General Assembly Newsletter
Stay up-to-date on what's new at the Department of Health Care Policy & Financing with this newsletter created specifically  for the  Colorado General Assembly. 
Editor's Note

As a reminder, this newsletter is published on a quarterly basis outside of the legislative session. We will return to monthly publishing during the next legislative session, beginning January 2020.

Please continue to direct any questions or constituent issues to the Department of Health Care Policy & Financing (the Department) legislative team:
Proposal for Affordable Coverage Option HB19-1004 Implementation

Today, Nov. 15, the Department and the Colorado Division of Insurance will submit the final report proposing a public option for Colorado to the General Assembly. The proposal takes into account months of extensive stakeholder engagement. Throughout the engagement process, the Department received 260 public comments, hosted 20 stakeholder engagement sessions and conducted three focus groups. The report will be publicly available on our Proposal for Affordable Health Coverage Option webpage.

Section 1115 Substance Use Disorder (SUD) Waiver Application

In October, the Department submitted Colorado's Section 1115 SUD demonstration waiver application to the Centers for Medicare and Medicaid Services (CMS). As the next step in the process, CMS will post the application for a 30 day federal comment period. The Department is in the process of developing its implementation plan as required by CMS. The Department is also mapping treatment demand and capacity across the state. As part of the capacity development process, the Department will host a statewide series of meetings from December 2019 through February 2020. These meetings will be an opportunity for the Department to share data on capacity with stakeholders and receive feedback about local needs related to SUD treatment. Additional information regarding the meetings will be posted on the Department's SUD webpage.   

Dental Coverage for CHP+ Pregnant Women

As of Oct. 1, 2019, dental services are available for Child Health Plan  Plus (CHP+) prenatal women who will now benefit from the same services provided for current CHP+ children except for orthodontics (braces). These benefits include: 
  • Diagnostic services (exams and x-rays)
  • Preventive (fluoride, sealants and cleanings)
  • Basic restorative services (fillings)
  • Endodontic (root canals)
  • Emergency dental services
The annual maximum allowable is $1,000 per calendar year (Jan. 1 through Dec. 31) while the member is eligible and enrolled. 
 
CHP+ prenatal women will not be charged co-payments for dental services. Members can contact DentaQuest at 1-888-307-6561, State Relay: 711 or via email through the Member Access Portal. Providers can contact the DentaQuest Provider Relations Representative in their region for more information. 

Hospital Transformation Program (HTP)

1115 Demonstration Application 

Beginning Nov. 10, the Department began engaging stakeholders, through public comment and public hearings, for the waiver component of the HTP. The waiver will be submitted to the Centers for Medicare and Medicaid Services (CMS) on Dec. 31 and a specific section on the HTP website was created to serve as an information hub for all component updates and documents. 


Public Comment

The public notice pertaining to the HTP was published Nov. 10 to the  Colorado Register Upon publication, the Department alerted stakeholders via email and will accept comments and inquiries until 5 p.m. Sunday, Dec. 15. During the public comment period, comments may be submitted to COHTP@state.co.us or by mail to Special Financing Division Director, Colorado Department of Health Care Policy & Financing, ATTN: Public Comment - HTP DSRIP, 1570 Grant St., Denver, CO 80203.
 
Public Hearings

The Department invites stakeholders to attend public hearings in person or join by teleconference/webinar to learn more about Colorado's 1115 Demonstration application and provide comments. A list of public hearings can be found on the HTP Waiver website .

If you'd like to know more about the HTP, we encourage you to visit the HTP website as well as read past editions of the HTP Newsletter in the online archives If you have additional questions, please contact Courtney Ronner, Hospital Relations and Communication Manager, at 303-866-2699

PROMETHEUS

Working with several vendors, the Department has developed Tableau dashboards to measure potentially avoidable complications (PACs) in care occurring in hospitals, primary care settings and throughout the health care delivery system using the PROMETHEUS model. The dashboards highlight areas of opportunity to improve care by looking at episodes of care for various conditions and procedures. The Department has distributed PROMETHEUS dashboards to Regional Accountable Entities (RAEs), which are crafting project plans to reduce the potentially avoidable complication rates for disease episodes occurring in their region. It has also distributed updated dashboards to hospitals in anticipation of the first year of the HTP occurring in the spring.

Electronic Visit Verification Updates

The Department continues to work toward implementation of Electronic Visit Verification (EVV), a system which electronically verifies that home- or community-based service visits occur by tracking six points of data (including type, date and location of service; individuals receiving and providing the service; and time the service begins and ends). The Centers for Medicare and Medicaid Services (CMS) recently approved the Department's request for a  Good Faith Effort Exemption to delay the EVV mandate in Colorado. The purpose of this delay is to allow time for the Department to operationalize an exemption for live-in caregivers, as permitted by CMS in a recent informational bulletinThis exemption will omit live-in caregivers from the Colorado EVV mandate. Individual providers may choose to collect EVV data from live-in caregivers.

With the Good Faith Effort Exemption approval, the Department will not mandate the use of EVV on Jan. 1, 2020. A new date for the EVV mandate will be communicated to stakeholders in early 2020. The Department anticipates mandating EVV in summer 2020. 

From now until when the EVV mandate is effective, the EVV project is in a soft-launch period. During this time, providers may begin to verify service provision through EVV and transmit data from the State EVV Solution or a Provider Choice System to the Department. Until EVV is mandated by Colorado Code of Regulation Rule, participation in EVV is voluntary. However, the Department strongly recommends that providers and caregivers participate in EVV during the soft-launch, as it is an opportunity to:
  • Test and interface Provider Choice Systems.
  • Familiarize providers with EVV prior to claims integration. Claims will continue to pay and EVV errors will appear on remittance advice.
  • Inform policy and system development for the exclusion of live-in caregivers.
  • Help the Department identify and develop supplemental training materials.
  • Facilitate EVV participation by caregivers and members.
The Department will continue to update stakeholders on the project timeline over the coming months. Please continue to attend stakeholder meetings to provide feedback to the Department and stay up-to-date on project developments.

For more information, please visit our EVV website

Non-Emergent Medical Transportation (NEMT) Update

IntelliRide is managing all Health First Colorado Non-Emergent Medical Transportation (NEMT) services as of Sept. 1, 2019.

IntelliRide serves these counties:
  • Adams
  • Arapahoe
  • Boulder
  • Broomfield
  • Denver
  • Douglas
  • Jefferson
  • Larimer
  • Weld
Since the transition, IntelliRide has experienced higher than normal call volumes and hold times. The Department is working closely with IntelliRide, providers and members to resolve individual issues as quickly as possible. IntelliRide has doubled the number of required call center agents for both the phone and chat feature, and allowed call centers in other states to take calls from Colorado. IntelliRide can be reached at 1-855-489-4999.

IntelliRide is asking that callers:
  • Listen carefully to phone tree options.
  • Wait to call for rides that are more than a week away. This will lower call volume and help to prioritize members with immediate transportation needs.
  • Provide specific details (member name and Health First Colorado ID, date and time of incident, and destination) when registering a complaint.
  • Consider scheduling rides using IntelliRide's website.
The Department and IntelliRide are working diligently to make sure members can get to and from appointments without a disruption in services.
For more information, please contact NEMT@State.co.us.

Employment First Update

The Department has made several strides in making Employment First a reality for individuals with Intellectual and Developmental Disabilities. In 2018, the Department received budget action to design and implement a Supported Employment Incentive Payment Pilot Program. This program will improve Competitive Integrated Employment outcomes for individuals in the Home and Community-Based Supported Living Services waiver and the Developmental Disabilities waiver.
 
The Department received the funding in Fiscal Year 2019-20 and has worked diligently to progress this work. Currently, the Department has been going through the hiring process to build the team that will manage the implementation of the pilot, and the development of a value-based payment structure that is based on best practices learned from other states.
 
In addition, the Department is also supporting providers in becoming certified in the Supported Employment model, Customized Employment. Customized Employment will be used in the pilot and has a track record of supporting individuals with the most significant disabilities with success in Competitive Integrated Employment. 

For more information, visit the  HCPF Employment First  webpage or the statewide Employment First Advisory Partnership webpage. 

The Colorado National Provider Identifier (NPI) Law

The Colorado NPI Law , mandated by House Bill (HB) 18-1282, requires newly enrolling and currently enrolled Organization Health Care Providers (not individuals) to obtain and use a unique and separate NPI for each service location and provider type enrolled in Colorado's Medicaid program. 
 
The rule supporting the Colorado NPI law was presented to the Medical Services Board (MSB) for initial approval Sept. 13 and passed by unanimous vote. It was presented again to MSB for final approval Oct. 11 and passed by unanimous vote. This rule will be effective Nov. 30.

HCPF Submits New Reports & LRFIs to the General Assembly

HCPF submitted new reports and Legislative Requests for Information (LRFIs) to the General Assembly since the last newsletter, all are on the Legislator Resource Center page:
Medicaid Snapshot and County-by-County Resources

These County Fact Sheets provide an annual snapshot by fiscal year for Colorado's Medicaid program activity including average annual caseload and top five claim types for each county.
Legislator Resource Center

The  Legislator Resource Center  on our website is available to help legislators and legislative staff easily find information. It includes links to reports, fact sheets and overviews of the budget process to help inform legislators.
Follow HCPF on Social Media

We invite legislators to follow us on social media to stay informed of news and happenings at the Department. You can follow us on Facebook , Twitter and LinkedIn
Colorado Department of Health Care Policy & Financing  
(303) 866-2993 | 1570 Grant Street, Denver, CO 80203
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