Mar. 5, 2021
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 Thank you for your interest!
A Message from the Executive Director
Stakeholders, Advocates and Partners:

This month marks one year into the COVID-19 pandemic - one year of immeasurable grief for lost loved ones and friends, one year of dynamic transformation, one year of coming together to  help each other through an unprecedented economic downturn, one year of incredibly difficult decisions.  

For those who have lost loved ones and friends, our hearts are with you; we hope that time brings you peace.  

Thank you to our county partners, eligibility workers, caregivers, contractors, advocates and many others who have overcome challenges to help us serve the 1.44 million Coloradans who are accessing our safety net coverage programs - coverage is even more critical during a pandemic. I, and our HCPF staff, am honored to work with you and appreciate your passion for service. Together, we are now serving 1 in 4 Coloradans. In fact, we just crossed the 200,000 mark this month, representing the additional Health First Colorado and CHP+ members we are serving. Our federal partners have said they expect to keep the Public Health Emergency in place throughout 2021, which means our membership will continue to grow throughout 2021.To meet this demand, I’m pleased to report that we are well on our way to achieving our goal of enrolling 10,000 new providers by June 30, 2021.  

Thank you to you – our new providers – and to all our care providers and first responders for putting all of us first at your own personal risk. Your selflessness has been exemplary, and we are very grateful. Thank you to our scientists, researchers and innovators: the vaccines speed to market has been miraculous. Lives will be saved. The economy will recover, and many who have lost their jobs will be employed again because of your passion, efforts and advances.   
This month, Colorado will surpass 1 million Coloradans being vaccinated with one dose and 500,000 with their second dose. The most recent information is available at With the recent approvals of a new one dose vaccine and with the industry joining forces to speed vaccine production, we are hopeful the immunization numbers will improve significantly in the coming months in parallel to the growing vaccine supply. To maximize this opportunity and to protect our members, we are working with our Regional Accountable Entities (RAEs) to ensure all our members have access to the vaccine and to help members understand where to go and when it’s their turn to get the vaccine. We are also working with our community partners to help overcome resistance and misinformation about COVID-19 vaccines with the goal of improving vaccine uptake and inoculation. Last, we are collaborating to get the vaccine to our members who are homebound or otherwise hard to reach.   

Thank you to our HCPF staff. This past year, you plunged boldly into a chapter that offered no playbook. You pulled together to serve more and do more while facing a state fiscal crisis. You reprioritized to meet the urgent demands. You created new forecasting and budgeting models and tools that recognized changing economic and utilization insights. You passed emergency rules to help our members more safely access care, while giving our providers more flexibility to adapt to an emerging “new normal” while helping reduce administrative burden. To protect those most vulnerable to COVID-19, you teamed-up with CDPHE and the Governor’s Office to create a Residential Strike Force focused on keeping our members in nursing homes and congregate settings safe. 

Just as we have done this past year, we will have to lean on each other to get through the next phase of this pandemic. As we turn the corner in battling COVID-19 and the economic downturn, I will continue to ask for your help as trusted voices, partners, leaders and care givers. Thank you in advance for your partnership, collaboration, help and support as we navigate through this next chapter together. 
Kim Bimestefer
Breaking News
Health First Colorado Mobile App Updates:
We made some updates to the Health First Colorado app! Now members can fill out basic redeterminations for Health First Colorado and CHP+ cases. Members can complete their medical assistance redetermination in the app if everything has stayed the same, or they need to make changes to their (1) home and mailing address and/or (2) job income.
Also new in the app:
  • Households with more than one case can switch between cases
  • It's easier to find contacts for benefit information

For more information, contact Erin Cummings.
Share How We Are Helping Families Get a Boost:
Please share this information with your networks. Content for newsletters, websites and other publications is below in English and Spanish. Images and video in English and Spanish to accompany the content is also available. We appreciate your partnership!

1 in 4 Coloradans are covered by Health First Colorado (Colorado’s Medicaid program). Coloradans from across the state and all walks of life get their health care from Health First Colorado, including people who never thought they’d need public health insurance. Arlene and Pedro were able to get health care coverage for their girls from Health First Colorado. They want you to know that everyone needs help sometimes, and applying for Health First Colorado is easy. Watch the Soto Ynigo family’s story and listen to Health First Colorado members tell in their own words how Health First Colorado was there to help.

1 de cada 4 ciudadanos de Colorado tiene cobertura de Health First Colorado (programa de Medicaid de Colorado). Los ciudadanos de Colorado de todo el estado y de todas las esferas sociales reciben atención médica de Health First Colorado, incluso las personas que nunca pensaron que necesitarían un seguro médico público. Arlene y Pedro pudieron conseguir cobertura de atención médica para sus hijas con Health First Colorado. Quieren que sepa que todos necesitamos ayuda en algún momento, y solicitar cobertura de Health First Colorado es sencillo. Mire la historia de la familia Soto Ynigo y escuche a afiliados de Health First Colorado contar con sus propias palabras cómo Health First Colorado estuvo allí para ayudar. Otros afiliados de Health First Colorado quieren que los ciudadanos de Colorado sepan que es posible que reúnan las condiciones para una cobertura de atención médica de buena calidad. Infórmese más en
Operational Excellence
Mental Health Parity Public Comment Opportunity:
The Department has begun work on the annual Mental Health Parity and Addiction Equity Act (MHPAEA) Report to assess the compliance of the Health First Colorado benefit with mental health parity laws. To inform this work, the Department is gathering stakeholder thoughts and experiences related to mental health parity that will be used to design the mental health parity analyses and inform its annual report.

Individuals interested in submitting written comments can use this form. The form will be open until April 1. The purpose is to collect feedback from stakeholders; the Department will not be responding to submitted comments.
Health First Colorado Recovery Audit Contractor (RAC):
In compliance with Section 6411(a) of the Affordable Care Act, the Department contracted with Health Management Systems, Inc. (HMS) to serve as its Recovery Audit Contractor (RAC) to conduct post-payment reviews of claims submitted for fee-for-service and managed care services. This is a federally-mandated contract program. In February 2018, HMS began reviews to identify overpayments and assist the Department in recovering any overpayments made to providers for Health First Colorado medical claims.

The RAC audits claims from as far back as seven years (84 months) from the date the claim was originally paid as approved in the State Plan Amendment CO-16-0003. This lookback period extends to all claim and provider types.

Providers are encouraged to update their contact information using the HMS RAC Provider Portal. This is a tool that providers can use to track the progress of their audits, as well as add contact information that is specific to RAC correspondence. Providers can also upload documentation through this portal if medical records are requested for a post-payment audits. If a provider does not update address and contact information in the HMS portal, all correspondence will go to the provider’s service address listed in the Colorado interChange. Providers can access the portal and update contact information at  

The Department website has RAC resources and information available for providers at

HMS has also published a number of resources for providers including a recorded webinar, RAC 101, RAC FAQ, provider portal training and contact information.

For more information, visit the HMS Colorado RAC at
Prescriber Tool Project:
The Department is implementing the Prescriber Tool, a multifunctional platform that will be accessible to all prescribers through most electronic health record (EHR) systems. The Prescriber Tool will help improve health outcomes, reduce administrative burden for prescribers and better manage prescription drug costs by providing patient-specific information to prescribers at the point of care. 

The Prescriber Tool is being implemented in modules which will provide different types of patient information or functionalities. 

Opioid Risk Module
The opioid risk module will be implemented first and is anticipated to be operational in January 2021. OpiSafe has been contracted to administer this module which will help prescribers prevent the misuse and abuse of opioids and benzodiazepines. The module will provide:
  • Easy access to Prescription Drug Monitoring Program (PDMP) data 
  • Identification of Opioid Use Disorders (OUD)
  • Educational tools with access to evidence-based treatment
  • Tools for overdose prevention

Additional modules are expected to be implemented by summer 2021, including a module that will provide real-time, patient-specific pharmacy benefit information. 

Open Access License Program
In order to access the opioid risk module, each prescriber must have an individual license. To facilitate rapid adoption of the module, the Department will be awarding a limited number of user licenses free of charge to qualified Health First Colorado prescribers. The subsidized license will be valid for one year, thereafter prescribers will need to pay an annual license fee to OpiSafe. Please note, the Department is unable to assist with any EHR-related costs (if applicable) for accessing the opioid risk module.

The online application for the Open Access License Program will be available from Jan. 2 through March 1, 2021, or until all subsidized licenses have been awarded.
Once operational, the cost to prescribers for accessing the Prescriber Tool will vary depending on the specific module(s) and EHR utilized. Visit the Prescriber Tool Project webpage to apply for a user license, or for more information about the Prescriber Tool project.

For more information, email 
Helpful Resources
Female provider, kneeling next to parents holding small child.
In January 2021, there were
1,424,251 Coloradans enrolled in Health First Colorado and
64,505 enrolled in Child Health Plan Plus.