. Part of this work includes developing new qualifications for Case Management Agencies and Case Managers. In May and June 2018, the Department presented proposed final qualifications at eight regional stakeholder meetings and two statewide webinars. The Department will finalize these qualifications in June and July before presenting to the Medical Services Board.
What is next:
- The Department will continue to send out Quarterly communications.
- The Department expects to present the Case Management Agency and Case Manager qualifications to the Medical Services Board in late summer or early fall 2018.
- Beginning July 1, 2018 the Department is receiving and reviewing Business Continuity Plans (BCP).
Conflict-Free Case Management Updates
The Department received rural exception requests on July 1, 2017. Upon review the Department has submitted rural exception requests via waiver amendments to the Centers for Medicare & Medicaid Services (CMS) for the 10 CCBs requesting the exception. The Department is working closely with CMS to gain approval. If CMS approves the rural exceptions, the Department must demonstrate to CMS how the state will mitigate the conflict of interest issues.
Each CCB must submit a Business Continuity Plan (BCP) that indicates which of the four CFCM options it selects and details both its plans for transitioning to compliance with CFCM and the timeline for meeting the Department's deadlines. BCPs were due to the Department July 1, 2018.
While HB 17-1343 is specific to case management for individuals with intellectual and developmental disabilities through CCBs, the Department is working to remediate conflict of interest in case management for all individuals enrolled in an HCBS waiver.
Redesign Updates
In November 2017, the Department conducted stakeholder engagement meetings throughout the state to present the recommended Case Management Agency and Case Manager Qualifications. These qualifications were based on research of other states including Colorado. The qualifications were revised based on additional feedback from an informal comment period and stakeholder engagement meetings held in the Spring of 2018. The final qualifications will be used to amend the HCBS waiver agreements, the State Plan, and Department regulations. The Department plans to present these qualifications to the Medical Services Board by the end of this year.
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County Grant & County Incentives Programs
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FY 2017-18
- Status Reports on which Incentives were met for FY 2017-18 were sent on July 16, 2018
- Counties have a 10 calendar day period to dispute the Incentives results; disputes are due by 3pm on Wednesday, July 25, 2018
- Once the dispute period is closed, counties will receive final FY 2017-18 Status Reports that will include final Incentives payments earned
FY 2018-19
The Department has released guidance regarding implementation of the FY 2018-19 County Incentives Program:
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- The County Team will schedule Quarter 1 check in calls within the next week
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Timeliness for all Medical Assistance
applications
was measured at
97.09 percent
. The Department and its county partners have registered 48 consecutive months above 95 percent timeliness.
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Timeliness for all Medical Assistance
redeterminations
was measured at
98.83 percent
. The Department and its county partners have registered 28 consecutive months above 95 percent timeliness.
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Connect for Health Colorado
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New Eligibility System (NES)
Connect for Health Colorado (C4HCO) is reaching out to let you know that we are developing a New Eligibility System (NES) for this coming open enrollment period. We are working closely with the Department of Health Care Policy and Financing (HCPF) and the Governor’s Office of Information Technology (OIT) on
functionality changes and engaging various stakeholder groups, including county representatives, on communications and change management.
In an effort to keep you informed, we have created a one-page
Fact Sheet
for your reference (attached). We encourage you to print this out and keep it handy in case questions from clients or customers arise. Some highlights include:
What NES is:
- C4HCO is developing a separate eligibility system for Advanced Premium Tax Credits and Cost Sharing Reductions.
- The system will be funded, developed, and maintained entirely by Connect for Health Colorado.
- It will be implemented by November 1, 2018 (for Plan Year 2019).
- Only minor changes to PEAK language and CBMS client correspondence will be made.
What NES is not:
- Changing eligibility rules and guidelines.
- Being funded by Federal or State dollars.
- Requiring county workers to do additional work when processing in CBMS.
Why we are doing it:
- Streamline the customer experience.
- Continue to meet federal compliance obligations.
- Control system enhancements and troubleshooting with more speed and flexibility.
If you have any questions, please contact Jessica Smith at
jsmith@c4hco.com
or visit the
NES webpage
dedicated to the most current information.
New Eligibility System Training
C4HCO will host four 30-minute training webinars including a Q&A session at the end. Dates/Times of the webinars are as follows:
Wednesday, September 26, 2018:
- 9:00-9:30 a.m.
- 3:30-4:00 p.m.
Wednesday, October 3, 2018:
- 9:00-9:30 a.m.
- 3:30-4:00 p.m.
Webinars will be recorded and posted on CO.Learn for those who cannot attend.
These training hours will count towards the HCPF County Incentives.
Specific links/call-in information for these webinars will be sent out via CBMS communication and CHSDA Roundup emails in September. Please reach out to Jessica Smith at
jsmith@c4hco.com
with any questions.
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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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