TopAt a Glance
February 28, 2020                                                                                  
In This Issue
In January 2020, there were 1,198,332 Coloradans enrolled in Health First Colorado and 76,855 enrolled in
Upcoming Events and Helpful Resources
Health First Colorado printed materials are available on our website
Health First Colorado videos for use in waiting rooms and other areas members visit are available for download on our website
New to PEAK or Need a Refresher?

The Intro to PEAK and Application Walk-Through recorded webinars are available anytime. For more information and trainings, visit the PEAK Outreach Initiative website.
Public Rule Review Opportunities

Anyone interested in a one-on-one discussion with Department staff about upcoming rules is invited to attend the Department's Public Rule Review Meeting. Information is available on the Public Rule Review Meetings webpage. 

For more information, or to be added to the Medical Services Board email distribution list, please contact Chris Sykes.
Employment Opportunities

Applying for state government jobs is easy. Applications are electronic, you will receive updates, and you do not need to answer any written questions until it is determined that you meet the minimum qualifications. 

Check out the website for State of Colorado jobs including the Department of Health Care Policy & Financing jobs.
Welcome to the February 2020 edition of At a Glance!

At a Glance is a Department of Health Care Policy & Financing (Department) publication which provides information on major initiatives including policy changes and program updates. Please feel free to share At a Glance with your colleagues. Previous editions of At a Glance are available on our website.

Thank you for your interest!

A Message from the Executive Director
The legislative session is underway, and the Department is hard at work supporting efforts to improve health care affordability for all Coloradans and our employers. 

Our Department provides health care coverage to more Coloradans than any insurance carrier in the state, covering almost one in four Coloradans with a budget of more than 25 percent of the state's General Funds. Consequently, we are called upon to be a trusted advisor, resource, leader and innovator for responsible health care transformation to the betterment of our members and all Coloradans. At the same time, our leadership in transforming health care better enables our Department and our passionate staff to provide cost-effective access to the critical benefits, services and support programs that so many Coloradans rely on each day. 

To that end, together with Lt. Gov. Dianne Primavera and the Office of Saving People Money on Health Care, we released the  Colorado Hospital Cost Shift Analysis report on Jan. 23. The report reveals that despite significant reductions in Colorado's uninsured rate and uncompensated care, and significant increases in Medicaid reimbursements, Colorado hospitals are persistently increasing the price they charge for their services. Hospital costs represent both the largest component and the most significant driver of rising health care costs; Department reports like this are therefore critical tools to help elected officials and stakeholders form effective affordability policy to the betterment of Coloradans and our employers.

On Dec. 31, the Department submitted the  Hospital Transformation Program (HTP) 1115 demonstration waiver application and State Plan Amendment to the Centers for Medicare and Medicaid Service (CMS). The federal comment period for the waiver ended Feb. 9 and the Department is working with CMS on specific program components. At the end of February, the HTP team will begin providing in-person trainings throughout the state to review the requirements and answer questions for hospitals participating in the program. We'd like to thank stakeholders, hospitals and community partners for their participation in the HTP process.

On Jan. 15, the Department submitted the  Hospital Expenditure Report to the General Assembly. This report details the activities the Department has undertaken to implement  HB19-1001 (Hospital Transparency) and  HB19-1320 (Hospital Community Benefit) to date. An addendum to this report will be submitted before the end of the 2019-20 fiscal year, when the detailed data from hospitals has been collected and analyzed. 

Together, we can achieve greater health care affordability for Coloradans and our employers. Thank you for your continued partnership on this important work! 

Kim Bimestefer
Breaking News
Public Charge Rule 
The U.S. Department of Homeland Security's public charge rule went into effect on Monday, February 24. As you may have heard, this rule changes which public benefits may be taken into consideration in some immigration determinations. This rule may impact members of Colorado's immigrant communities. 
Health First Colorado Buy-In Program Training
The Department is offering a refresher training to teach eligibility workers about the Health First Colorado Buy-In programs and February 2020 program updates: Buy-In for Children with Disabilities and Buy-In for Adults with Disabilities.
Eligibility workers will learn how a member can become eligible for a Buy-In program, the application enrollment process, and the benefits that are available.
Buy-In Training Webinar
Thursday, March 5
9:30 - 11:00 a.m. MST
Department of Health Care Policy & Financing Annual Report Now Available
The Department's  Fiscal Year 2018-19 Annual Report  is now available. Check it out to learn important Department data and budget information, and read provider and member testimonials.
Legislative Update
The Department has three bills on its legislative agenda this session, including:  
  1. SB20-171: Children's Habilitation Residential Program Rules
  2. Renew Overexpenditure and Transfer Authority
  3. Skilled Nursing Facilities: Establishing a Demonstration of Need and Technical Changes
Details on each are here.

For more information, contact Nina Schwartz.
Health Care Affordability
Hospital Transformation Program Update
Update on federal authorities
On December 31, 2019, the Department submitted the Hospital Transformation Program (HTP) 1115 demonstration waiver application and State Plan Amendment to CMS. We'd like to thank stakeholders, hospitals and community partners for their participation.
The next steps in the process involve a 30-day federal comment period and well as the Department working with CMS to address any questions that arise during this period. The waiver is currently posted for federal public comment on the CMS website and public comment period will be open through February 9, 2020.
HTP Road Show training for hospitals
The HTP team will be traveling around the state for in-person trainings to review the requirements and answer questions for hospitals participating in the HTP. Please mark your calendars or contact Joe Sekiya, Hospital Transformation Project Coordinator, for additional information.
  • Thursday, March 5 from 10 a.m. to 2:30 p.m. - St. Mary's Medical Center in Grand Junction
  • Friday, March 6 from 1 p.m. to 5 p.m. - Valley View Hospital in Glenwood Springs
  • Friday, March 13 from 10 a.m. to 2:30 p.m. - Heart of the Rockies Regional Medical Center in Salida

Measures updates

At the end of January, updated versions of HTP Measures list, Measures Overview, Scoring Framework and Measures Specifications were posted to the HTP website under the "Hospital Transformation Program Overview & Framework" section.  
If you'd like to know more about the HTP, we encourage you to visit  the HTP website   as well as read past editions of the HTP Newsletter in  our online archives.
For more information, contact Courtney Ronner.
Operational Excellence
Substance Use Disorder Benefit Update
Information for treatment providers
In this and future updates, we will highlight information relevant to Substance Use Disorder (SUD) providers who plan to offer residential and inpatient SUD services in Colorado through Health First Colorado funding. 

Regional Accountable Entity (RAE) communication
At this time, we encourage providers interested in receiving Health First Colorado reimbursement for residential and inpatient SUD treatment and withdrawal management services to reach out to the RAEs and Managed Service Organizations (MSOs) to discuss the credentialing and contracting process. Contact information for each RAE can be found on the Department's Accountable Care Collaborative Phase II webpage

American Society of Addiction Medicine (ASAM) alignment and training
Providers are encouraged to acquaint, or reacquaint, their staff with ASAM criteria. ASAM criteria will be utilized as the basis for the management of SUD benefits covered by Health First Colorado. Providers are encouraged to enact plans to ensure that all staff needing ASAM training have completed relevant training by July 2020.

Federal approval process update
Prior to the opening of coverage for SUD residential and inpatient services, the state must receive approval from the Centers for Medicare and Medicaid Services (CMS) for three components that will authorize coverage for SUD services in residential and inpatient settings. Those authorities include the State Plan, 1115 waiver and 1915(b) waiver. Each item authorizes a component of the services or service delivery system. The State is engaged with CMS in discussion of each of those components and is working toward obtaining approval for all components in advance of the target benefit opening date of July 2020.

SUD capacity assessment and planning
To date, the Department has completed 9 of 11 Regional SUD Capacity Stakeholder Meetings, scheduled through March 2020. After these public meetings and capacity assessment activities conclude, a capacity expansion plan will be developed in conjunction with the Office of Behavioral Health, RAEs, MSOs and external consultants. This plan will document gaps in the SUD service continuum and propose plans for the use of existing resources to address deficiencies. Presentation slides for these meetings are available here .  
For more information, please visit the Department's SUD website . 
If you have not signed up to receive the newsletter, please do so through this link.

Electronic Visit Verification Mandate
Beginning Monday, August 3, 2020, providers of Electronic Visit Verification (EVV) services will be required to utilize an EVV system to collect service visit data. 

EVV is an electronic system that verifies home or community-based service visits by documenting six points of data:
  1. Type of service
  2. Date of service
  3. Location of service
  4. Individual Receiving Service
  5. Individual Providing Service
  6. Time Service Begins and Ends
To determine if your agency will be required to use EVV, please review the EVV Types of Service - Service Code Inclusion document located on the EVV website, under resources. Provider participation is voluntary until EVV is mandated. Beginning now, until August 3, 2020, EVV implementation is in a soft launch period. This means that providers may voluntarily collect EVV data and transmit to the Department. The Department strongly recommends that providers and caregivers participate in EVV during soft launch as it is an opportunity to: 
  • Test and interface EVV Systems
  • Familiarize providers with EVV prior to claims integration
  • Claims will pay as usual while EVV errors appear on Remittance Advice
  • Help the Department identify and develop supplemental training materials 
  • Facilitate EVV participation by caregivers and members
For more information, contact the EVV team

Consolidated Return Mail Center Vendor Selected
A Consolidated Return Mail Center (CRMC) will be implemented in 2020 to change the current cumbersome process. Counties with high volumes have indicated they do not have the resources to timely process most of the returned mail. Due to workload, it is difficult for counties to prioritize receipt and processing of returned mail, often leading to a low priority for counties with the largest volumes.
The CRMC work group has selected a county to serve as the vendor for mail processing. We congratulate Prowers county on the contract award! We look forward to working with Prowers to implement the CRMC and alleviate the burden of returned mail from our county partners. 

Nondiscrimination Policy
The Colorado Department of Health Care Policy & 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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