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The next iteration of the Accountable Care Collaborative (ACC) began July 1, 2018. As a reminder, the Department has published resources and guidance for providers, members, and other interested parties on
CO.gov/HCPF/ACCPhase2
.
In this issue, you'll find:
- Member Attribution Update
- Transition of Care Policy
- What Home and Community Based Service Providers Need to Know
- Identifying Denver Health Member Enrollment in the Provider Web Portal
- Member Enrollment in Kaiser Permanente
- Primary Care Medical Provider Panel Limits/Caps
- Updated Member Handbooks Online Now
- Submitting Questions
- Key Resources
- Contact Information
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Member Attribution Update
Through ongoing communications with our partners and contractors, the Department has identified a handful of issues that may have contributed to some members being attributed to the incorrect primary care medical provider (PCMP). We are working to address these issues at the individual and system level.
Health First Colorado members are encouraged to continue to contact the Health First Colorado Enrollment to change their primary care provider at 1-888-367-6557. State Relay: 711 for callers with hearing or speech disabilities. Call Monday to Friday, 8 a.m. to 5 p.m.
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Transition of Care Policy
Per 42 CFR 438.62, the Department must have in effect a transition of care policy to ensure members with special health care needs have continued access to services during a transition from fee-for-service (FFS) or from one Managed Care Entity (MCE) to another MCE. For more information, see the Department's
Transition of Care Policy
on the
ACC Phase II page
or the
Regulatory Resource Center
.
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What Home and Community Based Service Providers Need to Know
The implementation of ACC Phase II does not change the way Home and Community Based Service (HCBS) services are provided and how HCBS providers get paid. HCBS providers may continue rendering care and services to the Health First Colorado members they currently see.
A member's attribution to a primary care provider does not prevent HCBS providers from rendering care and services. If a member would like to change their primary care provider, they should contact Health First Colorado Enrollment at 303-839-2120, 1-888-367-6557 (outside of Denver), Monday-Friday, 8:00 a.m. to 5:00 p.m.; State Relay: 711 for callers with hearing or speech disabilities.
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Identifying Denver Health Member Enrollment in the Provider Web Portal
When verifying Health First Colorado member eligibility in the Provider Web Portal, a practice/provider may see that a member has a Managed Care Assignment with Denver Health and Hospital Authority. This does not always mean that a member is enrolled in Denver Health's Medicaid Choice Managed Care Organization.
Denver Health and Hospital Authority currently participates with Health First Colorado in two Benefit Plans:
- Primary Care Medical Provider--A fee-for-service provider within the open network of Health First Colorado; and
- Denver Health Medicaid Choice (PIHP)--a closed-network managed care organization.
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Member Enrollment in Kaiser Permanente
Kaiser Permanente has changed its participation with Health First Colorado. As of July 1, 2018, Kaiser Permanente will no longer serve as a Medicaid Primary Care Medical Provider (PCMP) outside of the Denver and Boulder area. Kaiser Permanente has chosen to not contract as a PCMP with the following regional organizations: 1,2,4, and 7.
In late June, Kaiser Permanente sent letters to approximately 5,600 impacted Health First Colorado members enrolled with Kaiser Permanente notifying them of this change. The impacted Kaiser Permanente members were disenrolled from Kaiser Permanente effective June 30, 2018. Impacted members were assigned a new PCMP and regional organization following the Department's attribution methodology, see our fact sheet and FAQs for more information. Members will be notified of this assignment through a letter from Health First Colorado Enrollment.
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Primary Care Medical Provider Panel Limits/Caps
Primary care medical providers (PCMPs) have the ability to set their own panel limit/cap on the number of Health First Colorado members that can be attributed to them, but are not required do so.
What PCMPs Need to Know:
- PCMPs are not required to have a limit on the number of health First Colorado members that can be attributed to them
- PCPMs have the ability to set their own panel limit/cap
- PCMPs can maintain an open panel with no limit
- PCMPs should contact their RAE to establish their panel limit/cap
- If a PCMP chooses to have a panel limit/cap and reaches this limit, the PCMP will not receive any additional attributions, including claims history, geographic attributions or member choice
- PCMPs must contact their RAE for their panel limit/cap, if one has been established; PCMPs cannot view their panel limit/cap through the Provider Web Portal
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Updated Member Handbooks Online Now
Health First Colorado member handbooks in English and Spanish have been updated to reflect the transition to regional organizations. Members can find the
handbooks on HealthFirstColorado.com
and can request a hard copy handbook by calling
Health First Colorado Enrollment if they have any questions regarding their letter at 1-888-367-6557. State Relay: 711 for callers with hearing or speech disabilities. Call Monday to Friday, 8 a.m. to 5 p.m.
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Common Member Questions
Can I enroll in regular Health First Colorado?
You are enrolled in regular Medicaid. From now on all Health First Colorado Members are assigned to a primary care provider and a
regional organization. Members still have their choice of primary care provider. In addition, members may see Health First Colorado providers of their own choosing even though they are assigned to a primary care provider and regional organization.
If you want to change your primary care provider you can do so at any time by calling Health First Colorado Enrollment at 1-888-367-6557. For TDD/TTY, call 888-876-8864. Call Monday to Friday, 8 a.m. to 5 p.m. The call is free.
Why do I need to have a primary care provider?
Health First Colorado thinks it is important for all members to have a primary source of medical care to help a member understand and coordinate their health needs. All members of Health First Colorado are now required to have an assigned primary care provider and a
regional organization. Members still have their choice of primary care provider. In addition, members may see Health First Colorado providers of their own choosing even though they are assigned to a primary care provider.
If you want to change your primary care provider you can do so at any time by calling Health First Colorado Enrollment at 1-888-367-6557. For TDD/TTY, call 888-876-8864. Call Monday to Friday, 8 a.m. to 5 p.m. The call is free.
Additional Health First Colorado member FAQs can be found here.
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Key Resources
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Submitting Questions
At this time, we ask that members, providers and other interested parties start by contacting their RAE if they have questions. In addition, interested parties can submit their questions to the Department using this form.
The Department will not be able to respond directly to all inquiries but will direct questions to the appropriate entity while we work closely with the RAEs and other contractors to address critical issues. The Department will continue to use the questions submitted to tailor upcoming communications and resources.
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Contact Information
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Region
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Entity Name
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Contact Information for Providers
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Contact Information for Health First Colorado Members
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1
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Rocky Mountain Health Plans
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2
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Northeast Health Partners
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9925 Federal Drive, Suite 100
Colorado Springs, CO 80921
Phone: 1-800-804-5040
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3
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303-368-0037 or 1-855-267-2095 (toll free)
Monday-Friday, 8:00 a.m. to 5:00 p.m.
State Relay: 711 for callers with hearing or speech disabilities
http://www.coaccess.com/
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4
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Health Colorado, Inc.
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9925 Federal Drive, Suite 100
Colorado Springs, CO 80921
Phone: 1-800-804-5040
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1-888-502-4185
Care Coordination Line: 1-888-502-4186
Monday-Friday, 8:00 a.m. to 5:00 p.m.
State Relay: 711 for callers with hearing or speech disabilities
https://www.healthcoloradorae.com/
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5
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Colorado Access
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303-368-0038 (Denver County) or 1-855-384-7926 (toll free) (Denver County)
Monday-Friday, 8:00 a.m. to 5:00 p.m.
State Relay: 711 for callers with hearing or speech disabilities
http://www.coaccess.com/
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6
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Colorado Community Health Alliance
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Phone: 303-256-1717 (Local) or 1-855-627-4685
Contact Us
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303-256-1717 or 1-855-627-4685 (toll free)
Monday-Friday, 8:00 a.m. to 5:00 p.m.
State Relay: 711 for callers with hearing or speech disabilities
http://www.cchacares.com/
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7
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Colorado Community Health Alliance
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Phone: 719-598-1540 (Local) or 1-855-627-4685
Contact Us
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719-598-1540, or 1-855-627-4685 (toll free)
Monday-Friday, 8:00 a.m. to 5:00 p.m.
State Relay: 711 for callers with hearing or speech disabilities
http://www.cchacares.com/
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The Colorado Department of Health Care Policy and Financing complies with applicable federal and state civil rights laws and does not discriminate on the basis of race, color, ethnic or national origin, ancestry, age, sex, gender, sexual orientation, gender identity and expression, religion, creed, political beliefs, or disability. Learn more about our Nondiscrimination Policy.
ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-800-221-3943 (State Relay: 711).
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1-800-221-3943 (State Relay: 711).
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