The next iteration of the Accountable Care Collaborative (ACC) is scheduled to begin July 1, 2018. The goals of the next phase are to improve member health and reduce costs.
In November 2017, the Department announced the awards for the seven Regional Accountable Entity (RAE) contracts.
The Department has made available the contact information,
and contracts for each of the entities on
In this issue, you'll find:
- Countdown to Phase II: Update on Our Progress
- Contracting Guidance for Mental Health and Substance Use Disorder Providers
- Contacting Your Regional Accountable Entity
Update on Our Progress
The Department has executed contracts with the RAEs and has made them available on CO.gov/HCPF/ACCPhase2. All contracts must be approved by the Centers for Medicare and Medicaid Services (CMS).
RAE Readiness Reviews
The Health Services Advisory Group has completed site visits and desk audits of each of the RAEs. All RAEs satisfactorily met the basic requirements to begin operations.
Section 1915(b) Waiver
The Department has responded to questions from CMS regarding the waiver application and is currently on schedule for formal approval of the waiver by July 1.
All RAEs are successfully enrolled as a new RAE provider type. The Department is continuing to work with DXC Technologies (DXC) to implement system changes to support the implementation of Phase II, including attribution processes, compensation, and reporting.
Assignment & Attribution
RAEs have submitted their list of contracted Primary Care Medical Providers (PCMPs) for processing of the initial enrollment of all eligible members. These PCMPs will be affiliated to their RAEs within the Colorado interChange for attribution processing.
- Now to Mid-May: DXC will process attribution and assignment for all eligible Health First Colorado members.
- Mid-May to End of May: The Department will work with RAEs and large, multi-clinic practices to ensure Health First Colorado members are attributed to the appropriate service location ID and other quality checks.
- Early June: The Department will submit final attribution information to the Health First Colorado Enrollment Broker for processing of member notification letters.
- June: Health First Colorado Members will receive notification of their RAE and PCMP via Health First Colorado Enrollment Broker letter.
The Department acknowledges that there have been changes to some provider's billing practices, including the requirement for providers to bill under their practice site id, that may impact member attribution and assignment. In addition, the Department is implementing a new approach to attribution that seeks to better meet provider and member needs. While the Department and the RAEs are taking a number of steps to ensure a smooth attribution process, we recognize there will be issues. The Department and the RAEs have systems in place to work through any issues that arise and will provide guidance at a later time about how to report attribution issues. We ask for everyone's cooperation as we work with providers and the RAEs to identify and resolve critical issues in attribution and assignment.
What Physical Health Providers Must Do to Have Members Attributed
- Be validated by the Department and enrolled as a Medicaid provider in the Colorado interChange. Providers that successfully revalidated do not need to do so again.
- Contract with a RAE. Each site of a practice must be contracted with a RAE as a PCMP to receive attributions. For more information see our Primary Care Medical Provider Contracting Guidance Fact Sheet on CO.gov/HCPF/ACCPhase2.
- Use the correct site ID in billing. Submit claims with the right service location ID and address where services are rendered, so the member is attributed to the right location. For guidance, see our Multiple Service Locations Fact Sheet.
The Department has been working alongside the outgoing Behavioral Health Organization and Regional Collaborative Care Organization contractors and incoming Regional Accountable Entities to develop member communications about the transition. Communications and resources will be posted to a forthcoming Member Messaging Resource Center on CO.gov/HCPF/ACCPhase2.
Contracting Guidance for Mental Health and Substance Use Disorder Providers
On July 1, 2018, the new RAEs will administer the capitated behavioral health benefit. All behavioral health providers who want to receive reimbursement for providing mental health and substance use disorder services covered by the capitated behavioral health benefit must contract directly with the RAE(s).
Behavioral health providers will need to contract with the RAE and be credentialed by the RAE to receive reimbursement for providing capitated behavioral health services as of July 1, 2018. Behavioral health providers must be enrolled as a Health First Colorado provider before they can be credentialed by a RAE.
Who Does Not Need to Contract with the RAEs
- Behavioral health providers who do not provide services covered by the capitated behavioral health benefit.
- Behavioral Therapists who do not provide mental health or substance use disorder services.
- Contact a RAE immediately to begin the contracting and credentialing process. Behavioral health providers must contract with and be credentialed by a RAE to receive reimbursement for providing capitated behavioral health services after June 30, 2018.
- Continue billing your current BHO for capitated behavioral health benefit services through June 30, 2018.
For more information please see the follow resources:
ACC Phase II Implementation Process Overview
ACC Phase II Key Concepts
ACC Phase II Attribution
ACC Phase II: Provider Contracting (What Providers Need to Know)
ACC Phase II: Short-term Behavioral Health Services in the Primary Care Setting
ACC Phase II: Performance Measurement
Phase II Questions
Contacting Your Regional Accountable Entity
Providers are strongly encouraged to contact their RAE directly regarding contracting.
We encourage all interested parties to check out our
Accountable Care Collaborative
Phase II site for the latest information:
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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