Dear Provider,
Starting July 1, 2018, Health First Colorado (Colorado's Medicaid Program) physical and behavioral health care is managed by new Regional Accountable Entities (RAEs), also known as regional organizations, under the Accountable Care Collaborative (ACC) program. The RAEs will perform the duties previously contracted by Behavioral Health Organizations (BHOs) and Regional Care Collaborative Organizations (RCCOs).
Read below for important updates for RAE-contracted Primary Care Medical Providers (PCMPs).
Key Concepts for PCMPs
- All full-benefit Health First Colorado members (excluding members enrolled in Program for All-Inclusive Care for the Elderly [PACE]) will be enrolled in the ACC and assigned to a RAE. Health First Colorado members will no longer be able to opt-out of the ACC in to regular or basic Medicaid. Refer to the ACC Phase II Key Concepts Fact Sheet for more information.
- All full-benefit Health First Colorado members will be assigned a PCMP that will serve as a member’s medical home. Health First Colorado members will continue to have their choice of provider, including specialist, and can change their PCMP at any time. Providers interested in becoming a PCMP should refer to the Contracting Guidance for Primary Care Medical Providers Fact Sheet.
- Physical health services will continue to be reimbursed fee-for-service. Member assignment to a PCMP does not affect fee-for-service payments.
- The Department will no longer directly pay PCMPs administrative Per Member Per Month or key performance indicator incentive payments; instead, the RAEs will distribute these payments to PCMPs. Refer to the Performance Measurement Fact Sheet for more information.
- Members will be assigned to a PCMP using the new attribution methodology. Refer to the Attribution of Members to Primary Care Medical Providers Fact Sheet and the ACC Phase II Attribution Frequently Asked Questions for more information.
- Geographic location of member’s assigned PCMP site will determine member’s assignment to a RAE.
List of Assigned Members
- RAEs will share a list of attributed members prior to July 10, 2018.
- Starting in mid-June 2018, a PCMP’s member panel will be available in their “My Members” dashboard of the Data Analytics Portal and will be updated on a monthly basis.
- Individual member PCMP assignment can be identified when verifying a member’s eligibility in the Provider Web Portal.
PCMPs should contact their RAE with any questions about their list of assigned members.
More Information
- PCMPs should contact the RAE they are contracted with.
- Refer to the resource materials available on the ACC Phase II web page, including provider webinars, fact sheet and member communications.
Thank you,
Department of Health Care Policy & Financing
