At a Glance is a Department of Health Care Policy & Financing (Department) publication that provides information on major initiatives, policy changes and program updates. Feel free to share At a Glance with your colleagues. Find previous editions of At a Glance on the Department website at colorado.gov/hcpf/publications. Thank you for your interest!
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A Message from the Executive Director |
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Stakeholders, Advocates and Partners:
The new year has already been full of informative events and exciting new developments!
We presented our $12.3 billion 2021-2022 fiscal year proposed budget at the Joint Budget Committee hearing last month, presented to the Senate Health & Human Services and House Public & Behavioral Health & Human Services committees as part of the SMART Act requirements, and released our 2019-20 Annual Report. The annual report illustrates the many ways we serve Coloradans each and every day, including videos in our members’ own words. We invite you to review it and celebrate all that we accomplished together this past year.
Vaccines are now rolling out to those over 70 years of age. We appreciate your help reaching the one in four Coloradans who are Health First Colorado members to ensure they are able to get their vaccine when it’s their turn. Of course, members will not be charged a co-pay for the vaccine or for their ride to and from their appointments. We also recently communicated to providers the amount that Medicaid will pay for the administration of the first and second doses. As the vaccine rolls out, please continue to follow public health protocols by washing your hands, wearing your masks and maintaining 6-feet of physical distance from those outside your households, and please help us lead others in doing the same.
Since the start of the pandemic, the number of Coloradans we serve has grown by more than 175,000 people. This growth is now projected to continue rather consistently all year, with the “likely extension of the Public Health Emergency” (PHE) through the end of 2021, as recently communicated by the U.S. Department of Health and Human Services. In this same spirit, and in alignment with the federal government opening the federal exchanges, Connect for Health Colorado, our state exchange, is also holding a special enrollment period from Feb. 8 - May 15. Together, our efforts are connecting Coloradans to affordable coverage, especially those who have lost their jobs during this economic downturn. Thank you for your partnership on this important work. We are here for Colorado.
On the affordability front, we hosted the Health Cabinet Health Policy Summit virtual conference, which included five remarkable sessions and over 1,850 registrants. Agency leads, state and national experts discussed initiatives to reform our behavioral health system, get Coloradans vaccinated, help employers control their health care costs, support rural hospitals, improve the effectiveness of hospital community investments, and reduce prescription drug costs. This latter topic included a review and discussion of the top recommendations within the Department’s newly released and updated prescription drug report. In support of one of the recommendations in that report, the Department released an invitation to negotiate on drug importation, inviting domestic and foreign partners to help us import drugs from Canada, which will drive savings of over 60% on importable drugs. As part of the Summit, we also launched a new affordability webpage with tools to help communities address the many factors that contribute to rising health care costs.
In partnership with the Colorado Hospital Association, the Colorado Healthcare Affordability and Sustainability Enterprise (CHASE) legislative report demonstrates some of the ways we are innovatively addressing costs by collecting a hospital provider fee. We invite you to review this report to learn how we disbursed $393 million in increased reimbursement to hospital providers, reduced uncompensated care costs and the need to shift those costs to other payers, while expanding coverage to an additional 502,000 Coloradans and providing $114 million in relief to the state’s General Fund.
We look forward to collaborating with you on many other initiatives this year to help us serve our growing membership while saving Coloradans money on health care. As always, we are deeply grateful for your partnership!
Kim Bimestefer
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Mobile App Helps Fight COVID-19:
You can now download an app to help fight COVID-19, slow its spread, and protect yourself and your loved ones. CO Exposure Notifications will quickly notify you if you’ve likely been exposed to the virus, allowing you to seek timely medical attention and take action to protect others.
The app is free and does not share your personal information. It can alert you if you have been exposed to COVID-19 in the last 14 days. Visit AddYourPhone.com to watch a short video about how it works and how to turn it on with Apple or Android devices.
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Remote Application Assistance During the COVID-19 Public Health Emergency:
During the COVID-19 public health emergency, counties, Medical Assistance (MA) sites, Presumptive Eligibility (PE) sites, and Certified Application Assistance sites (CAAS) will be authorized to assist individuals applying for Medical Assistance remotely (telephone, video conferencing, etc.) upon receipt of verbal consent. The authorization of verbal consent will expire at the end of the Public Health Emergency. Normal policies and procedures will resume when the federal emergency period ends. The Department has released a Memo: Remote Application Assistance for more guidance.
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Changes to the Health First Colorado and CHP+ 1095-B Form Process:
The law has changed; Health First Colorado and CHP+ members no longer need to provide proof of health insurance coverage in order to file their taxes. Therefore, the Department will not be mailing out 1095-B forms this year. Even though the 1095-B isn't required anymore for tax filing, members can get a copy of their 1095-B for their records if they want one. Please visit the resources below for options on obtaining a 1095-B form.
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Member Video Toolkit:
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.
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ConnectToCareJobs.com Update:
The State of Colorado, led by the Department and in collaboration with Advancing States, is launching its latest update to ConnectToCareJobs.com.
This release will open the site to home care and home health providers. The website is dedicated to matching long-term care providers with direct care workers and other medical professionals seeking jobs. Watch your news feeds for this exciting release in late October to early November!
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Electronic Visit Verification Update:
Electronic Visit Verification (EVV) is an electronic system that verifies home and community-based service visits by documenting six points of data, including the type, date, and location of service; the individuals receiving and providing the service; and the time service begins and ends. On Aug. 3, 2020, EVV became mandated by Colorado Code of Regulation 2505-10 8.001.
A tiered implementation strategy is being utilized to allow providers time to familiarize themselves with the use of EVV, minimize long-term administrative burden and reduce financial impact when EVV records are required prior to claim adjudication.
The timeline has recently been shifted for prepayment claim review, which was originally scheduled to begin on Jan. 1, 2021. These changes are outlined below and further described in Operational Memo 21-007.
Claim Suspension
Jan. 16, 2021 – Feb. 28, 2021:
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EVV-required claims from providers who are not making an earnest effort to utilize EVV will be suspended.
- Providers whose EVV-required claims are being suspended must provide a written implementation plan to the Department.
- Providers who are making an earnest effort to utilize EVV will not experience disruption in payment at this time.
Pre-Payment Claim Review
Beginning March 1, 2021:
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All EVV-required claims submitted to the Department must be matched to a valid EVV record to pay.
- Due to the unique payment structure of Hospice services, Hospice claims are exempt from pre-payment review. Hospice claims are subject to compliance monitoring and over-payment recovery only.
Additional Information
Contact Sandata Technologies by phone 855-871-8780 or email cocustomercare@sandata.com with questions regarding the State EVV Solution or connecting a Provider Choice EVV System.
For all other questions, contact the Department at EVV@state.co.us.
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Health First Colorado Recovery Audit Contractor (RAC):
In compliance with Section 6411(a) of the Affordable Care Act, the Department 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 2018, HMS began reviews to identify overpayments and assist the Department in recovering any overpayments made to providers for Health First Colorado medical claims.
The RAC audits claims from as far back as seven years (84 months) from the date the claim was originally paid as approved in the State Plan Amendment CO-16-0003. This lookback period extends to all claim and provider types.
Providers are encouraged to update their contact information using the HMS RAC Provider Portal. This is a tool that providers can use to track the progress of their audits, as well as add contact information that is specific to RAC correspondence. Providers can also upload documentation through this portal if medical records are requested for a post-payment audits. 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 portal and update contact information at https://ecenter.hmsy.com.
HMS has also published a number of resources for providers including a recorded webinar, RAC 101, RAC FAQ, provider portal training and contact information.
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Prescriber Tool Project:
The Department is implementing the Prescriber Tool, a multifunctional platform that will be accessible to all prescribers through most electronic health record (EHR) systems. The Prescriber Tool will help improve health outcomes, reduce administrative burden for prescribers and better manage prescription drug costs by providing patient-specific information to prescribers at the point of care.
The Prescriber Tool is being implemented in modules which will provide different types of patient information or functionalities.
Opioid Risk Module
The opioid risk module will be implemented first and is anticipated to be operational in January 2021. OpiSafe has been contracted to administer this module which will help prescribers prevent the misuse and abuse of opioids and benzodiazepines. The module will provide:
- Easy access to Prescription Drug Monitoring Program (PDMP) data
- Identification of Opioid Use Disorders (OUD)
- Educational tools with access to evidence-based treatment
- Tools for overdose prevention
Additional modules are expected to be implemented by summer 2021, including a module that will provide real-time, patient-specific pharmacy benefit information.
Open Access License Program
In order to access the opioid risk module, each prescriber must have an individual license. To facilitate rapid adoption of the module, the Department will be awarding a limited number of user licenses free of charge to qualified Health First Colorado prescribers. The subsidized license will be valid for one year, thereafter prescribers will need to pay an annual license fee to OpiSafe. Please note, the Department is unable to assist with any EHR-related costs (if applicable) for accessing the opioid risk module.
The online application for the Open Access License Program will be available from Jan. 2 through March 1, 2021, or until all subsidized licenses have been awarded.
Once operational, the cost to prescribers for accessing the Prescriber Tool will vary depending on the specific module(s) and EHR utilized. Visit the Prescriber Tool Project webpage to apply for a user license, or for more information about the Prescriber Tool project.
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Health Care Affordability |
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Hospital Transformation Program (HTP) Update:
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. The Provider Attestation Form, along with additional information about the Rural Support Payment, is on 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 every month with the last meeting taking place on Monday, Jan. 25. The agenda, meeting materials and previous meeting notes are 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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In December 2020, there were
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