At a Glance is a Department of Health Care Policy & Financing (HCPF) 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 our website. Thank you for your interest!

HCPF Hospital Reports Webinar

HCPF released three annual, statutorily required hospital reports. We invite you to register for a free and engaging Colorado Hospital Transparency Reports webinar on Feb. 13, from 7:30 to 8:45 a.m. We will take a deeper dive into these reports, provide greater context on their findings, and answer attendee questions.

You can review all three reports, the Hospital Financial Transparency Report, Hospital Community Benefit Accountability Report, and Colorado Healthcare Affordability and Sustainability Enterprise (CHASE) Report, on our website. These reports provide valuable information on Colorado hospital revenues, profits, reserves, costs, community benefit investments and more. The webinar will help attendees understand and leverage this new information to drive meaningful results to the betterment of Coloradans, employers, care providers, the state and Colorado’s health care system overall. 

Provider Services Call Center Transition Coming This Spring

Beginning in spring 2025, management of the Provider Services Call Center module will transition from Gainwell to OptumInsight (Optum). 

What does this mean? 

Gainwell currently manages the Provider Services Call Center, and assists providers with claims submission and billing questions, member eligibility, provider enrollment assistance and the Provider Web Portal. 

This vendor change will only apply to the Provider Services Call Center providers call for the above inquiries. The Care and Case Management (CCM), Dental, Pharmacy and Electronic Visit Verification (EVV) call centers will not change. Visit the Provider Contacts webpage for a complete list of assistance resources. 

Gainwell’s contract to provide the Provider Services Call Center ends Spring 2025 and HCPF selected Optum to take over as the new vendor for the Provider Services Call Center.  

More information will be shared about changes providers should be aware of as the transition approaches. Some changes will include: 

• A new phone number. 
• Providers will be able to choose to have an agent call back to avoid waiting on hold, without losing their place in line. 
• Providers will be offered an after-call survey to provide valuable feedback about their call. 

Will the Provider Web Portal or Colorado interChange system change? 

No, Gainwell will continue as the vendor managing the Colorado interChange and Provider Web Portal. Gainwell and Optum will work closely together to ensure high quality resolution to provider questions and concerns.  

Why is the Provider Services Call Center vendor changing? 

HCPF is required by state and federal regulations to solicit competitive responses from vendors to procure vendor services on a regular basis.  

HCPF believes this transition will enhance customer service options and capabilities for providers and is committed to minimizing disruptions and keeping providers informed as the transition nears.

Visit the Colorado Medicaid Enterprise Solutions (CMES) Transition webpage for more information. 

Certified Community Behavioral Health Clinic Planning Guide

HCPF, in partnership with the Colorado Behavioral Health Administration (BHA), is pleased to announce that Colorado has been awarded a one-year, $1,000,000 Certified Community Behavioral Health Clinic (CCBHC) Planning Grant for the 2025 calendar year. Colorado’s participation in the CCBHC Planning Grant is a part of a state-wide, multi-agency effort to build and expand Colorado’s behavioral health system of care. The CCBHC Planning Grant will allow HCPF and BHA to explore how the CCBHC model could complement the Colorado Safety Net System to promote Colorado’s overall goal of integrated and accessible behavioral health care with sustainable funding practices.  

Thank you to all the stakeholders, community partners, and state department partners who participated in the application submission process. More information is on the CCBHC webpage. 

Improving Intensive Behavioral Health Services: Medicaid System of Care for Children and Youth

HCPF is announcing the launch of a new Medicaid System of Care (M-SOC) initiative designed to improve the health and well-being of children and youth under the age of 21. This innovative approach is based on an evidence-based, systemic framework and aims to provide comprehensive, coordinated care for children and families. The goal of M-SOC is to ensure that intensive services are delivered in an effective, supportive, and family-centered manner. More information is on the Improving Intensive Behavioral Health Services (IBHS) for Medicaid webpage.  

Sign up to receive the Medicaid System of Care for Children and Youth Behavioral Health newsletter. This newsletter will be sent out quarterly with meeting information, training updates and opportunities, benchmark achievements, and other exciting news. Email any questions to hcpf_msoc@state.co.us. 

Child Health Plan Plus (CHP+) Stakeholder Meetings

CHP+ is public low-cost health coverage for certain children and pregnant women. It is for people who earn too much to qualify for Health First Colorado (Colorado's Medicaid program), but not enough to pay for private health insurance. Interested stakeholders are invited to one or both stakeholder meetings to learn about the changes being made to specific benefits with the CHP+ program effective July 1, 2025. 

At these meetings, HCPF staff will present an overview of changes to Dental, Vision, and Durable Medical Equipment (DME) benefits within the CHP+ program. These changes will specifically impact CHP+ members. The webinar on Feb. 4 will cover specifically Dental benefits under the CHP+ program. The webinar on Feb. 5 will cover both DME and Vision benefits under the CHP+ program. Attendees are invited to learn and ask questions about the upcoming changes. 

Meeting date and time: Feb. 4, from 4 to 5 p.m. and Feb. 5, from 3 to 4 p.m.  

Registration and location: these meetings will be virtual via Zoom. Register for the meeting on Feb. 4. Register for the meeting on Feb. 5.  

After registering, attendees will receive a confirmation email with information about joining the webinar. 

A recording of the meeting may be requested by emailing Kyra Acuna at HCPF_stakeholders@state.co.us. 

For more information about CHP+, refer to the webpage.  

Meeting Accommodation and Language Access Notice: Auxiliary aids and services for individuals with disabilities and language services for individuals whose first language is not English may be provided upon request. Contact Kyra Acuna at HCPF_stakeholders@state.co.us at least one week prior to the meeting to make arrangements. 

Working Adults with Disabilities Stakeholder Meetings

The Health First Colorado Buy-In Program for Working Adults with Disabilities allows adults with a qualifying disability "buy into" Health First Colorado (Colorado's Medicaid Program). Members who work and earn too much to qualify for Health First Colorado may qualify for the Buy-In Program. Interested stakeholders are invited to one of two virtual stakeholder meetings to learn about updates being made to the Working Adults with Disabilities Buy-In Program effective July 1, 2025. 

At these meetings, HCPF staff will present an overview of the changes to how Health First Colorado members enroll into the Working Adults with Disabilities Buy-In Program. These changes will specifically impact Health First Colorado Members who also receive services through Home and Community-Based Services (HCBS) waivers. Attendees are invited to learn and ask questions about the upcoming changes. These two meetings are identical and therefore attendees only need to choose the meeting date and time that best fits their schedule. 

Meeting date and time: Feb. 20, from 11 to 12 p.m. and March 13, from 1 to 2 p.m.

Registration and location: these meetings will be virtual via Zoom. Register in advance for the meetings. Register for the meeting on Feb. 20. Register for the meeting on March 13.  

After registering, attendees will receive a confirmation email with information about joining the webinar. 

A recording of the meeting may be requested by emailing Kyra Acuna at HCPF_stakeholders@state.co.us. 

For more information about the Health First Colorado Buy-In Program for Working Adults with Disabilities, refer to the webpage.  

Meeting Accommodation and Language Access Notice: Auxiliary aids and services for individuals with disabilities and language services for individuals whose first language is not English may be provided upon request. Contact Kyra Acuna at HCPF_stakeholders@state.co.us at least one week prior to the meeting to make arrangements. 

Prescriber Tool Alternative Payment Model (APM) Update

The Prescriber Tool Alternative Payment Model (APM) is an upside-risk-only program designed to incentivize increased and consistent use of the Prescriber Tool by Health First Colorado providers receiving fee-for-service payments for their outpatient pharmaceutical claims, specifically the Real-Time Benefits Inquiry (RTBI) module, and prescription of preferred medications where clinically appropriate.   

The Prescriber Tool Alternative Payment Model webpage has been updated for Program Year 2, including a list of eligible practices searchable by Practice Business Name or National Provider Identifier (NPI). The slides and recording from October 2024’s webinar discussing the updates being made to Year 2 are also on the webpage.   

Program Year 2 for Prescriber Tool APM began in October 2024. The activity window begins in January 2025. Eligible providers should look for an email in mid-January 2025 with a link to complete the activities required and be eligible for payment.   

Contact HCPF_PharmacyAPM@state.co.us with any questions.

Bariatric Surgery Rule Revision Stakeholder Meeting

HCPF invites stakeholders to participate in a meeting to discuss revising the bariatric surgery rule. This meeting will build on feedback from earlier sessions, where stakeholders expressed a preference to revise the rule rather than remove or leave it unchanged.

HCPF staff will provide an overview of the current rule, present proposed revisions based on feedback and open the floor for discussion to gather stakeholder input.

Thursday, March 13, 2025, 9:30 a.m. to 12:30 p.m.

Location: Virtual via Zoom. Register in advance

Meeting Accommodation and Language Access Notice: Auxiliary aids and services for individuals with disabilities and language services for individuals whose first language is not English may be provided upon request. Please notify us at HCPF_Stakeholders@state.co.us at least one week prior to the meeting to make arrangements.

For more information, visit the HCPF Bariatric Surgery Rule Revision webpage or contact HCPF_Stakeholders@state.co.us.

Non-Emergent Medical Transportation (NEMT) Stakeholder Meeting

HCPF invites the public to a virtual stakeholder meeting to learn more about moving to a statewide broker model. 

HCPF staff will review the reasons for and benefits of the proposal. Attendees are invited to listen, learn, ask questions, and provide feedback. 

Meeting date and time: Monday, Feb. 3, 9:30 to 11:30 a.m. 

Registration and location: the meeting will be virtual via Zoom. Register in advance for the meeting. 

For those who cannot attend, a recording will be shared afterward and posted to the NEMT HCPF webpage. 

Meeting Accommodation and Language Access Notice: Auxiliary aids and services for individuals with disabilities and language services for individuals whose first language is not English may be provided upon request. Please notify Patrick Potyondy at HCPF_Stakeholders@state.co.us at least one week prior to the meeting to make arrangements. 

Las ayudas y servicios auxiliares para individuos con discapacidades y servicios de idiomas 

para individuos cuyo idioma materno no sea inglés pueden estar disponibles por solicitud. 

Comuníquese con Patrick Potyondy a HCPF_Stakeholders@state.co.us al menos una semana antes de la reunión para hacer los arreglos necesarios.

If you have general questions, please contact Patrick Potyondy at HCPF_Stakeholders@state.co.us for more information. 

Update: Long-Term Care and Buy-In 60-Day Eligibility Extension Through December 2025 and updates to termination reason exceptions

The Centers for Medicare and Medicaid Services (CMS) has granted a waiver that allows the LTC and Buy-In 60-day eligibility extension through December 2025. Prior to this update, we only had authority through June 30, 2025. In addition, CMS feedback was received for termination reason exceptions. 

HCPF has received approval to allow for the LTC and Buy-In 60-day eligibility extension to be applied through December 31, 2025. Based on CMS feedback, we are modifying the terminations that are exceptions to the 60-day extension. We will be adding over income and over resources. The updated list of exceptions will be the following:

• Death
• No longer a Colorado resident
• Withdrawal from the program
• Incarceration
• Over Income
• Over Resources

HCPF is working on adding the over income and over resources termination reasons to the exception list, which will require a CBMS project. We will provide you with an update once we have more information and the project date. 

In the meantime, the January renewal cohort will still have the 60-day extension applied to over income and over resources. This may potentially apply to February and March renewals as well until CBMS can be updated. 

Contact hcpf_medicaid.eligiblity@state.co.us if you have any questions.

Member Correspondence Improvements

HCPF is holding a series of quarterly virtual stakeholder meetings to present information about ongoing improvements to member correspondence.

At the meetings, HCPF staff will share

• updates on improvements being made,
• timelines for making changes,
• plans for future letter improvements, and
• opportunities for stakeholders to stay involved.

Attendees will be able to submit questions to be answered live when possible. Frequently asked questions will be posted on the Member Correspondence Improvements webpage following the meeting. Attendees will also be able to submit feedback via Google form for two weeks following the meeting.

The meetings will be in English and Spanish. ASL interpretation will be provided.

Meeting dates and times: 

• Thursday, April 17, 2025, 12 to 1 p.m.
• Thursday, July 17, 2025, 12 to 1 p.m.
• Thursday, Oct. 16, 2025, 12 to 1 p.m.

Please register for the meetings in advance. After registering, you will receive a unique link to join the meeting. For those who cannot attend the meetings, you may request a recording.

Meeting Accommodation and Language Access Notice: Auxiliary aids and services for individuals with disabilities and language services for individuals whose first language is not English may be provided upon request. Please notify the Stakeholder Engagement Section at HCPF_stakeholders@state.co.us at least one week prior to the meeting to make arrangements. 

If you have general questions, please contact the Stakeholder Engagement Section at HCPF_stakeholders@state.co.us for more information. 

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Mejoras de la Correspondencia de los Miembros

Health First Colorado está trabajando para mejorar las cartas de miembros y están planeando cambios basados en los comentarios de miembros y las partes interesadas.

Únase a nosotros en enero para una reunión virtual para escuchar actualizaciones y compartir comentarios en el paquete de renovación. Todos los que se registren recibirán materiales para repasar al menos una semana anticipada de la reunión. Por favor, vengan preparados para proveer sus comentarios.

Para aquellos que no puedan asistir, una grabación será compartida después y publicada en la página web de correspondencia de miembros.

Los asistentes también serán capaces de someter comentarios a través de un formulario en línea por dos semanas después de la reunión.

Fechas y horarios de las reuniones: 

• Jueves, 16 de enero de 2025, de 12 - 1 p.m.

• Jueves, 17 de abril de 2025, de 12 - 1 p.m.

• Jueves, 17 de julio de 2025, de 12 - 1 p.m.

• Jueves, 16 de octubre de 2025, de 12 - 1 p.m.

Por favor, registrarse para las reuniones con anticipación. Después de registrarse, Usted recibirá un enlace único para unirse a la reunión. 

Las reuniones serán en inglés y español. Se proporcionará interpretación en lenguaje de señas (ASL, por sus siglas en inglés).

Aviso sobre las adaptaciones y el acceso lingüístico para las reuniones: Ayudas y servicios auxiliares para individuos con discapacidades y servicios de lenguaje para individuos cuya primera lengua no sea el inglés puede ser proporcionado bajo solicitud. Por favor, notifique a la Sección de Compromiso con las Partes Interesadas a HCPF_stakeholders@state.co.us al menos una semana previa de la reunión para hacer los arreglos.

Si usted tiene preguntas generales, por favor comuníquese con la Sección de Compromiso con las Partes Interesadas a HCPF_stakeholders@state.co.us para más información.