In October 2019, there were 1,216,214 Coloradans enrolled in Health First Colorado and 77,440 enrolled in
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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 November 2019 edition of
At a Glance!
Thank you for your interest!
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| A Message from the Executive Director |
This month, I want to address the third pillar of our Department Performance Plan:
Improving Member Health.
Improving member health is a core focus for the Department. It transcends almost every aspect of what we do - from the creation of new policies and cost control initiatives, to our emerging analytics innovations, and how we will measure our partners' performance going forward. Even our mission is being modernized to reflect the importance of improving member health.
Look for an emerging health score in Q1 of 2020 from the Department that will provide better insights into member health by individual, by the Primary Care Practices assigned to care for our members, by Regional Accountable Entities which take accountability for the programs that improve their health and the like. Measuring and improving health is what you will see from the Department in 2020.
This vision builds upon this fiscal year's Department Performance Plan goal: develop a health score for every member so we can better serve them. Each Health First Colorado (Colorado's Medicaid program) member is an individual and we use data and analytics to learn how to best serve our members while ensuring the most effective use of limited resources.
The entire performance plan, including more detail on the five pillars and how we measure progress is available
on our website
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Thank you for your partnership and dedication to our members and their health.
Kim Bimestefer
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| Connect for Health Colorado Open Enrollment Resources |
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Connect for Health Colorado (C4HCO) Open Enrollment begins November 1, 2019, and ends January 15, 2020.
Please send all your C4HCO related requests via email
. This inbox is dedicated to county eligibility workers.
Please remove all C4HCO inboxes from previous Open Enrollments, including the Case Transfer inbox from your email, and use only the
County Partners Inbox
, as the others are now inactive.
Please only send one case per email. We cannot process email requests that have more than one case included.
Free resources are available to you through C4HCO's Online Store. Simply create a login and shop for materials such as posters, brochures, and financial help charts. Materials will be mailed to your office at no cost. This resource is available to you year-round.
Free, in-person help is available from our certified C4HCO enrollment experts located throughout the state. If anyone in the community you serve needs help, you can refer them to one of our experts to ensure they get the right health insurance coverage and financial help. Find assistance in your area.
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Reminder for Providers: Billing Procedures
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Providers cannot bill members for the difference between commercial health insurance payments and their billed charges when Health First Colorado (Colorado's Medicaid Program) does not make additional payment. The provider also cannot bill members for co-pay or deductibles assessed by Third-Party Liability (TPL) (commercial insurance).
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Reminder for Providers: Load Letters
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The purpose of the load letter is to allow providers to submit claims outside of the timely filing period if the member was retroactively enrolled. Load letters will only be granted for cases where the member's eligibility was backdated.
The load letter is not intended to provide proof of eligibility.
If the member was enrolled on the date of service but failed to inform the provider of existing coverage, the provider must obtain that information within 365 days.
The Load Letter Request Form is available under the Claim Forms and Attachments drop-down list on the
Provider Forms webpage. All load letter requests should be faxed to the Department at 303-866-2082 or sent via encrypted email to
[email protected] with the subject line "Load Letter Request." Do not use the member's State ID in the subject line.
Requests will not be granted if the member has a commercial insurance (third-party liability) as primary. All claims where the member has commercial insurance must be paid within 365 days.
If a load letter is issued by the Department, providers have 60 days from the date of the load letter to submit the claim with the attached form for review by the fiscal agent. Claims should be submitted via the Provider Web Portal and not on paper.
For all other questions related to timely filing, refer to the
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No Co-Pays for Child Health Plan Plus Prenatal and Postpartum Dental Services
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Dental services are now available for pregnant Child Health Plan Plus (CHP+) members, during pregnancy and for 60 days after delivery.
As with all CHP+ prenatal and postpartum benefits, members will not have co-pays for dental services.
Members can contact DentaQuest at 1-888-307-6561, State Relay: 711, or via email through the Member Access Portal for more information about their benefits.
Providers can contact the DentaQuest Provider Relations Representative in their region for more information:
Northeastern Colorado
303-386-6752
Southeastern Colorado
Central/Metro Denver
720-614-2859
Western Slope
970-210-6395
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Hospital Transformation Program Update
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1115 Demonstration application
Beginning November 10, the Department began engaging stakeholders, through public comment and public hearings, for the waiver component of the Hospital Transformation Program (HTP). The waiver will be submitted to the Centers for Medicare and Medicaid Services (CMS) on December 31, 2019 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 HTP was published on November 10, 2019 to the
Colorado Register
. Upon publication, the Department alerted stakeholders via email and will accept comments and inquiries until Sunday, December 15, 2019 at 5:00 p.m. MST. During the public comment period, comments may be sent to
[email protected]
and submitted via the United States Postal Service using the following address:
Special Financing Division Director, Colorado Department of Health Care Policy & Financing
1570 Grant Street
Denver, Colorado 80203
ATTN: Public Comment - HTP DSRIP.
Public Hearings
The Department invites stakeholders to attend public hearings in person or to 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
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Partnerships to Improve Population Health
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Colorado, through Senate Bill 16-077, has become an Employment First State. Employment First has two fundamental tenets:
- First, that any person has the ability to work, even individuals with the most significant of disabilities;
- Second, that the first and most preferred outcome for anyone utilizing Home and Community-Based Services and Supports is that they are working.
These tenets are based on the idea that employment is a social determinant of health, which means employed individuals are healthier than those who are not employed.
To fully implement Employment First in Colorado, the service systems that support individuals seeking and who have already obtained employment need to work to improve their supports and services. This will ensure individuals with disabilities can be successful in the work place. To accomplish this the Department has engaged in several projects to improve Supported Employment Services that currently support Individuals with Intellectual or Developmental Disabilities.
Senate Bill 18-145 requires the Department to update provider qualifications for Job Coaches and Job Developers to include new training requirements. In addition, this legislation directs the Department to reimburse Health First Colorado service providers for the cost of these trainings. To learn more about this project please check out our
website for SB18-145.
The Department received funding starting in FY2019-20 to design and implement a Supported Employment Incentive Payment Pilot (SEIPP) program. This program will work with a small group of stakeholders over the next three years on developing and improving Supported Employment services and piloting incentives for successful Competitive Integrated Employment outcomes.
The goal for this pilot is twofold: First, to incentivize better employment outcomes for individuals utilizing Home and Community-Based Waver Services and secondly, to experience cost savings due to creating a more efficient system. In the pilot we will utilize the Customized Employment Model which has a proven track record showing that any individual with a range of abilities can be successful in the workplace.
To find out more about Customized Employment please visit the
webpage from the Office of Disability Employment Policy
with information about this model. The Department is currently developing the Scope of Work and hiring the team to implement this pilot project, which will go live early next year and run through Fiscal year 2021-2022.
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Home Care Workers Stakeholder Feedback
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The Department and the Department of Public Health & Environment are seeking input from stakeholders on training for home care workers. This effort is part of Senate Bill 19-238, which requires the Departments to consult with stakeholders "to establish a process for reviewing and enforcing initial and ongoing training requirements" for home care agency employees.
A Training Advisory Committee has been formed and is meeting regularly to develop recommendations to meet the requirements of this bill. Members of the public are invited to attend or listen-in to these Training Advisory Committee meetings. The final meeting is Thursday, December 5.
For more information, visit our webpage, send us an email or call 303-866-5086
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Delivery System Innovation
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| Substance Use Disorder Benefit Update |
Section 1115 Substance Use Disorder (SUD) Waiver Application
The Department submitted the state's Section 1115 SUD waiver demonstration application to the Centers for Medicare and Medicaid Services (CMS). The waiver application is now posted for federal public comment through early December on the CMS website. The Department is currently drafting the implementation plan and developing plans for monitoring and evaluation of the waiver services.
SUD Capacity Planning and Regional Capacity Meetings
The Department is in the process of mapping SUD treatment capacity for SUD services across Colorado. The Department will host a statewide series of meetings from December 2019 through February 2020 focusing on the state's SUD treatment capacity, regional needs, and strategies to address needs and gaps in the SUD continuum of care. The schedule of regional capacity meetings is posted on the Department's SUD webpage. The Department welcomes and encourages members of the public to participate in the meetings.
For additional information, please visit the Department's
SUD website
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Electronic Visit Verification Update
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The Department continues to work towards implementation of
Electronic Visit Verification (EVV). The 21st Century CURES Act required state Medicaid programs to implement an EVV system for select State Plan and Home and Community Based Services. EVV is an electronic-based system that verifies when provider visits occur, ensuring that members receive authorized services. For federal compliance, all EVV systems must collect the following six points of data: type of service performed, individual receiving the service, date of the service, location of service delivery, individual providing the service, and time the service begins and ends.
The Centers for Medicare & Medicaid Services (CMS) recently approved the Department's request for a
Good Faith Effort Exemption to delay the EVV mandate in Colorado. This delay allows time for the Department to operationalize an exemption for live-in caregivers, as permitted by CMS in a recent
informational bulletin. This 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 January 1, 2020. The Department anticipates mandating EVV in summer 2020.
Currently, 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 providers and caregivers participate in EVV during the soft-launch. This is an opportunity to become accustomed with EVV prior to claims integration. Claims will continue to pay and EVV errors will appear on remittance advice.
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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
