Provider Association Newsletter
February 2020
Message from the Executive Director
The legislative session is underway, and the Department of Health Care Policy & Financing (the Department) is hard at work supporting efforts to improve health care affordability for all Coloradans and our employers. 
Our Department provides health care coverage to more Coloradans than any insurance carrier in the state, covering almost one in four Coloradans with a budget of more than 25 percent of the state's General Funds. Consequently, we are called upon to be a trusted advisor, resource, leader and innovator for responsible health care transformation to the betterment of our members and all Coloradans. At the same time, our leadership in transforming health care better enables our Department and our passionate staff to provide cost-effective access to the critical benefits, services and support programs that so many Coloradans rely on each day. 
To that end, together with Lt. Gov. Dianne Primavera and the Office of Saving People Money on Health Care, we released the Colorado Hospital Cost Shift Analysis report on Jan. 23. The report reveals that, despite significant reductions in Colorado's uninsured rate and uncompensated care and significant increases in Medicaid reimbursements, Colorado hospitals are persistently increasing the price they charge for their services. Hospital costs represent both the largest component and the most significant driver of rising health care costs; Department reports like this are therefore critical tools to help elected officials and stakeholders form effective affordability policy to the betterment of Coloradans and our employers.
On Dec. 31, the Department submitted the Hospital Transformation Program (HTP) 1115 demonstration waiver application and State Plan Amendment to the Centers for Medicare and Medicaid Service (CMS). The federal comment period for the waiver ended Feb. 9 and the Department is working with CMS on specific program components. At the end of February, the HTP team will begin providing in-person trainings throughout the state to review the requirements and answer questions for hospitals participating in the program. We'd like to thank stakeholders, hospitals and community partners for their participation in the HTP process.
On Jan. 15, the Department submitted the Hospital Expenditure Report to the General Assembly. This report details the activities the Department has undertaken to implement HB19-1001 (Hospital Transparency) and HB19-1320 (Hospital Community Benefit) to date. An addendum to this report will be submitted before the end of the 2019-20 fiscal year, when the detailed data from hospitals has been collected and analyzed. 
Together, we can achieve greater health care affordability for Coloradans and our employers. Thank you for your continued partnership on this important work! 
Kim  Bimestefer
Reducing Prescription Drug Costs in Colorado
The Department released a comprehensive report outlining the primary drivers of prescription drug costs in Colorado. Prescription drug costs are the fastest-growing consumer health care expense.

The report is intended to inform dialog about how to control the cost of prescription drugs. For more information, read the report and the news release.
Electronic Visit Verification Implementation Update
Beginning Monday, Aug. 3, providers of electronic visit verification (EVV) services will be required to utilize an EVV system to collect service visit data.

EVV is an electronic system that verifies home- and community-based service visits by documenting six data points:
  • Type of Service
  • Date of Service
  • Location of Service
  • Individual Receiving Service
  • Individual Providing Service
  • Time Service Begins and Ends
To determine whether your agency is required to use EVV, please review the EVV Types of Service - Service Code Inclusion document located on the EVV website, under resources. Provider participation is voluntary until EVV is mandated Aug. 3.

From now until then, providers may voluntarily collect EVV data and transmit it to the Department. The Department strongly recommends that providers and caregivers participate before the mandatory launch as an opportunity to:
  • Test and interface with EVV systems
  • Familiarize providers with EVV prior to claims integration
  • Have claims pay as usual while EVV errors appear on Remittance Advice
  • Help the Department identify and develop supplemental training materials
  • Facilitate EVV participation by caregivers and members
Beginning Aug. 3, claims requiring EVV will be subject to Department review and recoupment if EVV is not used in accordance to Department rules and guidance. The Department understands that collecting EVV data is a new process for many providers and recoupment is not likely if providers make earnest efforts to use EVV correctly.

On Jan. 1, 2021, claims requiring the use of EVV will encounter a pre-payment review process. Claims without corresponding EVV records will deny during claims adjudication. To determine which claims will be subject to denial beginning Jan. 1, 2021, review Remittance Advice located in the DXC Provider Portal and look for EOB 3054 - Missing EVV Information.

For more information about EVV implementation, visit the EVV website . The Department hosts monthly stakeholder meetings to discuss EVV and welcomes provider participation.

For questions regarding the State EVV Solution or connecting a Provider Choice Solution, please contact Sandata Technologies by phone: 855-871-8780 or email: [email protected].  For all other questions, please contact the Department at [email protected] .
Denver Health Medicaid Choice Contract Change
The Department has revised its contract arrangement for members enrolled in Denver Health Medicaid Choice. Under this new contract, Denver Health is partnering with Colorado Access to manage behavioral health services for its members. 

This contracting change alters how Denver Health Medicaid Choice members appear in the Provider Web Portal. Denver Health Medical Plan is now listed in the Regional Accountable Entity field.  

There is no change to how providers deliver, authorize or process reimbursement for services to members enrolled in Denver Health Medicaid Choice.  
  • Denver Health still administers and reimburses all covered physical health services. (Contact Denver Health Medicaid Choice at 303-602-2116 with questions.) 
  • Colorado Access still administers and reimburses all covered behavioral health services. (Contact Colorado Access at 303-368-0038 or 855-384-7926 with questions.) 
For more information and frequently asked questions,  read the fact sheet .  
Hospital Transformation Program
HTP Road Show Training for Hospitals

The Department will be providing in-person trainings throughout the state to review the HTP requirements and answer questions for participating hospitals. Please mark your calendars or contact HTP Coordinator Joe Sekiya for additional information.
  • 10 a.m. to 2:30 p.m. Thursday, Feb. 27 at University of Colorado Anschutz Medical Campus in Denver
  • 10 a.m. to 2:30 p.m. Friday, Feb. 28 at Yuma District Hospital in Yuma
  • 10 am. to 2:30 p.m. Thursday, March 5 at St. Mary's Medical Center in Grand Junction
  • 1 p.m. to 5 p.m.  Friday, March 6 at Valley View Hospital in Glenwood Springs
  • 10 a.m. to 2:30 p.m. Friday, March 13 at Heart of the Rockies Regional Medical Center in Salida
 
Measures Updates

At the end of January, updated versions of the HTP Measures List, Measures Overview, Scoring Framework and Measures Specifications were posted to the  HTP website  under the "Hospital Transformation Program Overview & Framework" section.  

For additional information, we encourage you to visit  the HTP website  and to read past editions of the HTP Newsletter in  our online archives .  If you have questions about the HTP, please contact Hospital Relations and Communication Manager  Courtney Ronner . 
Public Charge Update
The U.S. Department of Homeland Security's public charge rule went into effect on Monday, Feb. 24, 2020. As you may have heard, this rule changes which public benefits may be taken into consideration in some immigration determinations. This rule may impact members of Colorado's immigrant communities. Please visit this link to view helpful resources. 
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