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County Incentives Program
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Contract Deliverables for FY 2015-16 County Incentives Program
Contract deliverables for the current fiscal year's County Incentives Program are
due to the Department no later than July 5, 2016. The following deliverables require county action:
1. Collaboration documentation attached to the Collaboration Template
2. Training documentation attached to the Training Template
The Department will send out the required Templates to county directors.
For the Timeliness and Backlog Incentives, the Department will reach out to individual counties after July 1, 2016 to report whether an exemption form may be necessary to meet both Incentives benchmarks.
No action is required at this time for the MEQIP Incentive.
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| FY 2016-17 County Incentives Program |
Implementation Date for FY 2016-17
Contract requirements for the FY 2016-17 County Incentives Program will become effective July 1, 2016.
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FY 2016-17 County Grant Program
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Projects can begin on July 1, 2016
The Department will notify counties that have submitted grant applications by the end of June 2016 whether their applications were approved or denied.
If a county's application was approved, the project can begin on July 1, 2016.
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| County Training Opportunities |
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Staff Development Center:
Building Foundations: Perspectives - Virtual Instructor Led Training
July 14
, 2016
1:00pm - 5:00pm
July 19, 2016
8:00am - 12:00pm
Building Foundations: Data Entry - Virtual Instructor Led Training
July 13, 2016
1:00pm - 5:00pm
July 20, 2016
1:00pm - 5:00pm
Introduction to COGNOS - Virtual Instructor Led Training
June 22, 2016
9:00am - 12:00pm
Expanding Foundations Long Term Care - Denver Metro
July 13, 2016 -
July 14, 2016
8:30am - 4:00pm
Online through TrainColorado:
Building Effective Relationships
Civil Rights
Client ID State ID
Colorado Address Confidentiality Program
IRS 1095-B Health Coverage Video
Medicaid Buy-In
PEAK
Health App
Single Streamlined Applications (SSAp) 101
Understanding Poverty
Your Road to Resources
Department of Health Care Policy and Financing:
Health First Colorado Webinar
Annualized Income Webinar
Other trainings not mentioned above may qualify for the HCPF Training Incentive. Contact the County Relations team for more questions on the Training Incentive.
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Quick Links and Resources
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Medicaid and CHP+ Rules and Guidance
Volume 8 - Rules - direct link to Secretary of State
HCPF Forms and Rules
HCPF Agency and Directors Letters
HCPF FAQs and Training
HCPF County Relations
CBMS Enhancement Sheets - Governor's Office of Information Technology (OIT)
Staff Development Center (SDC)
Training Calendar
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Welcome to the June 2016 edition of County Connections!
Welcome to the newest edition of the
County Connections newsletter. The content in this newsletter is designed to inform county directors, management, and staff in areas such as county performance, process improvement, collaboration, policy updates, upcoming due dates and more.
The content will continue to evolve. We encourage our county partners to give us your content suggestions. Feedback can be sent to the
HCPF County Relations team.
Please feel free to share County Connections with your colleagues by selecting forward this email
at the bottom of this page.
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Breaking News - Policy and Process Updates |
| System and Policy Updates for Annualized Income and Five Year Bar for Non-Citizens |
Upcoming Updates to Colorado.gov/PEAK and the Colorado Benefits Management System (CBMS)
Several updates to CBMS and PEAK are scheduled to be implemented on June 26, 2016, to improve the overall eligibility partner and consumer experience.
- Modified Adjusted Gross Income (MAGI) Annualized Income
Effective July 1, 2016, the Department will start using annualized income for certain MAGI Medicaid and Child Health Plan Plus (CHP+) eligibility determinations for individuals with income from self-employment, seasonal employment, and/or commission-based employment.
CBMS users will notice the following:
- An MA annualized amount will display in CBMS Wrap Up if the annualized income methodology was applied
- MA eligibility will continue to be determined on a monthly basis
- The RRR packet will display annualized income, if applicable, and will request that clients indicate if their earned income is commission-based or seasonal
To learn more about the changes in PEAK, watch the HCPF and PEAK Outreach webinar Annualized Income for Health First Colorado (Colorado's Medicaid Program) and CHP+, available on CO.Learn.
Effective July 1, 2016, the five-year bar will be lifted for lawfully residing pregnant women and children eligible for non-MAGI programs. This change was previously implemented for lawfully residing pregnant women and children eligible for MAGI Medicaid and CHP+.
In addition, users will see the newly added statuses and class codes in the drop-down menu on the CBMS Non-Citizen page. Upon selection of one of these new values, individuals should be considered an eligible non-citizen for MA as long as all other criteria are met.
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Medicaid Eligibility of Individuals Residing in Community Corrections Facilities
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Policy and Data Entry Updates
Effective June 1, 2016, residents of Department of Public Safety (DPS) funded Community Corrections facilities, who otherwise qualify for Medicaid, are eligible for full Medicaid benefits.
Read the Department's full policy statement on this issue.
See CBMS Communication 715, Medicaid Eligibility for Individuals Residing in Department of Public Safety (DPS) Community Corrections (Halfway House) Facilities
, dated June 2, 2016, for more information about the process CBMS users should follow to implement this policy change.
If you have any questions about the policy change, contact the Medicaid Eligibility Inbox. For more information on data entry, refer to CBMS Communication 715.
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Updates to CBMS Caseloads: Project 9615
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The Department and the County CBMS Users Group (CCUG) would like to ensure that all County staff are aware of new functionality that will be coming soon via the CCUG-funded Project 9615 - CBMS Caseload Revisions. This project is scheduled for release in the June 2016 system build, and will allow for new capabilities for Counties that will ease workload. This training will also be covered in the June build training provided by Staff Development Center (SDC).
Project 9615 will provide the following important functionality to Counties:
- Provides the ability for County Security Administrators to create a generic user and associate a caseload to that user. This functionality will assure that caseloads do not need to be tied to a CBMS worker, in order to allow for task based and generalized caseloads in counties, as well as remove the need to have a specific individual listed on noticing and in CBMS as the owner of that case.
- Provides the ability for each County to have one active PEAK caseload per County, which can allow for any PEAK RTE cases to be routed to this caseload, rather than the transfer caseload, which is currently utilized for these cases.
- Implements the ability for Counties to pull a case assigned to Connect for Health Colorado back to the County for processing. This will also allow Connect for Health Colorado to pull a case assigned to the county, back to them for processing. Current functionality requires a request for transfer, which can take time to complete. This new functionality will allow for Counties and Connect for Health Colorado to be able to independently pull cases to their entity as needed, to work the case at that time, in turn reducing the waiting time for our clients.
If you have any questions, please refer to the June 2016 build training provided by the SDC. Thank you to Kathy Smith from Arapahoe County for providing this information!
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Contacting the Service Desk after hours or on weekends
for Priority 1 Incidents
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Here is the process for contacting the Service Desk after hours and on weekends if you need to report a Priority 1 incident:
- Call the OIT Service Desk at 303-239-HELP (4357).
- Choose either CBMS or CDHS option.
- Stay on the line, and a Service Desk Technician will answer the call.
- Identify the problem with the system, which must meet the Priority 1 criteria: Business function/application outage, which has the potential to cause loss of life or risk or injury to a citizen, or 7x24x365 service, or cause an impact on customers and users that is disabling.
- The OIT Service Desk will page the appropriate person on call.
- If you do not receive a call back within 30 minutes, please call back into the OIT Service Desk and let them know that you have not received a call from the individual working your Priority 1 HDT.
For more information, please contact [email protected].
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Medicaid Billing 101 for Counties, Partners, and Stakeholders
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A message from the Health First Colorado (Colorado's Medicaid Program) Member Contact Center
This information is designed to assist County staff, Partners and Stakeholders in understanding the Medical Assistance billing processes which will ultimately improve the member experience.
Which Medicaid program is the member eligible for?
- Individuals who qualify for Medicaid have access to full medical, mental health and pharmacy benefits. There is also a limited benefit for dental and vision services. The exception is for individuals who are receiving Medicare and/or those who are only eligible for the Medicare Savings Program (MSP) like QMB, SLMB and QI-1.
- SLMB, and QI-1 recipients do NOT receive any medical benefits through Medicaid. QMB recipients will only receive the same Medicaid covered benefits that are covered by their Medicare program.
- Medicaid benefit coverage is based on medical necessity. Some services, procedures and prescriptions require a Prior Authorization Request to demonstrate medical necessity.
Does the Medicaid member have any other medical insurance?
- Medicaid is the payer of last resort. If a member has another type of medical insurance, including Medicare, the other insurance must pay their portion of the claim first. Medicaid will cover the rest of the bill including the co-insurance and co-payments.
- Medicaid recipients who are not pregnant or under age 18 may be subject to Medicaid co-payments of $1-3 for office visits, procedures, lab work and prescriptions, and $10/day for hospital stays.
Claims and Reimbursements
- Claims are submitted and paid electronically from Medicaid contracted providers.
- Medicaid cannot accept paper claims.
- Medicaid does NOT reimburse individuals who have paid out of pocket for a Medicaid covered service, procedure or prescription. Reimbursements must be obtained from the provider. Medicaid will not enforce reimbursement.
Billing Issues
- Medicaid members must provide their Medicaid State ID# to Medicaid providers. Common mistakes include incorrect name or date of birth information which needs to be corrected to facilitate verification of Medicaid eligibility and proper billing protocols.
- Billing is based on the date when services are rendered. The date of service must be within an individual's medical span (dates of eligibility) for Medicaid payment of claims.
- Medicaid members who receive a bill from a provider for a Medicaid covered service, and the date of service is LESS THAN 120 days old, must first contact that provider to ensure correct information is on file regarding State ID#, name, date of birth, SSN, and gender. Then request the provider to submit the bill to Medicaid for payment.
- If the date of service is OLDER THAN 120 days, inform the member to call the Health First Colorado (Colorado's Medicaid Program) Member Contact Center (MCC) and request a Provider Notice Letter (PNL).
- The PNL confirms Medicaid eligibility for the member. The member will be directed by the MCC to take the PNL to the billing provider.
- The PNL guides the provider on how to submit their claim to Medicaid for payment.
Members can call the Health First Colorado (Colorado's Medicaid Program) Member Contact Center at 1-800-221-3943 for more information.
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| Medical Services Board (MSB): Who approves HCPF rules? |
MSB established by law
The Medical Services Board (MSB) was established by law effective July 1, 1994. It is the responsibility of the Medical Services Board to adopt the rules that govern the Department's programs. The Board has eleven members, with at least one member from each congressional district and no more than six members from the same political party. Members are appointed by the Governor and confirmed by the Senate.
Medical Services Board meetings are scheduled for the second Friday of each month and are open to the public. The Board hears each proposed rule twice to allow time for the public to participate.
For additional information visit the Department's
MSB webpage.
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Timeliness numbers for the month of May 2016 are in!
Timeliness for all Medical Assistance
applications for the month was measured at
97.99 percent.
The Department and its county partners have registered 23 consecutive months above 95 percent timeliness.
Timeliness for all Medical Assistance redeterminations for the month was measured at
97.35 percent.
The Department and its county partners have registered 4 consecutive months above 95 percent timeliness.
This could not have been accomplished without the hard work of our county partners. Many thanks!
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The following counties were below the 95.00 percent benchmark for the month of May 2016.
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Applications
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Redeterminations
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| Archuleta - 62.69% |
Baca - 84.62% |
| Baca - 57.69% |
Broomfield - 89.56% |
| Costilla - 92.00% |
Crowley - 93.12% |
| Dolores - 89.47% |
Fremont - 82.61% |
| Park - 93.10% |
Garfield - 94.59% |
| Yuma - 84.62% |
Gunnison - 92.38% |
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Jackson - 85.19% |
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Otero - 93.18% |
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Phillips - 86.67% |
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Rio Blanco - 93.20% |
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Saguache - 78.29% |
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San Miguel - 92.20% |
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Yuma - 91.17% |
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Medicaid Eligibility Quality Improvement Plan (MEQIP)
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MEQIP FY 2016-17: Changes to MEQIP Incentive
As part of the County Incentives Program, counties must submit their quarterly and annual reports on the specified due dates in order to earn MEQIP Incentives funds.
Beginning on July 1, 2016, there will be several changes to the MEQIP Incentive. In order to earn MEQIP Incentive funds, each county must follow the requirements as specified in the FY 2016-17 County Incentives Program contract amendment. Some of these changes include
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- Quarterly and Annual Reports must be submitted by the specified due dates
- Quarter 4 Report is due August 1, 2016
- Quarter 1 Report is due on November 1, 2016
- Quarter 2 Report is due on February 1, 2017
- Revised Annual Plans are due on March 31, 2017
- Quarter 3 Report is due on May 1, 2017
- Quarterly and Annual Reports must be completed per the instructions provided by the MEQIP Manual, which includes either the Value Stream Mapping with data and/or Business Process Plan with data
- Quarterly and Annual Reports must be revised per the direction of the MEQIP Program Manager
- Accurate Authorizations as measured by the county's case reviews must be greater than or equal to 90 percent, for counties that complete more than ten (10) case reviews in any given quarter
- Accurate Authorizations as measured by the county's case reviews must be greater than or equal to 70 percent, for counties that complete ten (10) or less case reviews in any given quarter
More information about MEQIP can be found on the MEQIP website. For assistance on MEQIP reporting, contact Gina Martinez, MEQIP Program Manager.
Note: MEQIP reporting on County Connections represents a point-in-time. If you have made corrections and/or other arrangements with the MEQIP program manager, they may not be reflected in County Connections at the time of publication.
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Public Assistance Reporting Information System (PARIS)
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PARIS expenditures in FY 2015-16 - As of May 31, 2016
Each fiscal year, the ten counties with the most cases listed in the PARIS system are allotted additional funds in order to work these cases. This system is critical to determining if a beneficiary is receiving benefits in multiple states, and if so, whether the client's case in Colorado should be closed or remain open.
As of May 31, 2016, these counties have only spent 78 percent of the state-wide allotment. Breakdown by counties is listed below.
| County |
Percent of PARIS Allotment Spent |
| Adams |
66.7% |
| Arapahoe |
124.5% |
| Boulder |
88.9% |
| Denver |
45.7% |
| El Paso |
68.8% |
| Jefferson |
83.3% |
| Larimer |
95.7% |
| Mesa |
83.2% |
| Pueblo |
68.7% |
| Weld |
122.2% |
The Department encourages these counties to utilize the funding allotted to them to work those cases listed in the PARIS system.
For more information regarding PARIS, contact Jared Shaffer, PARIS Program Manager.
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Process Improvement and Collaboration
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FY 2015-16 County Grant Program: Pueblo County LEAN Initiative
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Pueblo County implemented Train-the-trainer/LEAN Initiative for Medicaid technicians and management
As part of the FY 2015-16 County Grant Program, Pueblo County requested funds for a LEAN initiative that benefited Medicaid applications and redeterminations processing. Per Pueblo County, the goals of the initiative are:
"Teach how to coach for optimal LEAN performance, how to leverage LEAN management systems for continuous improvements, and lastly data and analytic skills for LEAN organizations."
In addition, Pueblo County certified trainers in the Bridges Out of Poverty program. The certified trainers assist staff with understanding the customer experience, while also understanding the barriers that people living in poverty experience.
More information on the Pueblo County project can be found in the FY 2015-16 County Grant Program:
Project Summaries.
Questions regarding the County Grant Program can be directed to the HCPF County Relations team.
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Accountable Care Collaborative (ACC): Access KP Payment Reform Initiative
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Department implements new payment reform initiative
ACC: Access KP is a new payment reform initiative within Colorado's Accountable Care Collaborative (ACC). The initiative is a limited benefit, capitated primary care model designed to pilot an alternative to the current fee for service payment mechanism. This initiative is a partnership between the Department, Colorado Access, and Kaiser Permanente (KP)
Who will be enrolled in the initiative?
All ACC Region 3 (Adams, Arapahoe, and Douglas Counties) Medicaid clients who are currently attributed to KP as their Primary Care Medical Provider (PCMP) as of May 1, 2016, will be passively enrolled into the new ACC: Access KP initiative. The initial enrollment is estimated to be about 26,000 Medicaid clients.
Clients who are located outside ACC Region 3 will not be eligible for ACC: Access KP.
When will the initiative begin?
ACC: Access KP will begin July 1, 2016.
Will this have an impact on counties?
ACC: Access KP will only affect clients who currently reside in RCCO region 3 counties (Adams, Arapahoe, and Douglas). These counties should be prepared for an increased volume of client questions relating to the program. The member FAQ and additional resources can be found on-line at
http://www.kp.providers.coaccess.com/.
How will providers identify clients enrolled in ACC: Access KP?
Clients enrolled in ACC: Access KP will have a KP member ID card and a unique identification within the Department's provider portal.
How can I learn more about ACC: Access KP?
Join us for one of six webinar opportunities to learn more about The ACC: Access KP program.
This webinar will:
- Provide an overview of the ACC: Access KP program
- Identify who will be enrolled in the ACC: Access KP program,
- Review which Medicaid benefits are covered in the ACC: Access KP program, and which benefits are considered wrap around benefits
- Review how to bill for patients enrolled in the ACC: Access KP program
- Provide you with ACC: Access KP resources that will support your staff and patients
Dates and registration information are below. We hope you join us!
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Date and Time
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Webinar Audience
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Registration Link
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June 21
Noon - 1:00 p.m.
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Medicaid Providers and Office Staff
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June 23
Noon - 1:00 p.m.
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Medicaid Providers and Office Staff
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June 28
Noon - 1:00 p.m.
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Medicaid Providers and Office Staff
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July 19
Noon - 1:00 p.m.
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Medicaid providers: FQHCS & SBHCs
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Gov. Hickenlooper Signs Medicaid Mail Order Prescription Bill
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Legislation allows maintenance prescriptions by mail
DENVER, CO - On June 1, 2016 Governor Hickenlooper signed Senate Bill 16-027 into law which will allow Medicaid members the option to get their health maintenance medications through the mail. Previously, Medicaid members could only get maintenance medications through the mail in very limited circumstances, such as a proven physical hardship. This legislation will increase convenience and efficiency while improving consumer choice and health outcomes.
"This legislation is another example of how Colorado continues to drive health care transformation. Mail order prescriptions increase our members' access and choices," said Susan E. Birch, MBA, BSN, RN, executive director of the Department of Health Care Policy and Financing. "This is an important piece of our Department's continual work toward modernizing Medicaid delivery systems to engage our members, improve quality of care and make more efficient use of taxpayer dollars."
Any medication that is taken regularly such as prescriptions for asthma, diabetes, high blood pressure and high cholesterol are now eligible for mail delivery. Medicaid members will experience more flexibility with the implementation of this new law as they will have the option to go to any Medicaid participating pharmacy.
"The Department is excited for this improvement because research has shown people who receive their chronic health medications through the mail often have better drug adherence," said Dr. Judy Zerzan, MD, chief medical officer. "People are less likely to run out of medication or skip doses when their prescriptions are delivered to the home at regular intervals."
Many local and independent pharmacies already offer mail delivery programs for their private insurance customers. These pharmacies have an opportunity to increase the number of people they serve now that Medicaid members may use their mail programs without having to prove a physical hardship. Opioids and other narcotics are not eligible for the mail order program as federal law prohibits their distribution through the mail.
This new law, which takes effect July 1, 2016, will provide a more cost-effective delivery system. Mail order prescriptions are delivered in 90 day quantities, rather than 30 day quantities provided during a trip to the pharmacy. This reduces the number of dispensing fees Medicaid pays. The Colorado Legislative Council projects mail order prescriptions will result in $1.7 million in savings in FY 2017-18.
Senate Bill 16-027 was sponsored by Senators Nancy Todd (D-Aurora) and Beth Martinez-Humenik (R-Thornton) and Representatives Dianne Primavera (D-Broomfield) and Lois Landgraf (R-Fountain).
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| Promoting Health Insurance Literacy in Colorado |
From the Colorado Health Foundation
Together, we can help promote health insurance literacy in Colorado!
Join advocates from across the state in exploring how shared messaging and educational resources can help all Coloradans to better understand and use health insurance, ultimately assisting them in improving their own health and that of their families.
WHAT:
WHEN:
Tuesday, June 28
11 a.m. to noon
HOW:
The webinar is being hosted by a collection of organizations interested in joining together to improve health insurance literacy in Colorado. Partners include Connect for Health Colorado, Colorado Consumer Health Initiative, the Colorado Department of Health Care Policy and Financing, the Colorado Division of Insurance, the Colorado Health Foundation and many others.
Please join us in our efforts to improve health insurance use for all Coloradans.
For questions, contact Keri Jones, communications associate.
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The Colorado Department of Health Care Policy and Financing does not discriminate against any individual 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 in employment, admission or access to, treatment or participation in, or receipt of the services and benefits under any of its programs, services and activities.
For further information about this policy, to request free disability and/or language aids and services, or to file a discrimination complaint, contact:
504/ADA Coordinator
1570 Grant St
Denver, CO 80203
Phone: 303-866-6010, Fax: 303-866-2828, State Relay: 711
Civil rights complaints can also be filed with the U.S. Department of Health and Human Services Office for Civil Rights electronically through the
Office for Civil Rights Complaint Portal
or by mail, phone, or fax at:
1961 Stout Street Room 08-148
Denver, CO 80294
Telephone: 800-368-1019, Fax: 202-619-3818, TDD: 800-537-7697
Complaint forms are available online
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For more information, please visit our website at
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