At Colorado Access, caring for you and your success is our top priority as you serve our members. This monthly Provider Update highlights important information and resources to help you as a contracted provider with us.

Adult Dental Benefit Limit for Health First Colorado (Colorado’s Medicaid program)

The PHE ends May 11, 2023. The renewal process for the more than 1.75 million people covered by either Health First Colorado (Colorado’s Medicaid program) or Child Health Plan Plus (CHP+) starts in May. The Colorado Department of Health Care Policy and Financing (HCPF) estimates that 30% of enrolled people will not need to take any action to remain covered, while the other 70% will need to submit eligibility verification.

HCPF also estimates that more than 325,000 people will no longer qualify for Health First Colorado and CHP+ coverage. People who no longer qualify can apply for insurance through the state’s official marketplace, Connect for Health Colorado, online or by calling their customer service line at 855-752-6749.

As more updates become available, we will continue to share what this means for you and for our members.

As of July 1, 2023, Health First Colorado has removed the adult and intellectual and developmental disabilities (IDD) dental benefit maximum. Members were previously limited to $1,500 per year, but there is no limit now; all services will be covered at 100%. Frequency limits are the same. Learn more here or click to download flyers [English | Spanish​].

Depression Screen Billing Changes: Adding Modifiers and Allowing Other Caregivers 

under Child’s ID Cancelled

The requirement to have a U modifier on depression screens delivered to members that was outlined in the January 2023 Department of Health Care Policy and Financing (HCPF) Provider Bulletin (B2300488) will not be enforced, to avoid additional barriers to accessing depression screens for members, birthing parents, and non-birthing caregivers. You can give depression screens to any caregiver of a child enrolled in Health First Colorado, as required by Senate Bill (SB) 21-137. Depression screening claims without the U modifiers will not be denied due to lack of a modifier.

If you have any questions, please email morgan.anderson@state.co.us and susanna.snyder@state.co.us.

Public Health Emergency (PHE) Update

The PHE ended on May 11, 2023. You can learn more about which flexibilities were made permanent, and which are changing, here. HCPF will continue to communicate changes as they occur.

 

Health First Colorado and CHP+ members have returned to normal eligibility renewal processes. Renewals were first due in May 2023 and will continue each month through April 2024 for all 1.75 million members. Not all members will have to renew at the same time; members will be due for renewal in the calendar month they enrolled.

HCPF will report its progress on the continuous coverage requirement unwind to the federal government. The first unwinding data report for the May 2023 renewal period is live here.

2023 HCPF Health Equity Plan Public Meetings

HCPF has multiple health equity plan public meetings coming up. These meetings are for providers, members, and community stakeholders to learn more about the plan and give input and feedback. 

Tuesday, August 22, 2023 from 12:00 p.m. to 1:00 p.m.

- Focus: Disability community

- Register here.

Tuesday, September 26, 2023 from 3:00 p.m. to 4:00 p.m.

- Focus: Latino community

- Register here.

411 Behavioral Health Audit

The annual state-mandated 411 behavioral health audit has been completed, with a total of, 1233 claims across the entire state being reviewed. Documentation was audited across three behavioral health service categories – inpatient, residential, and outpatient psychotherapy. If you were involved in this audit, you will get a letter with your results this month. In the meantime, our compliance team is working to incorporate more education and training opportunities to support you. We can also support you with any remediation efforts that are required from the audit.

Provider-Carrier Dispute Process Updates

We have made updates to the provider-carrier dispute process to streamline processes and ensure compliance with Division of Insurance and Colorado Medicaid requirements. We have ensured that the provider-carrier dispute process and the member appeal process are separate. These changes will be reflected in letters that you may get from the claims appeals unit for provider-carrier disputes, letters from utilization management for member appeals, information at the top of explanation of payments (EOPs), and in an updated provider manual.

A provider-carrier dispute is an administrative, payment, or other dispute between a “participating provider” and Colorado Access that does not involve utilization review analysis, a member appeal of any kind (including a denial of benefits for services that are not medically necessary or covered by the applicable benefits program), credentialing, ad claim validation audit, or routine provider inquiries that we resolve in a timely fashion through existing informal processes. Formal provider-carrier disputes must be submitted within 60 calendar days of the incident on which the provider-carrier dispute is based, or the EOP on which the claim in dispute appears.

Customer service representatives and provider network managers will continue to resolve daily questions or routine provider inquiries in a timely fashion through our existing informal processes. If you are making an appeal on a member’s behalf, you must have permission (as the designated client representative) from the member and follow the member appeal process instead of the provider-carrier dispute process. If you have any questions, please contact your assigned provider network manager.

Administrative Changes Coming to Colorado Behavioral Health Administration (BHA)

On May 16, 2023, Governor Jared Polis signed House Bill 1236 into law, which makes administrative changes to the operation of the state’s BHA, including eliminating the Office of Behavioral Health and dividing its responsibilities between the Colorado Department of Human Services and the BHA. The new law also allows the BHA to establish regionally-informed care coordination for behavioral health administrative service organizations (BHASOs) to operate. The new law also strategically delays license issuing for behavioral health entities and mental health residential facilities to January 1, 2024.

The BHA will continue to be the central body for managing jail-based behavioral health services, and the regulatory oversight agency for the behavioral health care system, including regulating community-based providers and developing a care coordination system.

Multi-State Initiative to Strengthen Primary Care

The Centers for Medicare & Medicaid Services (CMS) will be partnering with the state of Colorado for a new primary care model to enhance access to, and quality of, primary care services. This collaboration on the making care primary (MCP) model will boost Colorado’s current efforts to strengthen the primary care infrastructure, and will help improve health equity and reduce health disparities across the state.

Colorado is one of many states, including Massachusetts, Minnesota, New Jersey, New Mexico, New York, North Carolina, and Washington, where CMS will be testing this model. Its flexible multi-payer alignment strategy allows CMS to build on existing state innovations and for patients to benefit from improvements in care delivery, financial investments in primary care, and learning tools.

This partnership has played an important role in Colorado’s multi-payer alignment work. Many payers, including Health First Colorado, are shifting towards value-based care. MCP will build from the current APM 2 payment model with HCPF and align with the Division of Insurance as Colorado implements HB22-1325. Aligning payment models across markets is a crucial step in improving health care quality, access, and outcomes for all Coloradans.

Are you interested in participating? Learn more here.

Payment Reform Updates for Family Medicine and Internal Medicine Primary Care Medical 

Providers (PCMPs)

We are retiring the HbA1c Testing metric and replacing it with the HbA1c Poor Control (>9.0%) metric for the state fiscal year (SFY) 2024-2025 Administrative Payment Models. This is an update to information that was previously communicated during our May 2023 PCMP Provider Forum.

We are offering a one-time $10,000 AMP2 early adoption incentive payment to providers/entities (at the TIN level) who join during SFY 2023-2024. Payments will be given to practices that joined in the previous quarter.

Family Planning Updates

Starting July 1, 2023, members in the emergency medical services (EMS) and reproductive health care program category are eligible to get family planning-related services for a $0 copay, which will expand the services this population is eligible for.

Family planning-related services are those that are provided with a family planning visit. Click here to learn more about the definition of these services. The expansion in this coverage is in addition to the existing coverage of emergency services, which has separate billing guidance.

Mifepristone Available as Pharmacy Benefit

As of July 2, 2023, mifepristone is available as a pharmacy benefit and can be dispensed by a Mifepristone Risk, Evaluation and Mitigation Strategy (REMS) Program-Certified Pharmacy. Mifepristone is available when prescribed and dispensed in compliance with the Food and Drug Administration (FDA) requirements. Mifepristone and/or misoprostol can be used for:

Treatment of a legal medication abortion, for circumstances of:

1. Life-endangerment for the pregnant individual

2. Rape

3.Incest

For treatment of a non-viable pregnancy (such as fetal demise or an incomplete miscarriage).

HCPF Extended Encounter Policy

The new HCPF Extended Encounter policy allows you to bill two units of 90834 for sessions scheduled longer than 75 minutes for:

1. The use of evidence-based modalities that require more time than a 90837 encounter can accommodate.

2.Family therapy sessions that address dyadic or family system factors that impact the functioning of the member       with family. members present.

Regional Accountable Entity (RAE) claims systems will allow for two units of 90834 to be billed on the same day by the same provider for a single member to align with this policy. These claims will be reimbursed at double the RAE rate for a single 90834 encounter.

CDPHE CO-CARES Initiative

The Colorado Department of Public Health and Environment (CDPHE) has launched the free CO-CARES initiative to support public health and health care workers who continue to help Colorado through the COVID-19 response. The initiative’s resources include conversations, training, webinars, peer support development, and expert consultation to help lower burnout and stress for public health and health care workers, and create a supportive workplace environment.

CO-CARES resources can help with individual, team, and organizational needs. Call their call center at 303-692-2642 to talk to someone who can help you find the right tools. The call center can accommodate multiple languages.

Member Copay Reductions

As of July 1, 2023, most of the current Health First Colorado member copays are being lowered to $0, to comply with Senate Bill (SB) 23-222 and SB 23-214. This applies to members who are eligible for Title XIX, the Alternative Benefits Plan (ABP) and the Old Age Pension (OAP) Health and Medical Care Program. Other special programs administered by HCPF, such as Child Health Plan Plus (CHP+), will continue to have normal copays. Services lowering their copays to $0 include:

Inpatient and outpatient hospital services

Optometrist visits

Podiatrist visits

Primary care physician (PCP) and specialist services

Durable medical equipment (DME) and disposable supply services

Claims with dates of service prior to July 1, 2023 will still have normal copays assessed. When you meet with a member, reference the Provider Web Portal to ensure their eligibility and if these reductions apply.

Learn more here.

Member ID Card Phone Numbers

The phone numbers of the RAEs, PCMPs, CHP+ providers and managed care providers are listed as the contact number on member ID cards, digital ID cards in PEAK, and on the Health First Colorado mobile applications. Any recent updates to the service location office phone number field made through the Provider Web Portal are now reflected on member ID cards and the Health First Colorado mobile application, as of June 15, 2023.

Recently Updated Billing Manuals and Fee Schedules

View all published fee schedules here.

View all published manuals here.

View 340B policy and procedures here.

Revised Obstetrical Global Billing Requirements

There is a new billing methodology to comply with CMS to capture information about care rendered through the maternity service time frame. The new methodology will give information needed to support high-quality maternity care and help providers report provision of these critical services. Learn more here.

Coding Committee

The quarterly coding committee meeting facilitated by HCPF is an opportunity to discuss coding questions, policy considerations, and requested edits to the billing manual with sister agencies, managed care entities (MCEs), and providers. These meetings are advisory opportunities for HCPF to engage state policy subject matter experts, MCE representatives, and providers to review and discuss issues that impact content in the billing manual. These meetings are not intended to be forums for general billing questions from providers.

The RAEs want to improve on how providers use RAE support related to coding questions, issues, and additions. Each RAE is requesting for providers to submit coding questions and potential agenda items as a first step for support and response. RAEs will then submit items to HCPF for the coding committee agenda. Learn more about the meetings here.

RAE Contact Information for Billing and Coding Questions

Region 1: Rocky Mountain Health Partners (RMHP)

Regions 2 and 4: Northeast Health Partners (NHP) and Health Colorado, Inc. (HCI)

Regions 3 and 5, and Denver Health: Colorado Access (COA)

Regions 6 and 7: Colorado Community Health Alliance (CCHA)

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