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.

Public Health Emergency (PHE) Update

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.

The PHE ends May 11, 2023. Health First Colorado (Colorado’s Medicaid program) and Child Health Plan Plus (CHP+) members will return to normal eligibility renewal processes. Noticing began in March 2023 and renewals will start to be due this month. The redetermination process will take place over 12 months, so not all members will have to renew at the same time. Members will be due for renewal in the calendar month they enrolled. 

Understanding the renewal process will help you to best support your Health First Colorado eligible patients through this transition. Click here to learn more about what they must do for their renewal, including determining eligibility and how to re-enroll. 

Learn more about our plan for the end of continuous coverage here. As more updates become available, we will continue to share what this means for you and for our members.

 

The State of Colorado's Provider Web Portal

The state of Colorado’s Provider Web Portal has moved here. Please make sure to update your bookmarks with the new URL.

You can check member eligibility, complete provider revalidation, and update information on the portal. Click here for a guide on how to use the portal.

Quick Guide Updates

 The provider web portal quick guide was updated to show the differences between coverage under the Family Planning (FAMPL) benefit and the Emergency Medical and Reproductive Health Program (EMS). Learn more here.

View all quick guides here.

Scam Alert

Health First Colorado and CHP+ members and applicants may be targeted by scam text messages and phone calls. Scammers may threaten members and applicants with loss of health coverage or legal action, demand money, or ask for sensitive personal information. The Colorado Department of Health Care Policy and Financing (HCPF) does not ask for money or sensitive personal information like social security numbers over phone or text; HCPF also does not threaten legal action over phone or text.

HCPF and county departments of human services are permitted to contact members by phone to ask about current contact information, including phone number, email address, and mailing address. Members can update this information online at CO.gov/PEAK

If you see a message that may be a scam, please report it to the Attorney General Consumer Protection Unit. Go to coag.gov/file-complaint to learn more about how to report a scam message.

Go to hcpf.colorado.gov/alert to learn more.

Telehealth Coverage Discontinued for Well Child Visits

Telehealth coverage for well child visits was added during the PHE, but as the PHE ends, this coverage ends on May 12, 2023. You will still be reimbursed for in-person well child visits. The affected procedure codes are: 99382, 99383, 99384, 99392, 99393 and 99394. Learn more here.

If you have any questions, please email Morgan Anderson at [email protected] or Naomi Mendoza at [email protected].

2023 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, May 23, 2023 from 3:00 p.m. to 4:00 p.m

- Focus: American Indian/Alaska Native community

- Register here.

Wednesday, June 21, 2023 from 1:00 p.m. to 2:00 p.m.

- Focus: African American community

- Register here.

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.

COVID-19 Booster Shot for Children

On April 18, 2023, the U.S. Food and Drug Administration (FDA) amended the emergency use authorization (EUA) for the Pfizer-BioNTech and the Moderna bivalent COVID-19 vaccines to simplify the vaccination schedule for most people, including authorizing both vaccines to be used for all doses for anyone 6 months old or older. This includes an additional dose or doses for certain populations.

The monovalent Moderna and Pfizer-BioNTech COVID-19 vaccines are no longer authorized for use in the United States. Learn more here.

Statewide Utilization Management Standards for Behavioral Health Providers

HCPF has been working with the Regional Accountable Entities (RAEs) to create statewide standardized utilization management (SSUM) guidelines to assess the most appropriate level of care for children referred for residential treatment. These guidelines complement national UM standards RAEs use to authorize behavioral health services. They have information about Qualified Residential Treatment Programs (QRTP) and Psychiatric Residential Treatment Facilities (PRTF).

Starting July 1, 2023, RAEs will be required to use these guidelines in their UM processes.

Learn more here. If you have any questions about the SSUM guidelines, please email John Laukkanen at [email protected].

For Obstetrics and Maternity Providers: Revised Obstetrical Global Billing Requirements

A new billing methodology was developed to comply with Centers for Medicare & Medicaid Services (CMS) requirements to identify the timing and numbers of prenatal and postpartum visits throughout the maternity service time frame. This will give necessary information for supporting high-quality maternity care. You can view updates to obstetrical billing requirements here. The Obstetrical Care Billing Manual will be updated as well.

If you have any questions, please email Melanie Reece at [email protected] or call the provider services call center at 844-235-2387 from 7:00 a.m. to 5:00 p.m. Monday through Friday.

Doc2Doc Well-Being Consulting

The Colorado Medical Society has three free, confidential peer well-being consultation sessions available for any Colorado physician or medical student. Call their hotline 24 hours a day, seven days a week at 720-810-9131 to talk to a masters-level licensed clinician. Learn more here.

For Opioid Treatment Providers: Take-Home Buprenorphine

As of May 1, 2023, a new policy is in effect where opioid treatment providers (OTPs) may dispense up to a seven-day supply of take-home oral buprenorphine and buprenorphine combination physician-administered drugs (PADs) to Health First Colorado members. These PADs are to be billed through standard buy-and-bill processes when an OTP:

Get the appropriate Drug Enforcement Agency (DEA) registration

Has authority based on the rules and regulations set by the State of Colorado

Follows all guidelines set by the Substance Abuse and Mental Health Services Administration (SAMHSA)

Learn more here.

Upcoming Provider Forum

Please join us on Thursday, May 18, 2023 at 12:30 p.m. for our annual administrative payment model information session on Zoom. In this forum, we will review updates to our administrative payment model that will go live on Saturday, July 1, 2023.

The forum will also cover:

Adjustments to the definition of “pediatric complex member"

Programmatic changes and investments

Administrative Payment Model metrics

A funding opportunity for providers who serve vulnerable populations

There will be time to answer questions at the end of the forum. Click here to learn more and to register. After you register, you will get a confirmation email with the Zoom link and more information about how to join the webinar.

Dental Payment Update

The technical specifications for HCPF’s dental key performance indicator (KPI) have changed to require that oral evaluations be performed only by providers with dentistry-related taxonomy codes. This means that very few of the oral evaluation services done within the primary care medical provider (PCMP) network counted towards meeting the FY 2022-2023 Quarter 1 KPI goal.

Region 5 of Colorado did hit this goal for Quarter 1. Payment was distributed during the first week of May 2023. While we do have an established distribution methodology for disbursing 50% of the dental KPI payment in proportion to the number of numerator hits generated by each PCMP in the network, the methodology is not appropriate for Quarter 1 earnings based on the new specifications, seeing as 99.6% of qualifying services came from outside of the PCMP network. So, we have decided to distribute 50% of funds according to PCMP attribution, and will continue to pay out the remaining 50% according to the tiered model that ranks the percentage of each PCMP’s attributed members that got a qualifying dental service during the quarter. 

To learn more about the latter payment, please go to coaccess.com/providers/resources/vbp and view the document titled “FY 22-23 COA Pay-for-Performance Program Document.” We will work with the Region 3 & 5 Governing Council to establish a new distribution methodology for the dental KPI, and we will update this document as soon as a model has been approved.

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