This Department of Health Care Policy & Financing (HCPF) newsletter is designed to inform county directors, management and staff about high-impact updates, important changes, county performance, new guidance, and program changes.

Redesigning care delivery for better outcomes

The Accountable Care Collaborative (ACC) is the Health First Colorado (Colorado’s Medicaid program) care delivery model, designed to cost-effectively provide access to quality health care services while improving member health. The model in place today, referred to as ACC Phase II, has been in effect since July 1, 2018, and was developed based on substantial stakeholder engagement. HCPF is now in the process of soliciting feedback from stakeholders to help frame the next generation of the ACC, Phase III, which will build on what works well today while making improvements to both modernize and address opportunities. The goals of Phase III, which will go into effect July 1, 2025, are to:

• Improve quality care for members
• Close health disparities and promote health equity
• Improve care access
• Improve the member and provider service experience
• Manage costs to protect member coverage and benefits, and provider reimbursements

We invite you to actively engage in the ACC Phase III stakeholder process by signing up for the newsletter, joining upcoming meetings and viewing our fact sheet as well as additional information on our website. HCPF will also leverage the opportunity to better collaborate with the Behavioral Health Administration (BHA) and stakeholders to more thoughtfully align where appropriate the ACC Phase III and the emerging BHA’s Behavioral Health Administrative Service Organizations (BHASO) model, now that the BHASO’s implementation date is being moved from July 1, 2024, to July 1, 2025. This updated timeline, reflected in the revised House Bill 23-1236 Implementation Updates To Behavioral Health Administration as amended on April 26, amendment number L.028, which exactly aligns with Health First Colorado’s ACC Phase III timing.

To further advance our quest for better member health outcomes while reducing health disparities, last month, HCPF released our latest Maternal Health Equity Report. The report looks at maternal health during the pandemic, provides a window into the lived experience of members, and lays out HCPF’s roadmap to improve maternal health care and equity. In tandem with the release of this report, HCPF held an Advancing Maternal Health Equity for All Coloradans event, which included about 200 attendees. We invite you to review the report and watch the webinar recording by visiting our website. 

Thank you for your continued partnership in helping Keep Coloradans Covered as the COVID-19 public health emergency and the continuous coverage provision end. This month is the first renewal anniversary month in three years that may result in membership disenrollment from the Medicaid and CHP+ safety net coverage programs, as federally required. Partners and providers, please help us Keep Coloradans Covered by educating staff and patients about the renewal process. Resources are available to help you achieve this shared goal, at the PHE Planning Resource Center and KeepCOCovered.com. Also, HealthFirstColorado.com/renewals has plain language resources in English and Spanish with links to help members with what they need to know about their renewals. Members need to take action when they receive their renewal notice electronically or through the mail in an envelope with red lettering reading - “URGENT - PLEASE REPLY”.  They can complete their renewal, including signing and returning their paperwork by the deadline listed on their renewal, in three ways: online at co.gov/PEAK, in the Health First Colorado app, or by mail. 

Thank you for your partnership through this legislative session. We will include a summary of the key bills impacting HCPF and affordability in our June message as well as our final fiscal year 2023-24 budget. In the interim, we thank the General Assembly and our stakeholders for your valued input and collaboration on so many impactful legislative items, which are on our Legislator Resource Center.

• Thank you for your collaborative efforts to improve our delivery system, better align our Phase III work with the BHA’s emerging BHASO work, reduce maternal health disparities, Keep Coloradans Covered, and drive meaningful legislation impacting Health First Colorado, CHP+ and health care outcomes and affordability for all Coloradans.

HCPF - New COVID-19 Unwind Resources

HCPF is releasing this communication to inform eligibility sites of two new COVID-19 unwind resources.

Details:

1. The End of Public Health Emergency for COVID-19 and Returning to Normal Operation memo, on the 2023 memo series webpage. 

1. A COVID-19 unwind section has been added to the Eligibility and Resource HCPF webpage under the FAQs and Training section, which includes the following:

• The COVID-19 Unwind Educational Session held on Feb.15, 2023 
• The webinar recordings  
• The presentation materials
• COVID-19 Unwind FAQs
• COVID-19 Unwind MA Renewal Ex-Parte Flowchart Desk Aid

Questions regarding this communication may be directed to: hcpf_medicaid.eligibility@state.co.us.

Gov. Polis Signs Legislation Eliminating Co-pays for Health First Colorado Members  

Elimination of co-pays reduces financial burden on members and families while improving overall

reimbursement to providers

Denver, CO - Today, Gov. Jared Polis signed SB23-222 which will help eliminate Health First Colorado (Colorado’s Medicaid program) co-pays for most members for pharmacy and outpatient health care services. 

While co-pays are common across health benefit programs, several studies have shown that cost sharing (such as co-pays) among Medicaid members can result in unintended consequences such as not scheduling or delaying needed health care visits, cutting pills in half or not filling prescriptions - all of which can lead to worsening health conditions and poor health outcomes, as well as increased use of the emergency room and higher overall health care costs. Examples include increased rates of uncontrolled high blood pressure and high cholesterol as well as reduced treatment for children with asthma. Additionally, research finds that cost sharing increases financial burdens for families, whereas the elimination of co-pays allows members to put those dollars toward other basic needs like rent or food. 

“Saving Coloradans money on health care is a priority of the Polis-Primavera administration,” said Kim Bimestefer, executive director for the Department of Health Care Policy & Financing (HCPF). “This bill accomplishes that important goal, while also improving member health, increasing reimbursements to many of our health care providers, reducing provider administrative burden, and lowering health care costs over the long term.”

HCPF anticipates that as co-pays are eliminated, it will be able to leverage additional federal funding for higher overall provider reimbursement. Currently, HCPF lowers the amount paid to providers based on the anticipated co-pay amount collected for each claim. By eliminating co-pays, HCPF would pay providers a higher amount and be able to draw down additional federal funds for the incremental difference. It would also result in less administrative burden for the providers to collect the co-pays from members. SB23-222 is a companion piece to HCPF’s FY2023-24 R7 budget request to remove most co-payments for Health First Colorado members. A co-pay will still be charged for non-emergency care delivered in an emergency room. 

Health First Colorado members will see most co-pays eliminated beginning in July 2023 pending federal approval. The list of services that will no longer have co-pays are:

• Inpatient hospital services
• Outpatient hospital services
• Optometrist visits
• Podiatrist visits
• Primary care physician and specialist services
• Rural health clinic visits
• Federally Qualified Healthcare Center (FQHC) visits
• DME/Disposable supply services
• Laboratory services
• Radiology services
• Dental X-rays already do not have a co-pay
• Prescription drugs or services (each prescription or refill)

HCPF will update providers, members and other stakeholders as the changes are made. 

All memos and their attachments are on the Memo Series website.

HCPF PM 23-002

Joint Policy Memo on Facility-Based Mobile Crisis Response in Colorado

This memo informs Mobile Crisis Response (MCR) service providers and the community of appropriate locations to deliver care within the scope of the MCR program.

HCPF administers Health First Colorado (Colorado’s Medicaid program), Child Health Plan Plus (CHP+) and other health care programs for Coloradans who qualify. The Behavioral Health Administration (BHA) is a new cabinet member-led entity within the state of Colorado, housed within the Department of Human Services, and is designed to be the single entity responsible for driving coordination and collaboration across state agencies to address behavioral health needs. The BHA is responsible for regulating the provision of behavioral health services by developing and monitoring reasonable and proper standards, rules, and regulations. The BHA contracts with Administrative Services Organizations (ASOs) to provide a network of walk-in crisis centers, crisis stabilization centers, respite, and mobile crisis services in their regions known as the Colorado Crisis Services (CCS) continuum. CCS fits into a larger behavioral health response and safety net system, within which other services and programs play an essential role (while not being MCR providers). From July 2024 going forward, these crisis contracts will be administered by the newly awarded Behavioral Health Administrative Service Organizations (BHASOs).

HCPF and the BHA are issuing this joint guidance to MCR stakeholders in Colorado, including those who intend to enroll as Medicaid MCR Behavioral Health Crisis Services Providers with a BHA endorsement for MCR, other providers within the larger behavioral health and safety net system that receive other crisis response funding from the BHA, as well as communities and organizations which receive services from the crisis response system. 

None

HCPF - MA COVID-19 Unwind Eligibility Sites Resource Guide

HCPF is releasing this communication to remind eligibility sites about the Medical Assistance (MA) Program resources on COVID-19 Unwind, the End of the Continuous Coverage Requirement & Public Health Emergency (PHE), MA Renewals, and General Eligibility Site Support. 

Details: Eligibility sites can access important information and materials from the following webpages. 

COVID-19 Unwind and the End of the Continuous Coverage Requirement & PHE Resources:

• Resources for County and Eligibility Partners
• COVID-19 Public Health Emergency Planning     
• Operations Memo
• Project Build Knowledge Transfer
• Recordings
• Member Toolkits
• CBMS Community 
• County Dashboard Tips Sheet
• 2023 CBMS Calendar
• Staff Development Division (SDD)  
• Train Colorado 
• CoLearn

MA Renewal Resources: 

• Training Topics Reference Documents and Guides
• Session Recordings 
• Presentations 
• Desk Aids

General Support:

• Eligibility Medicaid Inbox (Include the following)
• Background – Be clear about the issue or question and provide a concise description. 
• Research – Identify the steps taken in your attempt to find the answer to the issue or question. Example: Reviewing training materials, researching regulations, or any other available resources. 
• Conclusion – State that you are requesting assistance from the inbox because you have been unable to find the answer to the issue or question.
• OIT Help Desk
• Follow the normal Help Desk Ticket (HDT) process.
• Counties/HCPF PHE End - Touch Base Monthly Meetings 
• Ongoing meetings with eligibility sites are scheduled on the last Thursday of each month.
• COVID-19 Unwind Quarterly Session 
• Ongoing meetings with eligibility sites are scheduled on the last Thursday of April, July, October, and January.
• COVID-19 Unwind Command Center 
• A special Command Center is scheduled for Spring 2023. The COVID-19 Unwind Command Center will be available via phone and virtual meeting from 12 to 1 p.m. on the scheduled days to address systems (CBMS/PEAK) and policy questions. 

MA COVID-19 Unwind Command Center Schedule 

To join the MA COVID-19 Unwind Command Center by phone:

Phone: 1 321-351-6765‬

PIN: 140 027 642‬#

Join the MA COVID-19 Unwind Command Center by Google Meet

NOTE: The COVID-19 Inbox closed permanently on Feb. 17, 2023. Questions should be directed to the HCPF Medicaid Eligibility Inbox at hcpf_medicaid.eligibility@state.co.us. 

Contact: Questions regarding this communication may be directed to: hcpf_medicaid.eligibility@state.co.us.

HCPF - Asset Verification Program (AVP) Enhancements

The purpose of this communication is to advise eligibility sites of changes that will innovate the functionality of the Asset Verification Program (AVP).

Beginning April 15, 2023, AVP will be establishing a two-way web service communication between the vendor and the state, allowing for the ability to expedite information sent and received to make quicker eligibility determinations at intake and renewal.

HCPF will provide training and updates to existing AVP materials soon.

If you need additional information or have questions, please send an email to: hcpf_medicaid.eligibility@state.co.us.

HCPF - REMINDER: Incomplete Disposed Resource Records included in Medical Assistance VCLs 

Issue: Medical Assistance Verification Checklists (VCLs) include disposed resource records when records are not disposed of completely, resulting in cases pending for or failing for missing verification.

Root Cause: Medical Assistance will consider resource records that have been disposed of with invalid or incomplete data entry. If there are invalid/incomplete entries, a VCL will be created. 

Action Needed: If a VCL has been generated as a result of this scenario, the resource disposition records must be updated to complete all missing fields, such as Verified Date, Disposition Date, Amount Received for Resource. For additional data entry direction, please reference the SDD training resources for Process Manual for Disposing of a Resource and WBT for Resources Basic Data Entry.

If data entry is complete and a VCL is still generated for the disposed resource record and/or the VCL item will not clear, please submit a State Help Desk Ticket.

Additional Information: Please note that Medical Assistance also considers resource records that have a $0 value if not disposed of. 

Questions regarding this communication may be directed to: hcpf_medicaid.eligibility@state.co.us.

County Contact Lists

Thank you for continuing to submit updates to your contacts with us. For any additions throughout 2023, you or any staff member may complete this webform. This form does not require a Google account and accepts multiple submissions.

For staff removal from a contact list, please continue to use our County Relations Webform with the "ticket Type" set to "County Communications."

Communication Toolkits and Resources

HCPF has been working with stakeholders and partners to develop communication toolkits to prepare members for the return to normal renewal processes. 

The Take Action on Your Renewal toolkit is new! The materials in this toolkit are designed to encourage members to look for their renewal packet in the mail and PEAK mailbox and take action when they get it. This toolkit includes general member awareness outreach partners can share in their websites, newsletters, social media as well as direct-to-member email and text messaging communications. It also includes downloadable, customizable flyers. These resources are currently available in English and Spanish. 

The Preparing for Renewals toolkit includes renewal process information that explains key terms and provides sample notices so partners can see exactly what the member will see when they go through the renewal process. In addition, both partners and members can view short videos in English and Spanish on key actions: updating an address, completing the renewal process, and transitioning to other coverage if a member no longer qualifies.

Update Your Address Campaign

We know that many members have moved over the past few years. It is crucial that we have correct addresses so that members get the information they need to keep or change their coverage. Please continue to help us spread the word to Health First Colorado (Colorado’s Medicaid program) and Child Health Plan Plus (CHP+) members to update their contact information. Update Your Address tools are available in the top 11 languages for Health First Colorado members.

Health First Colorado Renewals Page

In preparation for renewals to start back up, HCPF has added an informational webpage for members on the Health First Colorado website. Members can find general information about the renewal process and answers to frequently asked questions. This page is published in English and Spanish. 

For the latest information on returning to normal renewal processes and other communication resources, visit the COVID-19 PHE Planning webpage. 

Emergency Additional SNAP Benefits Ending

All Coloradans who receive Supplemental Nutrition Assistance Program (SNAP) benefits will see a reduction in their monthly benefit amount after February 2023. The temporary additional benefit amounts (emergency allotments) are ending due to recent congressional action. This is a change enacted by Congress and is not appealable. SNAP serves more than 290,000 households and 554,000 individuals in Colorado each month by providing money to purchase food and safeguard the well-being of SNAP participants and their families.

Emergency allotment gave SNAP participants additional money for food during the COVID-19 pandemic, bringing households up to their maximum amount of money for food they can receive for their household size and circumstances. This reduction in benefits may have a significant impact on many households. 

A messaging toolkit has been created for community partners and the general public to use to help get the word out about the end of SNAP emergency allotment benefits. For more information please visit the SNAP website.

Pending Supervisory Authorization 

The purpose of this communication is to advise eligibility sites of the Pending Supervisory Authorization Memo being released. 

HCPF is notifying eligibility site (county departments of human/social services, medical assistance, and eligibility application partner sites) staff that when a case is put into a pending status for “Supervisory Authorization Required,” the Colorado Benefits Management System (CBMS) will set a calendar day count to clear the Supervisory Authorization status when the case is pending for 90 days unless there are additional exception reasons preventing authorization.

Effective Dec. 12, 2022, if a medical assistance (MA) program is pending for "Supervisory Authorization Required" for 90 calendar days, CBMS will automatically run Eligibility Determination Benefit Calculation (EDBC) and authorize the MA program. The new batch process will run daily, which will minimize the number of cases that have historically pended indefinitely for Supervisory Authorization.

View the memo: Pending Supervisory Authorization 

Contact: If you need additional information or have questions regarding the memo, please contact HCPF Medicaid Eligibility. 

Do you need help? Do you have a question? Does a case need to be escalated? There are two ways you can contact the HCPF County Relations team.

1. County Relations Web Form. Try this method first. It allows you to enter details to help us resolve your issues.
2. County Relations Email. You can still email us at hcpf_countyrelations@state.co.us. Your email to us will automatically create a service ticket with your email included. We cannot open encrypted messages within our ticketing system.

Customer Service Incentive 

Thank you to our Tier 1 counties with call center operations for continuing to submit Call Center performance data on the 10th of each month. Technical assistance meetings for June have been scheduled. 

Tier 2A counties will be provided with the outcomes of the first HCPF survey by mid-May. This information will help you to develop your outreach plan to increase your response rate by June 30, 2023. All counties should have their reports by the end of May. 

Tier 2B requirements are for all other counties who did not opt into Tier 2A, allowing them to create their own Customer Service Improvement Plan. To comply with contract requirements, Tier 2B counties will have from January 2023 to June 2023 to document a Customer Service Improvement Plan (CSIP). 

Accuracy Dashboard 

To earn the Customer Service County Incentive Program payment, counties were required to submit their Quality Assurance plans by Friday, March 17, 2023. All plans that have been received are in the review process. Counties will receive either notification of approval or notification for necessary revisions to allow for time to resubmit prior to June 30, 2023. 

Civil Rights Plans 

Civil Rights Plans are being completed, HCPF is in the process of reviewing corrections and hope to have all plans approved and posted in County offices by June 1, 2023.    

HCPF Contacts & Resources

Staff Development Center (SDC) Homepage

CO.Learn/Learning Management System Login

Premiums, Expenditures, Caseload Reports