PHE Coverage Update; Legislative and Affordability Priorities

Thank you for your partnership in another unprecedented year for health care. Together, we are now successfully serving 1.74 million Coloradans, representing an additional 490,000 people — an increase of 39% since the start of the pandemic. Related, H.R.2617, the federal budget signed into law on Dec. 29, 2022, indicates that beginning April 1, 2023, states can start disenrolling individuals who no longer qualify for Medicaid through the eligibility redetermination process. In partnership with the counties, and after many months of planning and preparation, Colorado will take 12 months (14 months including noticing) to complete this process, leveraging the member’s annual renewal date and our modernized, member-centric processes. We are analyzing the related guidance from CMS received on Jan. 5 and will make any refinements to our plans, accordingly. With continuity of coverage top of mind, we are collaborating with Connect for Health Colorado and others to connect members who are no longer eligible for our programs to other affordable health coverage. Please join us at our Jan. 25 Community Partner webinar to learn more, and please visit our website to help us achieve our shared goal of keeping Coloradans covered through this transition.

At our Jan. 12 SMART Act hearing, we shared more about HCPF priorities, our legislative agenda, performance against published goals and more. For further details, please visit our website. We also welcome your review of our FY 2021-22 annual report. Amidst the unprecedented growth in membership during the COVID-19 Public Health Emergency (PHE), we kept Health First Colorado per member per month cost trends flat while evolving innovations that drive industry transformation, improve quality, reduce disparities and improve the health of our members. Our leadership in driving affordability will continue to help us manage our own budget (about 30% of the state’s overall budget), while helping save Coloradans and employers money on health care as well.

As we begin the legislative session, feel free to visit 2023 Legislative Agenda Overview to learn more about our emerging legislative agenda, which currently includes:

• Nursing Facility Sustainability and Transformation to implement the 2022 Nursing Facility Reimbursement Recommendations and ensure the industry continues to transform and innovate to meet the needs of Colorado’s growing older adult population and individuals with disabilities, while ensuring industry fiscal stability.
• Removal of Most Medicaid Co-Pays consistent with our R-7 Provider Rate Adjustments budget request. This would help us make care more accessible to members, reduce health disparities, improve provider reimbursements while lowering provider administrative burden. 
• Public Health Emergency (PHE) Unwind Alignment to ensure the necessary state authority to continue to access federal COVID-19 funding while mitigating future federal non-compliance clawbacks of the $1.5 billion received from the 6.2 points of added FMAP to date and related funding still to come.  
• Medicaid Provider Rate Review Advisory Committee (MPRRAC) which supports the JBC in enabling targeted Medicaid provider rate adjustments more frequently - every three years instead of every five. 

To save Coloradans, the state and our employers money on health care, on Dec. 5, the Polis-Primavera administration and HCPF submitted Colorado’s proposal to the U.S. Food and Drug Administration (FDA) to import prescription drugs from Canada. The plan identifies 112 drugs with an average savings of over 60% that could be available through this program, once approved by the FDA. Additionally, Colorado Medicaid executed its third pharmaceutical value-based contract. These contracts will help deliver savings to taxpayers, state and federal budgets in the form of manufacturer refunds if the respective drug does not meet expected health outcomes for Medicaid members who are taking them. Last, a huge thank you to the more than 10,000 Health First Colorado prescribers (44%) who are using the affordability module of our prescriber tool. Through emerging value-based payment methodologies, we are taking the necessary steps now to share the millions in savings generated through the tool with providers starting next fiscal year.

Thank you for your continued partnership, and best wishes for a healthy, rewarding, transformational 2023!

SDD Training Timeframes Workgroup

The Staff Development Division (SDD) has received feedback regarding the amount of time it takes new workers to go through the new Process Based Training (PBT) curriculum. We would like to invite you to participate in a workgroup that will hopefully help us improve this without negatively impacting the worker's learning experience. 

Who should participate?

We are looking for a variety of participants to capture all viewpoints from our eligibility sites. New workers, seasoned workers, program area, and all levels of leadership are welcome to participate. 

What is the timeframe and commitment?

We are looking to get started mid to late January 2023. We will collect responses and then reach out to everyone who is interested and set up our first meeting. From there, we will schedule recurring meetings based on everyone's availability. 

After the first couple of meetings, we will be able to gauge how long this workgroup will last, but we are hoping for a 3–4-month commitment. We may need to pilot any new approaches to training to make sure it has improved - but this will be communicated throughout the process. 

How do I sign up?

Please complete the form using the link below if you are interested in participating in this workgroup. You must have Supervisor/Leadership approval in order to participate. 



SDD - Training Timeframes Workgroup Sign-Up

Have Questions?

Please contact Tiffany Spottke regarding any questions you have regarding this workgroup. 

Behavioral Health Secure Transportation Stakeholder Meeting

The Department of Health Care Policy & Financing (HCPF) is hosting the next virtual stakeholder meeting to specifically address Behavioral Health Secure Transportation on Tuesday, Feb. 21 from 11-12 p.m. (zoom link below). We will collaborate with the Behavioral Health Administration (BHA) and Colorado Department of Public Health & Environment (CDPHE) to present updates to this new benefit and solicit feedback on implementation concerns.  

Behavioral Health Secure Transportation is legislatively mandated by HB 21-1085 and the Colorado Department of Public Health & Environmental (CDPHE) has written standards in 6 CCR 1011-4. This meeting continues the stakeholder process for Medicaid reimbursement for Behavioral Health Secure Transportation. Behavioral Health Secure Transportation will be paid as a benefit no later than July 1, 2023.  

Zoom webinar

When: Feb. 21, 2023, 11 a.m. - 12 p.m. Mountain Time (US and Canada)

Or One tap mobile:

+17193594580,,85372997616#,,,,*097456# US

+17207072699,,85372997616#,,,,*097456# US (Denver)

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 Meghan Morrissey, Kelly O'brien, or the 504/ADA Coordinator, at least one week prior to the meeting to make arrangements.

Please find the January Stakeholder Meeting recording here and slides attached. As discussed, HCPF is collating a list of county contacts who are responsible for licensing and permitting of BHST for their respective jurisdiction in order to connect BHST providers with appropriate resources, so feel free to email Meghan Morrissey to contribute that information.

Thank you for your continued engagement.

None

HCPF IM 23-003

Office of Community Living BA-07 Budget Request

The purpose of this Informational Memo is to inform long-term services and supports (LTSS) members, families, advocates and providers of the contents of the BA-07 “Community-Based Access to Services” budget amendment that was submitted to the Joint Budget Committee on Tuesday, Jan. 3, 2023.

HCPF IM 23-002

January 2023 Home and Community-Based Services (HCBS) Waiver Amendments Approval from the Centers for Medicare & Medicaid Services (CMS)

The purpose of this Informational Memo is to inform stakeholders that the Home and Community-Based Services (HCBS) waiver amendments submitted to the Centers for Medicare & Medicaid Services (CMS) on Sept. 16, 2022, were approved.

HCPF IM 23-001

Providers Improper Billing HCBS Participants

The purpose of this Informational Memo is to inform all Home and Community-Based Services (HCBS) providers that billing HCBS waiver members for various fees, utilities, or supplemental charges violates federal and state law. Any fee or supplemental charge imposed on an HCBS waiver member should be refunded within 30 days from the issuance of this memo and the provider shall notify the Colorado Department of Health Care Policy & Financing (Department) of the billing error and provide proof of the corrective action taken. 

Renewal Process Timeline, Update on End of Continuous Coverage Requirement

We will be starting the return to normal medical assistance eligibility renewal processes with renewals due in May and noticing beginning in March. This COVID-19 Continuous Coverage Unwind update is based on the recent federal Consolidated Appropriations Act, 2023, which included language that ends the Medicaid continuous coverage requirement, and federal guidance issued on Jan. 5, 2023. 

As you have heard in our county engagements over the last couple of years, Colorado has focused its Unwind planning in partnership with you and your staff on achieving three key operational goals: 

1. maximize member continuity of coverage,
2. focus on the member experience and smooth transitions in coverage, and 
3. minimize impact to county and eligibility workforce.

The above timeline aligns with our operational planning, systems change timelines, and county readiness in support of these shared three key operational goals. Your partnership will be essential as we move to the next phase of our planning and execution of those plans. 

This May renewal timing decision was selected in consultation with the Colorado Human Services Directors Association (CHSDA) Executive Committee. Several factors were considered. First, this aligns with when new federal poverty levels will be active in the system, which ensures members are renewed with the new levels in place, thereby reducing county and member rework. Second, this timing is also consistent with our coordinated and collaborative plan already developed with a vast array of stakeholders, including you, our county partners. Third, it provides the time needed for operational or system adjustments while still limiting state budget impacts. Last, this takes into account your increased workload implementing changes to the SNAP program beginning in February, given the new federal law.  

In collaboration with you and your staff, and after many months of planning and preparation, we have opted to take the entire time allowed (12 months, 14 months including noticing), leveraging the member’s annual renewal date and our modernized, member-centric processes. Returning to normal renewal processes will include disenrollments where appropriate. With continuity of coverage a primary goal, handoffs to our Connect for Health Colorado partners are a critical strategy to ensure those who could choose marketplace health plans are made aware of their coverage options as well as the availability of financial subsidies that make coverage more affordable. 

We are working on refining our operational plans, timelines, communication toolkits, websites, partner frequently asked questions (FAQs) and other materials, accordingly. In the interim, all county partners are encouraged to attend our Jan. 26 COVID-19 Unwind Quarterly Meeting with Eligibility Sites to get the most up to date information. Information on this meeting below:

COVID-19 Unwind Quarterly Session for Eligibility Sites Thursday, Jan. 26, 3-4:30 p.m.

Details:

Passcode: 503967

Webinar ID: 854 2154 0600

Mobile: US: +17193594580,85421540600#, *503967# or +17207072699, 85421540600#, *503967#

We will update and continue to add resources to our County and Eligibility Site COVID-19 webpage as we work to achieve our shared goal of keeping Coloradans covered through this transition, focusing on the member experience and smooth transitions in coverage, and minimizing impact to county and eligibility workforce.

As always, we appreciate your partnership.

HCPF - Letter Regarding the Suspension of Medicaid Buy-In Premium Letters

The purpose of this communication is to advise eligibility sites of a special speed letter being sent to Medicaid Buy-in members.

Details: In December 2022, HCPF began suppressing the Buy-In Premium letters for the Medicaid Buy-In program for Working Adults with Disabilities and the Medicaid Buy-In Program for Children with Disabilities. Project 7329, implemented this past Sunday, Jan. 8, triggered a special speed letter. This letter is for all Buy-In members to let them know that Buy-In Premium letters are no longer going to be sent to them since Buy-In Premiums have been suspended and will continue to be suspended through COVID-19 Unwind. The speed letter should help prevent confusion for members and reduce the number of calls and/or visits to Eligibility Sites.

Action: The letters were triggered to be mailed out as of Monday, Jan. 9. This communication is to advise eligibility sites that the letter is available in CBMS within the member’s case to be referenced in case there are any questions from members. If members continue receiving Buy-In premium letters, please submit a help desk ticket.

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

County Contact Lists

Linked you will find the Google form to be used for indicating your site's contacts for HCPF. Please forward the link to all of your relevant staff so that we can engage the correct level of staff to resolve questions expediently. We will be accepting submissions until Friday Feb. 3, 2023. 

Note that we are performing a complete overhaul of our contact lists - not an update.

We will distribute a list of your site’s contacts after the third for your review and provide directions for any updates throughout 2023.

If you have any questions please fill out a County Relations Webform with the ‘Ticket Type’ = “County Communications”

2023 Contact Form

Pending Supervisory Authorization 

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

The Department 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, the Colorado Benefits Management System (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. 

2023 Social Security Cost of Living Adjustments (COLA) 

The purpose of this memo is to advise eligibility sites of the 2023 Social Security Cost of Living Adjustments (COLA). Please share this memo with all affected adult and long-term care Medicaid eligibility staff, supervisors, and outside agencies, as appropriate. 

Monthly Social Security and Supplemental Security Income benefits will increase due to a COLA of 8.7% in 2023. The purpose of the COLA is to ensure that the purchasing power of Social Security and Supplemental Security Income (SSI) benefits is not eroded by inflation. It is based on the percentage increase in the Consumer Price Index for urban wage earners and clerical workers from the third quarter of the last year's COLA to the current year's third quarter. 

The 300% income limit, home equity maximum, minimum monthly maintenance needs allowance maximum, and community spouse resource allowance will increase. The Medicare Part B premium will also increase. 

Beginning Jan. 1, 2023, the Medicare Nursing Facility Co-Insurance rate and the Income Trust Gross Income Limits and Average Nursing Facility Private Pay rates will change. Additionally, the Personal Needs Allowance (PNA) base amount for residents of nursing and intermediate care facilities will increase by 3%, setting the 2023 PNA base amount at $95.97.

Read the 2023 Social Security Cost of Living Adjustment Cola Memo. Please share this memo with all affected medical assistance eligibility staff, supervisors, and outside agencies, as appropriate. 

Questions regarding this communication may be directed to [email protected].

Department Annual Report

The Department's Annual Report to the Community is now available. This report illustrates the many ways we serve Coloradans every day. We invite you to review it and celebrate all that we accomplished together this past year.

Translations of Member Outreach Posters Now Available!

The Spanish version of the Member Assistance Opportunities posters and screensavers are now in our Toolkits for Partners Google folder.

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 contact us by email. at [email protected]. Your email to us will automatically create a service ticket with your email included. We cannot open encrypted messages within our ticketing system.

County Incentives Programs 

Status Reports for Reporting Period 1 will be emailed to County Directors by Feb. 24, 2023.  

Customer Service Incentive 

Thank you to our Tier 1 counties with call center operations. Everyone has scheduled their first technical assistance with the HCPF Member Contact Center (MCC) Operations team. Please continue to submit Call Center performance data on the 10th of each month. 

Tier 2A counties will be provided with the outcomes of the first Department-run survey in April 2023. This information will help you to develop your outreach plan to increase your response rate by the June 30, 2023. 

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 must first submit their Quality Assurance plans by March 1, 2023. These will be reviewed by the Department by June 1, 2023. Counties will receive either notification of approval or notification for necessary revisions to allow for time to resubmit prior to June 30, 2023.  

Submit your QA plans by completing a County Relations Request form ticket, or emailing HCPF_CountyRelations by March 1, 2023.   

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