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Upcoming Events and Helpful Resources
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| Health First Colorado videos for use in waiting rooms and other areas members visit are available for download on our website. |
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 webpage.
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 & Financing jobs.
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Welcome to the July 2019 edition of
At a Glance!
Thank you for your interest!
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| A Message from the Executive Director |
Over the past five years, the Department has implemented multiple initiatives to combat overprescribing and excess opioid utilization within Health First Colorado. These initiatives, along with provider education and heightened public awareness of the opioid crises, have resulted in a more than 50 percent reduction in the number of opioid units dispensed to Health First Colorado members and a 44 percent reduction in the number of members using opioids from January 2014 - December 2018.
Some of our Department initiatives over the past five years include:
- Tightened criteria on short-acting opioids and added quantity limits
- A pain resource webpage with information on opioid use/misuse, pain assessment guides, risk assessment tools and methods to reduce opioid use safely and effectively
- A Chronic Pain Disease Management Program to help train providers in appropriate use of opioids
- Limiting initial prescription fills to a 7-day supply and limiting the member to two refills
- Reducing the daily maximum dose from 300 MME/day to 200 MME/day.
- Implementing a dental opioid policy limiting members to three, four-day prescription fills
Our press release includes a year by year evolution of our opioid policy intended to combat addiction and opioid overprescribing. In 2020 the Department will launch a tool for all providers to help them reduce the chances of addiction among their patient populations. The tool is being designed in collaboration with physician groups, insurance carriers and stakeholders.
Together, we are tackling excess opioid utilization, which is protecting our members from the devastating consequences of addiction while ensuring access to proper pain management therapy.
Thank you for your partnership as we work to make Colorado the healthiest state in the nation.
Kim Bimestefer
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Entering Temporary Census Income - Medical Assistance
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This memo is intended to provide guidance for eligibility sites on how to receive and enter temporary census income for medical assistance cases. The memo provides a step-by-step guide on how to enter temporary census income into the Colorado Benefits Management System (CBMS) and will help ensure that the income is applied correctly for eligibility purposes.
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Medical Assistance Sites Update
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Over the past two years we have been working with the Centers for Medicare and Medicaid Services (CMS) to gain approval on enhanced funding for Medical Assistance (MA) sites. During this process, questions regarding MA roles and responsibilities have been discussed. According to 42 C.F.R. § 431.10, the Department can delegate authority for eligibility determinations to governmental entities with merit-based employees. Most MA sites do not meet this regulation. The good news is that we can comply with federal regulations and continue a partnership with MA sites with a few modifications:
- We will reclassify MA sites as out-stationing sites.
- We will rename the sites; the new name is still to be finalized.
- Roles, responsibilities, and contracts will be modified to meet federal requirements. This includes limiting MA sites to only accepting and processing intake applications within CBMS.
We are exploring the use of PEAKPro (PEAK Professional) to help support MA sites with ongoing case maintenance (Add a Baby, address changes, verification requests, Report My Changes, and RRRs). PEAKPro is designed to allow sites to process ongoing maintenance eligibility requests. We are optimistic that PEAKPro may support MA sites with some of the ongoing maintenance needed to serve our members. However, the member modules within PEAKPro have not been utilized and operationalized with any sites. Based on this, we will be performing a pilot phase to fully understand how this may be integrated for MA sites to use.
These changes are tentatively scheduled to take place fall/winter of 2019. This will allow us time to complete the pilot, provide training, provide clarity on roles and responsibilities, and execute new contracts. We are committed to communicate promptly once we have additional information to share.
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Recovery Audit Contractor Program
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The Department has contracted with Health Management Systems, Inc. (HMS) to serve as its Recovery Audit Contractor (RAC) to conduct post-payment reviews of claims submitted for fee-for-service and managed care services. This is a federally-mandated contract program.
In February of 2018, HMS began audits to identify overpayments and assist the Department in recovering any overpayments made to providers for Health First Colorado (Colorado's Medicaid Program) and Child Health Plan
Plus
(CHP+) medical claims.
The RAC audits claims from as far back as 7 years (84 months) from the date the claim was originally paid, and this lookback period applies to all claim and provider types.
All providers are encouraged to update their contact information using the HMS RAC Provider Portal, even if they have not received a letter that they are in an active audit. This is separate from the DXC Technology (DXC) Provider Web Portal.
Updating contact information ensures letters get to the preferred address and personnel. Providers who have access to the HMS Provider Portal already for other contracts will need to register for HMS RAC Provider Portal to have access to the RAC audit information. The HMS RAC Provider Portal is a tool that providers can use to track the progress of their audits and add contact information that is specific to RAC correspondence.
If a provider does not update address and contact information in the HMS portal, all correspondence will go to the provider's service address listed in the Colorado interChange. Providers can access the HMS RAC Provider Portal and update contact information.
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Inpatient Hospital Review Update
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Under Senate Bill 18-266 Controlling Medicaid Costs, the Department was charged with implementing a hospital review program to ensure that the utilization of hospital services is based on a recipient's need for care.
The goals of the inpatient hospital review program include:
- Improving Health First Colorado members' quality of care
- Facilitating better care planning and care transitions
- Ensuring services occur in appropriate care settings with the optimal stay length based on members' needs
- Monitoring hospitals to assure appropriate billing practices
- Providing timely, accurate information and tools to partners who can then reach out to high-needs members
The Inpatient Hospital Review Program (IHRP) successfully started reviewing inpatient admissions in March. As a reminder to providers, as of June 17, 2019, approvals must be in place for inpatient claims requiring prior authorization to be paid.
IHRP resources can be found on the
Department website. Questions may be directed to the Utilization Management team overseeing the IHRP at
[email protected].
In addition, providers may inquire directly to the Department's Utilization Management vendor, eQHealth Solutions' customer service at 888-801-9355.
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Hospital Transformation Program Update
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HTP Stakeholder Engagement Forum
The Department will host an HTP Stakeholder Engagement Forum to give all those involved in the program an opportunity to provide feedback to the CHASE Board as well as Department staff. Details about the forum will be forthcoming in the HTP Newsletter. If you're interested in participating in the HTP Stakeholder Engagement Forum,
please fill out this form.
State Plan Amendment vs. 1115 waiver
After multiple conversations with the Centers for Medicare and Medicaid Services (CMS) over the past several months, the Department expects to move to a State Plan Amendment (SPA) for the initial implementation of the developed Hospital Transformation Program (HTP) components. CMS guidance to the state is to utilize existing federal authority where possible. Most of the program's current recommended framework may be accomplished under the State Plan authority and the Department will seek to utilize waiver authority for more targeted areas of the program that cannot be accomplished under State Plan authority. While the HTP federal authority vehicle is expected to change, no revisions to the program framework or mechanisms are being proposed. Additional information about this potential change can be found on the HTP website.
Update on HTP timeline
The Department is committed to giving program participants and hospitals as much information as possible regarding the rollout and timing of HTP implementation. As we know you are eager for projected deadlines on program items, we are working diligently to formalize a document, that will be shared publicly, outlining the timeline of the remaining HTP development. The timeline will be shared with program participants and stakeholders by the end of July in the HTP Newsletter.
HTP Newsletter
Those interested in email updates about the HTP should sign-up through the HCPF website for the HTP Newsletter. To complete the sign-up process, enter your contact information and click the "Hospital Transformation Program" box.
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Alternative Payment Model: Next Steps for State Innovation Model Practices
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The Department's
Alternative Payment Model (APM) provides a prime example of how the State Innovation Model (SIM) has prepared providers for success with reimbursement that rewards the value (instead of volume) of health care delivered.
While practices participating in SIM and the Comprehensive Primary Care Plus (CPC+) initiatives were not required to select measures for this APM for the 2019 performance year, SIM-participating practices must select 10 measures for the second performance year (2020) before December 31. Practices participating in CPC+ get an additional year of credit in the APM model without the need to select measures this year.
As background, only primary care medical providers who reach the $30,000 Health First Colorado billing threshold are eligible for this APM. More information is in the
Primary Care Alternative Payment Model Survival Guide, which includes an APM measure point estimator with all measures as well as a full explanation of goals and timeline.
An FAQ is also available with helpful tips and information.
The Department frequently cites use of electronic clinical quality measures (eCQM) as a key component for success with the APM and the SIM-funded eCQM solution can be used for practices to report measures. Stay tuned for more information from the Department and the Office of eHealth Information (OeHI), which is assuming oversight of the tool after SIM ends July 31.
Department representatives will reach out to practices to provide clarity on the process of selecting measures and to field questions about the measure selection survey. Questions about measure selection should be directed to
designated regional accountable entities.
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Partnerships to Improve Population Health
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State Innovation Model: Free Resources for Health Care Teams
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The
Colorado State Innovation Model (SIM), which worked with 25 percent of the state's primary care practices and four community health centers during a four-year time frame, ends July 31. And while the federally funded, Governor's office initiative ends this month, resources created with SIM funding will be available to all providers free of charge through the SIM website, which will be maintained as an archive for one year.
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Delivery Systems Innovation
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| Substance Use Disorder Benefit Update |
Waiver Application
The Department is in the process of finalizing the waiver application and is in regular communication with the Centers for Medicare and Medicaid Services (CMS) to obtain feedback on program design and ensure the waiver submission aligns with federal requirements. The Department plans to submit the waiver application to CMS in October, following the public notice and comment period in August and September.
Public Comment Period
The Department invites the public to provide comments on the waiver application during the upcoming public comment period. Following the public comment period and prior to submission, the Department will review and assess all public comments, and amend the waiver application, if appropriate. Please visit the Ensuring a Full Continuum of SUD Benefits webpage for additional information coming soon regarding the public comment submission process, public hearings, and the proposed Section 1115 Waiver Demonstration Application for public comment.
Substance Use Disorder System and Benefit Implementation Planning
Department staff have begun working on system changes that, when introduced in 2020, will allow for billing of services. The Department met with state criminal justice partners to discuss the intersection of the newly covered services and the population involved in criminal justice, and continue to work with the Colorado Office of Behavioral Health on matters related to implementation, including assessment requirements and licensure alignment with American Society of Addiction Medicine (ASAM) treatment criteria.
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| e-Consults Increase Patient Access to Care and Save Money |
Delivering the right type of care when and where patients need it is a key driver for care teams to use e-Consults. This approach allows health
care providers to consult remotely with specialists through secure platforms to exchange health information and discuss patient care. Typically, e-Consults are initiated in primary care settings and physicians involved in the consultations send written reports to a patient's treating/requesting provider with recommended treatments or referrals for care delivery.
One health system engaged in the Transforming Clinical Practice Initiative (TCPi) will be showcased for its e-Consult pilot program during a national conference in August. Denver Health implemented the pilot in six specialty clinics using TCPi resources and, as a result, avoided nearly 2,500 unnecessary specialty care visits. A total of 86 percent of these e-consults eliminated the need for in-person follow ups, which resulted in an estimated savings of more than $2 million. Hear more from the people at Denver Health, who are engaged in the work and will travel back east for the TCPi conference in this video.
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The Colorado Department of Health Care Policy & 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
