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! | |
A Message from the Executive Director | |
Advancing the Medicaid Delivery System | |
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The Accountable Care Collaborative (ACC) is the primary delivery system for Health First Colorado (Colorado’s Medicaid program). Phase III of the ACC, scheduled to begin July 1, 2025, was designed through HCPF’s engagement with more than 5,700 stakeholder participants, including advocates, providers, community organizations, and members across 135 stakeholder meetings over 18 months. Phase III will build on the foundation set over the past 13 years to improve quality of care, close health disparities, improve care access, improve the member as well as provider experience, and manage costs, which is critical to protecting member coverage, benefits and provider reimbursements, especially in tight state budget years. We are excited to incorporate so many advances into ACC Phase III, including improving communication with members, member incentives, value-based payments, community‐based health equity plans, connecting members to health related social needs supports like housing and food assistance, standardizing care coordination, moving to a primary care model that ties payment to performance with increased supports for rural independent as well as Rural Health Clinic providers, and more. Additional information is on the ACC Phase III webpage.
A key component of the ACC is the Regional Accountable Entity (RAE). HCPF has issued an intent to award four RAE contracts for ACC Phase III.
- Rocky Mountain Health Plans (RMHP) in Region 1 is a returning RAE partner, inclusive of the Managed Care Organization (MCO) offering in this region, in the same counties.
- Northeast Health Partners (NHP) in Region 2 is a returning RAE partner, with a new administrative subcontract with RMHP.
- Colorado Community Health Alliance (CCHA) in Region 3 is a returning RAE partner, consisting of a jointly managed partnership between Anthem Partnership Holding Company, LLC (now branded Elevance) and CCHA.
- Colorado Access in Region 4 is also a returning RAE partner.
- Denver Health’s MCO will continue to serve the physical health needs of many members within Region 4, and collaborate with Colorado Access for their member’s behavioral health benefits.
With these awards, HCPF is working with each vendor to finalize and execute new contracts, in accordance with the new RAE Regions illustrated below.
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On the affordability front, HCPF released the new Hospital Price Transparency Tool last month. This free tool displays over 2.5 million commercially negotiated prices for more than 5,000 procedures provided by 82 Colorado hospitals. Since hospitals represent the biggest part of the health care dollar, this innovative and easy-to-use tool can fuel productive conversations between communities and hospitals to improve affordability for Coloradans, employers, municipalities and taxpayers. I and members of HCPF’s Affordability team will be meeting with employer chambers and other purchasing organizations starting this month to help them learn how to use this new tool.
Other efforts to save Coloradans and employers money on health care that will be discussed at these meetings include opt-in actions that self-insured employers need to take to secure savings on their prescription drug costs through the following laws passed in the state of Colorado: (1) House Bill 22-1370, which beginning in 2024 requires 100% of prescription drug rebates to be passed through from carriers and pharmacy benefit managers (PBMs) to employers and consumers. Savings for that depend on the amount of rebates the employer is receiving under their PBM or carrier contract, and can range from 10-20%; and (2) House Bill 23-1201, effective Jan. 1, 2025, eliminates “spread pricing,” or up-charging, of prescription drugs by carriers and PBMs. Savings can range from 10-25%.
At these meetings, HCPF will also share messaging intended to increase employer outreach going forward to better connect employees losing Medicaid coverage to employer sponsored coverage. This messaging is critical as we approach employers’ open enrollment periods to help individuals who lost Medicaid coverage enroll in their employer’s benefit plan coverage. Resources for employers are on our website. Thank you to all our partners who are working alongside HCPF to reduce the uninsured rate and Keep Coloradans Covered.
We also continue to propel a number of critical initiatives to improve Colorado’s Medicaid eligibility processes, county and Medical Assistance site performance, and system efficiencies. Due to the legislature in November 2024, the Senate Bill 22-235 County Administration Long-Term Support Plan will provide recommendations to improve county administration of eligibility and enrollment and related activities, including properly resourcing our state-county infrastructure, addressing county staff wage rate gaps, advancing the eligibility tools employed by county workers, and more.
Comparing prepandemic, pandemic, PHE Unwind and post-PHE Unwind periods, all Medicaid eligibility metrics are moving in the right direction. In accordance with our February 2024 budget assumptions, membership has returned to prepandemic levels. As of August 2024, and including the impact of the 90-day reconsideration period, Health First Colorado and Child Health Plan Plus (CHP+) combined enrollment for children, adults and those accessing Long-Term Services & Supports all have higher enrollment than before the pandemic.
As noted in the performance metrics chart on our website, all eligibility processing metrics are headed in the right direction. Increased efforts underway will further improve performance going forward. Performance measures include the 90-day reconsideration period, when members are able to submit their renewal information late and still be renewed without having to submit a new application. Counties also leverage this period to catch-up on their renewal processing backlogs. Thank you counties for focusing on reducing backlogs. Statewide, the Medicaid application processing backlog has decreased 75% from October 2023 to August 2024, while the renewal backlog has decreased 35% from January 2024 to August 2024. We also appreciate the parallel county efforts to reduce backlogged verifications and other processing tasks. As counties catch up on their renewal backlogs, verification processes and related work, individuals may receive new notices regarding their updated eligibility with potential retrospective approvals back to their renewal anniversary date. More information is on our website.
HCPF has 95 projects to achieve 45 Department goals during fiscal year 2024-25. This message covers just a few of them. We appreciate your support and collaboration across all HCPF’s work to help us address your areas of interest and to achieve our mission to improve health care equity, access, and outcomes for the people we serve while saving Coloradans money on health care and driving value for Colorado.
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Member Correspondence Letter Improvements
HCPF hosted two virtual stakeholder meetings on Oct. 9, 2024, to discuss upcoming enhancements to member correspondence, focusing on the Notice of Action and the Health First Colorado renewal packet.
At the meeting, HCPF staff provided updates on:
- Improvements underway,
- Timelines for making changes,
- Plans for future letter improvements, and
- Opportunities for stakeholders to stay involved.
Questions from participants will be added to a Frequently Asked Questions document to be posted on our webpage.
For those who were unable to attend, you may request a recording. HCPF is currently accepting feedback on the renewal packet. To request the feedback form in either English or Spanish, please email HCPF_stakeholders@state.co.us. Please provide feedback by Nov. 1, 2024.
If you have general questions, please contact the Stakeholder Engagement Section at HCPF_stakeholders@state.co.us for more information.
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Maternal Opioid Misuse (MOM) Model Meeting Announcement and Invitation
Medicaid's Perinatal Substance Use Disorder (SUD) Community Conversation
Health First Colorado providers, advocates, and stakeholders who provide integrated care for pregnant and postpartum people with substance use disorders (SUD) across Colorado are invited to attend Health First Colorado’s Perinatal Substance Use Disorder (SUD) Community Conversation.
HCPF staff, along with other guest speakers, will present an overview of the work completed by the Maternal Opioid Misuse (MOM) Model, followed by breakout sessions focused on peer support specialists, plans of safe care, and more. Attendees are invited to learn, ask questions and provide feedback, in addition to building connections with HCPF staff members, Regional Accountable Entities (RAEs), and other community members. An agenda will be sent out to all registrants one week prior to the conference.
Meeting date and time: Nov. 22, 8 a.m. to 12 p.m.
Registration and location: This meeting will be virtual via Zoom. Register in advance.
Attendees will receive a confirmation email containing information about joining the webinar after registering.
A recording of the meeting may be requested by emailing Kyra Acuna at HCPF_stakeholders@state.co.us.
Refer to the Maternal Opioid Misuse Model webpage for more information about the MOM Model.
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.
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 Kyra Acuna a HCPF_stakeholders@state.co.us al menos una semana antes de la reunión para hacer los arreglos necesarios.
Contact Kyra Acuna at HCPF_stakeholders@state.co.us with questions or for more information.
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Prescriber Tool Alternative Payment Model (APM) Stakeholder Meetings
Health First Colorado providers receiving fee-for-service payments for their outpatient pharmaceutical claims are invited to one of two virtual stakeholder meetings to present information about the updates being made to Year 2 of the Prescriber Tool Alternative Payment Model (APM).
At these meetings, HCPF staff will present an overview of the feedback received from Year 1 of the Prescriber Tool APM and provide updates being made to Year 2. Attendees are invited to learn, ask questions and provide feedback about the proposed 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: Oct. 28, 2 to 3 p.m. and Oct. 29, 7:30 to 8:30 a.m.
Registration and location: these meetings will be virtual via Zoom.
Register in advance for the meeting on Oct. 28.
Register in advance for the meeting on Oct. 29.
After registering, attendees will receive a confirmation email containing information about joining the webinar.
Feedback will be gathered at the meetings and via a feedback form that will be shared with attendees. A link to a feedback form may be requested by emailing Kyra Acuna at HCPF_stakeholders@state.co.us.
A recording of the meeting may be requested by emailing Kyra Acuna at HCPF_stakeholders@state.co.us.
For more information about the Prescriber Tool APM, visit our website.
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.
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 Kyra Acuna a HCPF_stakeholders@state.co.us al menos una semana antes de la reunión para hacer los arreglos necesarios.
Contact Kyra Acuna at HCPF_stakeholders@state.co.us with questions or for more information.
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Continued Support for Behavioral Health Providers
While HCPF’s training and technical assistance (TTA) program concluded in September 2024, HCPF is committed to continuing to provide support to behavioral health providers. Visit the safety net provider landing page for access to the latest information, resources, and FAQs. The Training Library page is your one-stop-shop for all trainings, including foundational and introductory training materials. Don’t miss out on these trainings added at the end of September including:
Please email hcpf_safetynetforum@state.co.us if you need assistance finding the right training for you.
Share These Resources
Now that the TTA program has concluded, The Provider Communication Toolkit has been updated in English and Spanish to help providers continue to share trainings and resources among their networks. The toolkit includes content and graphics to simply copy and paste into communication channels including social media, e-newsletters, presentations, and more!
Thank You
Thank you to the more than 300 individuals from across Colorado who attended live trainings and/or office hours as part of HCPF’s TTA program. We appreciate the shared dedication to expanding benefits and services, improving access to care, and elevating quality.
In addition to the 12 live trainings and 7 office hours, more than 38 pre-recorded trainings and 51 frequently asked questions (FAQs) were shared during the program period. Topics included behavioral health basics, Behavioral Health Administration (BHA) licensure and approval, payment, quality improvement and capacity building, serving specific populations and workforce.
Contact Information
Looking For More Information or Have a Question?
There is ongoing support for behavioral health providers:
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Introducing PROSPER: Perinatal Resource Supporting Obstetric Screening Psychiatric Education, Equity and Referral
PROSPER is Colorado’s new perinatal health and substance use consultation program. We support Colorado health care clinicians working with pregnant and postpartum individuals by providing free statewide perinatal psychiatry consultation and referrals. Our consultation line helps build capacity for universal screening, assessment, and treatment within routine perinatal and primary care settings.
This is achieved primarily through real-time phone access to reproductive
psychiatrists, and one-time face-to-face patient consultations for diagnostic clarity and
to guide treatment in the obstetric or medical home. We also provide referral resources
for clinicians to share with their patients, focused on equity, trauma-informed care, and
cultural considerations.
Join us and get Continuing Medical Education (CME)! The series is designed to provide clinicians with training on perinatal mental needs for their clients along alongside health equity themes. Virtual on Tuesdays Noon- 1 p.m. starting in September.
Register for Perinatal Mental Health: Bridging Gaps in Equity and Outcomes -
ECHO Colorado.
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