The purpose of this Policy Memo is to communicate to county member fraud investigators the requirement for Continuous Enrollment during the Coronavirus (COVID-19) public health emergency (PHE), and the related implications on member fraud investigations, eligibility terminations, and overpayments. This Memo will be available to all county staff working on member fraud investigations.

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.

The purpose of this Operational Memo is to inform Case Management Agencies (CMA) of the transition plan for long-term care services Utilization Review/Utilization Management (UR/UM) from eQHealth Solutions, Inc. (eQ Health) to Telligen, Inc. (Telligen).

The purpose of this Operational Memo is to inform all Pre-Admission Screening and Resident Review (PASRR) stakeholders that the PASRR functions currently completed by eQHealth Solutions will be moving a new vendor, Telligen, effective March 1, 2021.

Per HCPFF IM 21-007, on Jan. 1, 2021, the Department awarded long-term care Utilization Review/Utilization Management work to Telligen. Telligen will begin performing the work outlined in IM 21-007 on March 1, 2021. This memo further specifies the transition plan for PASRR. 

The purpose of this Operational Memo is to advise eligibility sites that the Internal Revenue Services (IRS) has suspended the requirement to mail physical copies of the 1095-B form to Health First Colorado and Child Health Plan Plus (CHP+) members. The memo provides instructions on how to furnish a copy of the 1095-B form to Health First Colorado and CHP+ members if requested. This guidance is for the 2020 tax year and later, or until states receive further guidance from the Internal Revenue Services (IRS).

The purpose of this Operational Memo is to inform Case Management Agencies (CMA) of the implementation of Utilization Review/Utilization Management (UR/UM) process for all skilled services under the Participant-Directed Programs, In-Home Support Services (IHSS) and Consumer Directed Attendant Support Services (CDASS).

The purpose of this Operational Memo is to inform Case Management Agencies (CMAs) of updated operational changes to case management documentation requirements for functional eligibility for long-term services and supports (LTSS) programs. This Operational Memo supersedes HCPF OM 20-049.

The purpose of this Policy Memo is to inform Non-Emergent Medical Transportation (NEMT) providers on temporary changes to the NEMT benefit.

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.

The purpose of this Operational Memo is to provide information and required action steps to Consumer Directed Attendant Support Services (CDASS) members, case managers, and stakeholders about a change in the Financial Management Services (FMS) vendors serving CDASS members.

The purpose of this Operational Memo is to inform providers and case management agencies (CMAs) of temporary rate increases in response to the COVID-19 pandemic for some Home and Community-Based Services (HCBS) waiver benefits. The service, corresponding rate increase, and instructions on how to receive the increase are found below.

The purpose of this Operational Memo is to inform providers and case management agencies (CMAs) of temporary reimbursement increases in response to the COVID-19 pandemic for Nursing Facilities, and Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF-IIDs).

This Operational Memo informs Electronic Visit Verification (EVV) Stakeholders about updates on the implementation timeline and how the Colorado Department of Health Care Policy & Financing (Department) will enforce implementation.

The purpose of this Operational Memo is to provide Programs of All-Inclusive Care for the Elderly (PACE) organizations with instructions for submitting the following information to the Department of Health Care Policy & Financing (the Department): 1. An adverse appeal. 2. A request to extend the timeframe of an expedited appeal. The memo also stresses the requirement of processing expedited appeals as indicated by the participant.

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 & 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.”

The Department of Health Care Policy & 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.

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 & Financing (Department), FY 2020-21 County Incentives Program, Training and Quality Incentive.

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 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 & Financing (“Department”).

The purpose of this Informational Memo is to inform all stakeholders of updates regarding the Case Management Redesign. The Colorado Department of Health Policy & Financing (Department) is currently working with HCBS Strategies (the contractor), Single Entry Point (SEP) and Community Centered Board (CCB) agencies, and the stakeholder community to make key decisions about how to design the infrastructure for implementing the Case Management Redesign (CMRD) initiative in Colorado.

On Dec. 22, 2020, the Centers for Medicare & Medicaid Services (CMS) issued State Health Official letter #20-004 informing states of the option to extend the Appendix K authorities related to the COVID-19 Public Health Emergency (PHE) to “6 months after the conclusion of the public health emergency.”

The audience for this Informational Memo includes Home and Community-Based Services (HCBS) providers, HCBS waiver participants, and Case Management Agencies (CMAs).

The purpose of this Informational Memo is to provide interested stakeholders a status update from the Department of Health Care Policy & Financing (Department) regarding the Single Entry Point (SEP) Request for Proposal (RFP) awardee selection for all Regions/Districts posted in the August 2020 solicitation.

The purpose of this Informational Memo is to inform agencies and providers that are impacted by Senate Bill 19-238 that the Reporting Tool will reopen Jan. 24, 2021 and close Feb. 6, 2021.

The purpose of this Informational Memo is to inform all Home and Community-Based Services (HCBS) providers and case managers regarding the payment timelines for the interim solution implemented for billing for certain HCBS waiver services. The Department has implemented this interim solution to meet the statutory requirements of House Bill (HB) 19-1210, and funded by the FY 2020-21 Long Bill, HB 20-1360.

Claims are temporarily suspending for EOB 0000: "This claim/service is pending for program review." The claims will be processed weekly on Friday at the correct reimbursement rate. No valid claims will be denied as a result of this interim process and will not be delayed if timelines are followed.

Note: The long-term solution is scheduled to be implemented in the first half of 2021. The interim solution impacts all claims by all HCBS providers statewide who are billing for services impacted listed below.

The Colorado Department of Health Care Policy & Financing (Department) invites the public to comment on proposed Transitional Living Program (TLP) regulation revisions provided under the Home and Community-Based Services (HCBS) Persons with Brain Injury (BI) waiver.

The purpose of this Informational Memo is to inform stakeholders of upcoming meetings hosted by the Department of Health Care Policy & Financing (Department) to discuss and received feedback on the Human Rights Committee (HRC) regulations, processes, training needs and to develop documents with guidance for providers and case managers. The meetings will be open to all interested stakeholders, including Home and Community-Based Services (HCBS) waiver participants, relatives of participants, advocates, representatives of providers, and case management agencies serving individuals enrolled in the HCBS waivers.

The purpose of this Informational Memo is to inform Case Management Agencies (CMAs), nursing facilities, and hospitals of the change in Utilization Review (UR)/Utilization Management (UM) vendor for long-term care services.

The purpose of this Informational Memo is to inform Stakeholders that the Home and Community-Based Services (HCBS) waiver amendments submitted to the Centers for Medicare & Medicaid Services (CMS) in September 2020 were approved.

The purpose of this Informational Memo is to provide an update and an overview of the development process for the new Level of Care (LOC) screen, Assessment and Person-Centered Support Plan. This memo includes information about the collaboration between the Department of Health Care Policy & Financing (the Department) and stakeholders regarding the selection and customization of a new process for LOC eligibility determination for individuals seeking or receiving Long-Term Services and Supports (LTSS) and the assessment and person-centered support planning for all individuals seeking or receiving Home and Community-Based Services (HCBS). This Memo also outlines the objectives and outcomes of the Department’s new Assessment and Person-Centered Support Plan Pilot, which concluded in May 2020.

The audience of this Informational Memo is Department stakeholders, especially those seeking or receiving Medicaid LTSS, through an HCBS waiver, Nursing Facility, or Program of All-Inclusive Care for the Elderly (PACE) services.

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.

The purpose of this Informational Memo is to notify Home and Community-Based Services (HCBS) Day Habilitation provider agencies, Case Management Agencies (CMAs), members, and stakeholders of the delay to proposed changes to Day Habilitation services. The proposed changes included implementation of a 1:1 service delivery model for Specialized Habilitation (SH) and Supported Community Connections (SCC), and annual dollar caps only for members who choose to utilize the 1:1 option. This memorandum impacts the HCBS Developmental Disabilities (HCBS-DD) and Supported Living Services (HCBS-SLS) waivers

The purpose of this Informational Memo is to provide interested stakeholders a status update from the Department of Health Care Policy & Financing (Department) regarding the Single Entry Point (SEP) Request for Proposal (RFP) process.

The purpose of this Informational Memo is to inform Long-Term Services and Supports (LTSS) members, families, case managers, providers and advocates that the National Core Indicator (NCI) survey: Intellectual and Developmental Disabilities (IDD), will soon be in the field. Members are selected randomly and asked to participate in the survey. Due to COVID-19 and the Safer at Home restrictions in Colorado, surveys will be conducted remotely using video conference technology from Jan. 25, 2021 through June 30, 2021.