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TopAt a Glance
May 31, 2017                                                                                      
In This Issue
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In April 2017 there were 1,354,311 Coloradans enrolled in Health First Colorado (Colorado's Medicaid Program) and 73,307 enrolled in Child Health Plan Plus (CHP+).
Upcoming Events and Helpful Resources
Health First Colorado printed materials are available on our website
New to PEAK or Need a Refresher?

The Intro to PEAK and Application Walk-Through recorded webinars are available anytime. For more information and trainings, visit the PEAK Outreach Initiative website.
Public Rule Review Opportunities

Anyone interested in a one-on-one discussion with Department staff about upcoming rules is invited to attend the Department's Public Rule Review Meeting. Information is available on the Public Rule Review Meetings web page. 

For more information, or to be added to the Medical Services Board email distribution list, please contact Chris Sykes.
Employment Opportunities

Applying for state government jobs is easy. Applications are electronic, you will receive updates, and you do not need to answer any written questions until it is determined that you meet the minimum qualifications. 

Check out the website for State of Colorado jobs including the Department of Health Care Policy and Financing jobs.
Welcome to the May 2017 edition of At a Glance!

At a Glance is a Department of Health Care Policy and Financing publication which provides information on major initiatives including policy changes and program updates. Please feel free to share At a Glance with your colleagues. Previous editions of At a Glance are available on our website.

Thank you for your interest!


Breaking News

Community Mental Health Center Claims Guidance
As of March 1, 2017, Health First Colorado enrolled community mental health center (CMHC) claims must be submitted, using TR3 guidance as follows:
  • Services performed by practitioners who are not enrolled in Medicaid must be processed as a facility claim, using a qualifier of 2. The rendering provider field should not be entered, as the billing provider is the same as the rendering provider.
  • Services performed by Medicaid enrolled practitioners must be processed as an individual claim, using a qualifier of 1 and with the Medicaid enrolled practitioner as the rendering provider.
Practitioners who meet the qualifications to enroll in Medicaid must enroll and submit claims as the rendering provider for services they perform. Additional Provider revalidation and enrollment information can be found on the Department's website
Resources & Top Questions About Colorado's interChange
The work to modernize our provider payment system continues as we add resources to improve call wait times and training to help call center staff resolve issues on the first phone call, whenever possible. 

The Provider Association Newsletter has been launched to help support providers by highlighting new resources for assistance and calling out known issues, updates and workarounds for ongoing challenges. Sign up for the Provider Association Newsletter and feel free to share the information with your association members.
The quickest path to resolution of individual provider issues continues to be the Health First Colorado Provider Call Center. Please call 1-844-235-2387 for help. Hold times have dropped dramatically since the system launch.
With the system change and updated policies, the way messages and codes display has changed. Additional data may be required that was not needed in the previous system. Providers accustomed to the old codes, messages and requirements may need help as they make the transition. Here are a few differences:
  • Why is my claim marked "suspended"?
This is the new identification for claims that simply need further manual review. In the old system, they would have been identified as "In Process." Suspended claims are in process and our vendor is working to reduce the backlog of claims by June 1. Currently, fewer than three percent of claims fall into this category each billing cycle.
  • I saw a suspended claim last week in my remittance advice. Why don't I see it again this week?
Suspended claims appear once on the remittance advice when they are filed and placed in the queue for additional manual review. They will only appear again when they are either paid or denied. Our fiscal agent keeps the claims on file and processes them for payment as soon as they are reviewed.
  • Why do claims now require a national drug code on medications not required before?
Today, the Centers for Medicare and Medicaid Services requires that a national drug code be collected on all drugs, even over-the-counter medications. This was not previously required.
To help with these types of issues as well as processes for navigating the new system, providers should visit our web site that provides quick guides for many common procedures.
New Supplemental Resource--Child Health Plan Plus
A new resource covering Child Health Plan Plus is  now available on our website along with new resources for Medicaid Expansion and Colorado's efforts to curb opioid abuse. Please feel free to share these materials, which provide a more in-depth look at these important topics covered in our  Department Annual Report . 
Legislative Update
Colorado's legislative session adjourned this year on May 10, 2017.

The Department had a successful 2017 legislative session, with many major policy initiatives approved with broad bipartisan support. 

Three of our Department bills have been sent to the Governor, focused on compliance with federal home health rules, conflict-free case management and improving our program integrity efforts.  A number of other bills impacting the Department were also passed this session, aimed at improving Health First Colorado member correspondence and moving the Hospital Provider Fee (HPF) into an enterprise, among other things.  

For more information, contact Zach Lynkiewicz.
Tools for Transformation

Colorado State Innovation Model Practices Integrate Care, Test Alternative Payment Models

Read this short article series for a practical perspective on what practice transformation activities look like for Colorado State Innovation Model (SIM) practices, practice coaches and one behavioral health specialist. 

Data Illustrates State Innovation Model Practice Progress

The Colorado State Innovation Model (SIM) released a rapid-cycle report that focuses on data quality along with quarterly data from cohort-1 practices. Learn more about how many practices are screening patients for depression and conducting follow-up visits along with other data that SIM practices are reporting in a quick SIM podcast, Innovation Insights, with data and evaluation experts.

Get Coaching, Guidance Transforming Clinical Practices Initiative
The Transforming Clinical Practice Initiative (TCPi) is recruiting practices. TCPi is a free, federally-funded support network that helps you and your care team navigate provider compensation changes. Specialists are eligible for this program. Learn more and apply for the initiative to receive the coaching you'll need to succeed with value-based reimbursement models.

Partnerships to Improve Population Health
Public Comment Opportunity on Long-Term Services and Supports Waiver Amendment    
The Department will be holding a public meeting to present recent internal work involving the revision of the Home and Community Based Services (HCBS) rate methodology for services within five of the Long-Term Services and Supports waivers. The purpose of this meeting is to review this new HCBS waiver rate methodology, explain how feedback can be provided for HCBS rates set using this methodology, and answer any questions regarding the rate setting process.
These waivers are as follows:
  • Brain Injury (BI) Waiver
  • Elderly, Blind, and Disabled (EBD) Waiver
  • Children's Home and Community-Based Services (CHCBS) Waiver
  • Community Mental Health Supports (CMHS) Waiver
  • Spinal Cord Injury (SCI) Waiver
The Department will host a stakeholder meeting June 2, 2017 to review the HCBS waiver rate methodology, explain how feedback can be provided, and answer any questions regarding the rate setting process.  
Date: Friday, June 2, 2017
Time: 9:30-11:30 a.m.
Location: 303 East 17th Avenue, Rooms 7ABC (7th Floor)
   Denver, CO 80203

Phone Conference Local 720-279-0026
Toll Free 1-877-820-7831
Conference Code 982280

For more information, contact Victoria Montoya.

Delivery Systems Innovation
Accountable Care Collaborative Request for Proposals Now Available
The Department has released the formal request for proposals (RFP) for seven Regional Accountable Entities for the next iteration of the Accountable Care Collaborative. We have made the scope of work of the RFP available for viewing on our Accountable Care Collaborative Phase II website .
In accordance with state procurement rules , the Department may only respond to questions from potential bidders regarding the RFP through the official inquiry process. The Department is also restricted from discussing the RFP until contract awards are formally announced and all protests and appeals are settled.
Potential bidders must access the RFP using the state's procurement website. Click the Public Access button on the left side of the screen once you are on the state procurement website.  T he deadline for proposal submission is July 28, 2017.

Accountable Care Collaborative Enrollment Update
As of May 2017, 1,049,765 Health First Colorado members were enrolled in the Accountable Care Collaborative. 

This number includes 37,139 who are members of the Accountable Care Collaborative PRIME program on Colorado's western slope and 21,672 who are members of the ACC: Access KP Program in RCCO Region 3.

Approximately 729,926 Accountable Care Collaborative members are attributed to a medical home.

Operational Excellence
Drug Utilization Review Board Vacancy and New Resource
The Drug Utilization Review (DUR) Board serves in an advisory capacity to the Department and makes recommendations regarding issues of drug utilization, provider education interventions, and application of standards.  The DUR Board also determines the prior authorization criteria for drugs with special prescribing guidelines and the prior authorization criteria for non-preferred drugs that do not make the Preferred Drug List (PDL).
DUR Vacancy: The DUR Board has an opening for one MD/DO.
  • Do you or somebody you know have a passion for serving the Health First Colorado population and availability for a quarterly three-hour meeting (with some preparation) to provide your/their expertise to the process of drafting medication use criteria for the state of Colorado?
  • If so, please send an email to Brandon Utter for more information.
DUR recently published its first newsletter which has some general DUR information and highlights positive impact of the opioid policy pertaining to opioid prescriptions greater than 300 morphine equivalent doses (MED) implemented in February 2016.  The DUR's first newsletter is available on the Department's website .

Qualified Medication Administration Personnel Changes      
Effective July 1, 2017, employees and contractors who administer medications must complete medication administration training in order to meet the minimum guidelines established in the Colorado Department of Public Health and Environment (CDPHE) Chapter 24 rules through an Approved Training Entity. 
The Department is conducting joint technical assistance calls with CDPHE for service provider agency nurses regarding this transition.
Dates: Every other Friday, May 26, 2017- Friday, September 1, 2017 

Time: 10:00 a.m.-11:00 a.m.
Call in number: 1-877-820-7831, participant passcode 869804#

For more information, contact Michele Craig.

Nondiscrimination Policy
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.

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