This Department of Health Care Policy & Financing (the Department) newsletter is designed to inform county directors, management and staff about high-impact updates, important changes, county performance, new guidance, and program changes.
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Message from the Executive Director
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County Partners,
The staff and leadership of the Department of Health Care Policy & Financing is filled with hope for 2021! We invite you to stay aligned with many of the Department's key initiatives intended to support the members we serve, our safety net programs, Colorado families and Colorado employers as well. Together, we can be the change in the world we wish to see and help Coloradans rise and shine through the end of this pandemic.
First, we are excited about the distribution of COVID-19 vaccines. If you need clarification as to where you and your community are placed in the distribution plan, the graphic below will provide helpful insights. Concurrent with this distribution, we will continue to collaborate with providers and our partners in public health to do our part in managing the COVID-19 pandemic while providing clear messaging to protect the health and well-being of our members and all Coloradans. So, please continue to help us message about the importance of “masking up,” social distancing and following public safety guidance until all Coloradans are vaccinated.
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With the economic downturn, many Coloradans have lost their jobs and, with that, their employer-sponsored health coverage. Accordingly, the Department will continue to connect these individuals and families to affordable health insurance coverage through Health First Colorado (Colorado’s Medicaid program), Child Health Plan Plus (CHP+) and Connect for Health Colorado commercial insurance offerings. Thank you to all the stakeholders who are engaging with us to battle the rising uninsured rate and keep Coloradans covered through this pandemic.
On Jan. 7, the Department had its Joint Budget Committee (JBC) Hearing. In one aggregated review, we address key issues and answer submitted JBC questions on HCPF’s Office of Community Living, Behavioral Health services and all other topics usually covered in the Executive Director hearing. Due to the economic impact of COVID-19, the Department is covering more Coloradans than ever -- more than 1.4 million, representing almost 1 in every 4 Coloradans. Given that, it is no surprise that the Governor’s budget for 2021-2022 indicates that the Department will consume 29% of the state’s general fund and 35% of total state funds.
Given our share of the state’s budget, the state’s fiscal challenges and the continued rising cost of health care, the Department will maintain its focus on health care affordability strategies and initiatives. Our goals are to help protect our programs, cover all Coloradans who need us, efficiently use state resources and lead collaborative efforts with the commercial industry to drive affordability innovations and strategies that also benefit Colorado employers and Colorado families -- we are all battling the same challenges and can produce better results through collaboration. Look for a new Department health care affordability website that includes a toolkit of resources available to help communities control costs to the benefit of Medicaid, CHP+, Colorado families and our employers. Also look for a new Prescription Drug report that outlines the cost drivers and possible solutions to control them.
The Department has been and will continue to be an active leader in the Behavioral Health Task Force blueprint and priorities implementation. Related and beginning Jan. 1, HCPF expanded the Medicaid substance use disorder (SUD) benefit to include inpatient and residential treatment. This addition will complete a full continuum of substance use disorder services offered to Medicaid members, enabling the Department to better respond to the increasing overall demand for behavioral health services.
COVID-19 has not just increased demands for substance use disorder and behavioral health services; it has also exacerbated pervasive health care disparities. We invite your partnership as the Department identifies and shines a light on opportunities to address and close these disparities with the goal of better serving all Coloradans.
Our Department experts will also be engaging with the current and incoming federal administration to manage through the Public Health Emergency, which is currently scheduled to end on April 20. We will also be sharing evolving federal policy priorities emerging from the new administration and their impact to the Department, our programs, our members and all Coloradans. Look for more communications on that opportunity in the coming months.
Through this unique chapter and this calendar year, Department staff and leadership will continue to leverage our strengths, health care expertise and insights to the benefit of those we serve and all Coloradans. There is a bright light on the horizon with the vaccine now in the distribution stage. We are grateful to have your partnership on all the above work toward a better, hope-filled tomorrow. Rise and shine, Colorado! Rise and shine!
Kim Bimestefer
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Substance Use Disorder Benefit Expansion
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Beginning Jan. 1, 2021, Health First Colorado added coverage for residential treatment, inpatient treatment and medical withdrawal management services for substance use disorder (SUD). With this addition, the full continuum of SUD care will be covered for our members.
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County fact sheets provide an annual snapshot by fiscal year of Health First Colorado (Colorado's Medicaid Program) activity including average annual caseload and top five claim types for each county.
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Recent Memo Series Issued to Counties
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PM 21-001
The purpose of this Policy Memo is to inform authorized individuals/entities such as
Counties, Medical Assistance (MA) Sites, Eligibility Application Partner Sites,
Presumptive Eligibility (PE) Sites, and Certified Application Assistance Sites (CAAS) that
they may assist applicants in completing the Application for Medical Assistance remotely
(telephone, video conferencing, etc.) during the COVID-19 Public Health Emergency
period. This guidance will exclude the disability application. Assisters should follow the
existing process for the disability portion. Assisters listed above have the option to
assist applicants to complete the application remotely. This interim process will not be
mandatory. Please share this memo with all eligibility staff, supervisors, and outside
agencies, as appropriate.
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OM 21-012
The purpose of this Policy Memo is to inform Non-Emergent Medical Transportation (NEMT) providers on temporary changes to the NEMT benefit.
OM 21-011
This Memo is intended to provide operational guidance for County Departments of Human/Social Services and Eligibility Sites regarding the Medicaid Estate Recovery Program and the noticing requirements to Health First Colorado (Colorado’s Medicaid Program) members.
OM 21-005
This Operational Memo communicates to county departments of human/social services and other eligibility sites the program requirements and processes for the Department of Health Care Policy and Financing (referenced herein as “the Department” or “HCPF”), in its statutory oversight role in the administration of the Medical Assistance Program, to implement site audits through the HCPF Management Evaluation (ME) Review Program. These site reviews will occur over a multi-year cycle and aim to address county or site compliance issues discovered by the ME Review Program and routine monitoring, quality assurance, administrative desk reviews and other types of Department supervision activities.
The purpose of this Operational Memo is to document the program requirements and processes used for the HCPF ME Review Program site reviews. Non-compliance with ME Review Program requirements and processes, as determined by the Department in its statutory oversight role, can result in notification of non-compliance as found in HCPF Operational Memo 21-004, “Improvement Action and Corrective Action Plans.”
OM 21-004
The Department of Health Care Policy and Financing, referenced herein as “the
Department” or “HCPF”, has the statutory responsibility for oversight of the Colorado
Medical Assistance Program (Medicaid) as defined by Colorado Revised Statutes
[Section 25.5-1-114(3)]. Medicaid is known as Health First Colorado. Medical
Assistance also includes the Children’s Basic Health Plan known as Child Health Plan
Plus (CHP+). The purpose of this Operational Memo is to document the processes used
to monitor the county department of human/social services, referenced herein as “the
county” or “counties” and subsequent improvement actions or corrective actions
required to correct any determined deficiencies.
The process as documented in this Operational Memo shall be used by the Department
until further notice.
OM 21-003
The purpose of this Operational Memo is to provide guidance to county departments of
human/social services (county) on meeting Quarter 2 and Quarter 3 Quality Meeting
requirements for the Department of Health Care Policy and Financing (Department), FY
2020-21 County Incentives Program, Training and Quality Incentive.
OM 21-002
The purpose of this Memo is to inform county departments of human/social services of
the processes for entering overpayments and overpayment interest into the Colorado
Benefits Management System (CBMS) for Health First Colorado/Medicaid (HFC) fraud
investigations. This Memo will be available to all county staff working on investigations
to advise on the reporting requirements for member/client fraud, county incentives for
member/client fraud and how to code overpayments and interest. This Memo
supersedes guidance issued in HCPF OM 19-002 and is the most current guidance
available.
The term “member” and “client” will both be used in this document as “client” is the
terminology used in CBMS and “member” is the term preferred by the Department of
Health Care Policy and Financing (“Department”).
OM 20-102
The purpose of this operational memo is to advise eligibility sites of the increased resource limits for Qualified Medicare Beneficiaries (QMB), Specified Low Income Medicare Beneficiaries (SLMB), Qualified Individuals (QI-1), and Low-Income Subsidy (LIS) resource limits.
OM 20-101
This letter is meant to advise counties and eligibility sites of the 2021 Social Security Cost of Living Adjustments (COLA). Please share this memo with all affected Adult and Long-Term Care Medicaid eligibility staff, supervisors, and outside agencies, as appropriate.
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IM 21-004
The purpose of this Informational Memo informs providers that the Colorado Department of Public Health & Environment's (CDPHE) has created a three-phase plan to be as fair as possible about when people get the COVID-19 vaccine. The plan is based on people's risk of serious complications and death from the virus.
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Upcoming Change to Reasonable Opportunity Period (ROP)
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The Department is changing the timeframe in which we will verify a Health First Colorado or Child Health Plan Plus (CHP+) applicant's income.
Beginning in February 2021, the Department will be narrowing the window for a member to provide verification for an income discrepancy from 90 to 30 calendar days, when requested. This change is based on member feedback that this timeframe reduces confusion because it better aligns with other timelines in the eligibility process.
In addition, the Department is excited to upgrade to a more timely income verification process that pulls from multiple database sources in Spring 2021. We hope doing so will help us verify income automatically without needing to request additional proof of income from applicants.
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Share how Health First Colorado helps Mary put the what-ifs away
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1 in 4 Coloradans are covered by Health First Colorado (Colorado’s Medicaid program). Coloradans from across the state and all walks of life get their health care from Health First Colorado, including people who never thought they’d need public health insurance. Health First Colorado provides Mary the peace of mind to live independently and do what she wants, knowing her health care is covered. Watch Mary’s story and listen to Health First Colorado members tell in their own words how Health First Colorado was there to help. Other Health First Colorado members want Coloradans to know that they may qualify for quality health care coverage. Learn more at HealthFirstColorado.com.
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Hospital Transformation Program (HTP) Update
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Rural Support Payment Update
At the Dec. 15, 2020 Colorado Healthcare Affordability and Sustainability Enterprise (CHASE) Board meeting, board members provided input and voted to approve the HTP Rural Support Payment framework and timeline.
On Dec. 3, 2020, a list of qualified hospitals was shared with program participants and stakeholders. Approval from the CHASE Board marks the beginning of the attestation process for qualified hospitals, with a due date of Friday, Jan. 22, 2021. The Provider Attestation Form, along with additional information about the Rural Support Payment, can be found in the Rural Support Payment section of the HTP website. Funds are expected to become available in Spring 2021. Please direct additional questions to the dedication Rural Support Payment inbox.
Program Updates
As we continue to move closer to HTP implementation, updated documents have been posted to the HTP website:
Please direct any questions about these updated documents to the HTP inbox.
Community Advisory Council
Community Advisory Council meetings continue to take place on a monthly basis with the next meeting taking place on Monday, Jan. 25. The agenda, meeting materials and previous meeting notes can be found on the Community Advisory Council website.
CHASE Board meeting
The next Colorado Healthcare Affordability and Sustainability Enterprise (CHASE) Board meeting will take place via webinar on Tuesday, Feb. 23 at 3 p.m. Additional information about the board, as well as meeting materials, can be found on the CHASE Board website.
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County Grants & County Incentives Program
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FY 2020-21 County Incentive Program
Thank you, counties, for your tireless hard work, you have completed Reporting Period 1 successfully. The Department looks forward to another successful Reporting Period in 2021. The Status Report for RP 1 was sent out on January 19. January 28 is the deadline to submit exemption requests for counties who qualify.
As a reminder, each incentive's Operational Memo should be a main reference for where and how to pull reports.
Training and Quality Incentive
All of the documents related to the Q2 Quality Check-in meetings have been sent directly to counties. Counties should have received a calendar invite. Q2 check-in meeting is set for the 3rd and 4th week of February.
Guidance and meeting dates/times for the Quarter 2 Quality Check-In meeting information (date/time) are in Operational Memo 21-003.
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The County Grant Program is a great opportunity for counties to use to implement new programs or improve existing programs that will impact the county’s performance. Currently, counties that are awarded a grant through the competitive application process have been implementing programs to improve quality assurance, improve error rates, increase Medicaid providers, and connect uninsured individuals to resources and to apply for Medicaid.
Application for the next fiscal year will be released in May 2021.
We are finalizing the Intergovernmental agreements for the Public Health Emergency (PHE) Targeted Grant. The final allocation and CFMS code were emailed on Nov. 19 to counties that opted in.
Counties are approved per the plan they submitted. Funds can be coded to CFMS from Jan. 1 - June 30, 2020.
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Timeliness for December 2020
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Timeliness for all Medical Assistance applications was measured at 98.09 percent.
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Timeliness for all Medical Assistance redeterminations was measured at 97.38 percent.
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Department Contacts & Resources
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