At a Glance is a Department of Health Care Policy & Financing (Department) publication that provides information on major initiatives, policy changes and program updates. Feel free to share At a Glance with your colleagues. Find previous editions of At a Glance on the Department website at Colorado.gov/hcpf/publications. Thank you for your interest!
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A Message from the Executive Director |
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A Better Tomorrow for Adults and Children
With your help, we have connected Coloradans who lost their jobs during this economic downturn to public health coverage, which is an important tool in the battle against health disparities and the most important contributor to maintaining the state’s uninsured rate at about 6.6%. Specific to Colorado children, together, Health First Colorado (Colorado’s Medicaid program) and Child Health Plan Plus (CHP+) now cover nearly one in two Colorado children. Contributing to this reality, the number of children and parents we cover is up by almost one-third since the start of the pandemic.
After health coverage, another top priority in battling health disparities for low-income children is vaccinating them against COVID-19. Across the nation and here in Colorado, we are experiencing a frightening vaccine uptake disparity for people with lower incomes. Our 5-19-year-old members' vaccination rate is almost 17 points below all Coloradans of the same ages, and our adult members’ vaccine disparity is about 26 points below all adult Coloradans.
In our quest to overcome this important health disparity, and to encourage more providers to be part of the solution, we have received approval from CMS to further increase the Health First Colorado and CHP+ reimbursement rate for COVID-19 vaccine administration to $61.77 for the first two doses, retroactive to Sept. 1, 2021. This rate is triple the typical Medicaid vaccine administration rate and 50% above the Medicare rate. With this change, we again ask our providers to please become a Health First Colorado vaccine distribution partner. That includes Health First Colorado primary care providers, dentists, pharmacists and specialists, too. We also ask that our provider partners leverage every opportunity, in every care setting to encourage vaccinating our kids as well as families, and to encourage boosters too, which is even more important given the Omicron variant surge. An outreach toolkit is available for your use.
We also want to thank you for your partnership in addressing the impact of COVID-19 on the mental health of children, youth and adults. The behavioral health workforce challenges and appropriate care site limitations are clearly frustrating for all of us, especially as the demand for behavioral health services continues to rise. Longer term, we are confident the 19 priorities of the Behavioral Health Task Force - including the Behavioral Health Administration - and the $450 million in American Rescue Plan Act funding to transform our behavioral health system, with committee recommendations forthcoming this month, will help address these significant challenges. In the shorter term, we are collaborating bi-weekly with hospitals to help them find placements here in Colorado and across the nation for children, youth and adults awaiting appropriate behavioral health services. Concurrently, we are improving community mental health center (CMHC) cost reporting methodologies and developing a new universal contract model to help address many of the CMHC safety net system opportunities. Look for further behavioral health safety net solutions in mid-January, and please read this statement reaffirming my shared commitment with Colorado Department of Human Services Executive Director Michelle Barnes on the importance of working together to transform the behavioral system to the betterment of all Coloradans seeking such services.
As we begin the new year, I want to thank you for your collaboration in navigating the COVID-19 pandemic. 2022 will be a year of dynamic transformation, to the betterment of the children, youth and adults who rely on our services each and every day.
Kim
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Information for Health First Colorado and CHP+ members impacted by Boulder wildfires:
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New utilization management program for physician administered drugs:
Health First Colorado will be implementing a new utilization management (UM) program for the fee-for-service, physician-administered drug (PAD) benefit. Starting on Jan. 18, 2022, a select number of PADs will be subject to prior authorization (PA) requirements.
After implementation, providers will need to submit a PA request to the UM vendor, Kepro, for any member receiving any of the PADs listed in Table 1. Providers must also ensure that an approved PA is on file prior to PAD administration. There must be an approved PA on file for each of the PADs requiring a PA that a member receives. Completed PA requests will be reviewed and responded to within 24 hours of receipt.
Providers may contact the following entities related to PA, claims, and PAD benefit questions:
PA questions or concerns may be directed to Kepro
Claims questions or concerns may be directed to the Department's fiscal agent, Gainwell Technologies (formerly DXC Technology)
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CDC recommends COVID-19 vaccine boosters for anyone 12 or older:
As a reminder, children ages 5-11 are eligible for the COVID-19 vaccine. Vaccines and boosters are common practice in routine childhood vaccination. Many vaccines require multiple doses at specific intervals to be most effective. Anyone with questions about boosters is encouraged to speak with their health care provider.
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Sign up for the Hospital Discount Program newsletter:
The Department is in the process of implementing the new hospital discount program created under HB21-1198. This new program goes into effect June 1, 2022, and will impact all general acute care and critical access hospitals, free standing emergency departments, and the health care professionals who work within those settings.
Stakeholder meetings will be held in January, and more information is on the Hospital Discounted Care webpage. If you would like to stay up to date with the implementation process and receive information on how you can participate, please sign up to receive the Hospital Discounted Care newsletter.
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Keep in the know about new legislation on the horizon:
Sign up to get the Department's latest newsletter highlighting Maternal, Child and Reproductive Health legislation. The new monthly publication will offer updates, information, and stakeholder engagement opportunities related to SB 21-194, SB 21-009, SB 21-025, SB 21-016 and SB 19-195, the Maternal Opioid Misuse Grant, and the Maternal Advisory Committee.
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It's Open Enrollment in Colorado!
For those who aren’t already covered by job health insurance, Health First Colorado or Medicare, now is the time to sign up for a health insurance plan for 2022 coverage through Connect for Health Colorado. You can sign up for a health insurance plan during the Open Enrollment Period, which runs through Jan. 15.
- Most current customers are eligible for plan renewal, which means that their health insurance plan will automatically renew on Dec. 1 for 2022 coverage.
- After Dec. 1, customers have until Dec. 15 to update their account and change their plan as needed for coverage starting Jan. 1.
- If you sign up for a plan or change your plan between Dec. 16 and Jan. 15, your coverage will begin Feb. 1, 2022.
To find out whether you qualify for additional savings on health insurance plans, how much financial assistance you can receive and to see all the plans available to you, contact Connect for Health Colorado at ConnectforHealthCO.com or by calling 855-752-6749.
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Sign Up for the ARPA Project Pulse Newsletter:
The Department is implementing a multitude of projects to expand, enhance, and strengthen the Home and Community-Based Services (HCBS) system from fall 2021 through spring 2024 tied to federal funding in the American Rescue Plan Act (ARPA). This newsletter will serve as a source for key updates on all project planning and implementation, stakeholder engagement opportunities, and other topics of interest related to the funding.
We anticipate the newsletter to launch later this fall/winter and to be sent out monthly. In the meantime, please visit and bookmark the ARPA webpage for all the latest information and updates.
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In November 2021, there were
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