In place of the Policy Advisory Council (PAC) update, the county team is using a newsletter in the style of County Connections to communicate critical information.
The content is designed for county human services directors and leadership.
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Letter from the Executive Director |
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Understanding HCPF Resource Needs & Protecting Our Children
HCPF’s budget hearing is scheduled for Dec. 21, all day. Thank you in advance for your support of our $14.9B total funds and $4.43B General Fund request, 96% of which goes to our valued providers to help provide care to the one in four Coloradans we are honored to serve. Four percent of these funds are allocated to administration expenses, such as our incredible, dedicated staff and our valued, contracted partners to help us meet the needs of our members. You can find more information on HCPF’s budget at CO.gov/HCPF/legislator-resource-center.
Together, Health First Colorado (Colorado’s Medicaid program) and Child Health Plan Plus (CHP+) cover more than 40% of children and more than 40% of births in the state. The number of children we cover in Health First Colorado is up by almost one-third since the start of the pandemic. Thank you to our hospitals and all medical providers, who are simultaneously responding to an especially challenging RSV season, the flu and COVID-19. Vaccination is the best way to protect children from these and other preventable infections. Consider the below actions you can take to help us achieve shared goals.
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Please promote flu and COVID-19 vaccines, with specific focus on the omicron booster as well as all routine childhood and adolescent immunizations. You can use the resources in these CDPHE toolkits on flu, COVID-19 and RSV and childhood and adolescent immunizations. Everyone 5 and older who has completed a COVID-19 primary vaccine series should get an omicron vaccine to increase their protection against the variants circulating in Colorado right now. And please leverage every opportunity when a patient is in front of you to discuss the importance of vaccination; even if someone said “no” before, they may say “yes” this time or be more open to the conversation. They may also not know they are due for a vaccine or booster.
- Provider leadership, please encourage your providers and staff to get their flu and COVID-19 shots.
This influx of patients with RSV, flu and COVID-19 is also adding to the already strained health care workforce, especially for the hospitals and pediatricians who treat children. Thank you in advance for your assistance on the above initiatives, which not only protect Colorado children, but also support our health care delivery system. In complement, we ask for your partnership in growing our health care workforce as well as the child care workforce (which helps women get back into the workforce), by printing and displaying these time-limited training opportunity communications in patient waiting rooms, exam rooms, and areas of your business operations frequented by Coloradans: hfcgo.com/assistance. Additionally, CDPHE's Healthcare Workers Recruitment and Re-engagement Fund supports the re-entry of health care professionals back into the workforce. Please visit the website for more information.
Thank you for your continued partnership in helping us cover and care for low-income Coloradans and people with disabilities, and best wishes to you and yours for a healthy, safe, and inspiring holiday season!
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ACC Phase III Stakeholder Engagement |
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The Department created the Accountable Care Collaborative (ACC) in 2011 to deliver cost-effective, quality health care services to its Health First Colorado members and to improve the health of Coloradans. The ACC features Regional Accountable Entities (RAEs) operating in seven regions.
Current contracts between the Department and the RAEs will end on June 30, 2025. The Department has developed goals and priority areas for improvement and innovation intended to better align with our modernized mission, advances made by our sister agencies, and stakeholder input received over the past several years. Additional information is available on the ACC Phase III webpage and in a fact sheet available on the webpage.
The Department, in partnership with the Colorado Health Institute (CHI), is pleased to be collaborating with stakeholders to discuss the vision for this next phase, referred to as Phase III. We are committed to receiving input from diverse perspectives through accessible, equitable, and productive engagement.
Dates are set for the first two Listening Sessions. We invite you to join us! Both sessions will feature the same agenda, so choose the meeting that is most convenient for your schedule. These sessions will take place virtually and will feature interpretation services.
- Dec. 20: ACC Listening Session #1 (12-1:30 p.m.)
- Jan. 10: ACC Listening Session #2 (6-7:30 p.m.)
An agenda and registration link for the Listening Sessions will be available in the coming days. Look for additional opportunities to engage over the next three months, including a public survey and other avenues to provide written feedback. Details will be available on the ACC Phase III webpage and shared in future newsletters. |
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Open Enrollment Has Begun |
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Open Enrollment for health insurance has begun! This year’s Open Enrollment
period began on Nov. 1, 2022, and ends on Jan. 15, 2023. Thanks to the
Inflation Reduction Act, there continue to be more savings for more people. Folks
can see how much financial help they qualify for and review plans before enrolling by
Exciting New Health Insurance Option for Coloradans who are Undocumented
OmniSalud is a new health insurance program that provides Coloradans who are
undocumented with a safe way to compare affordable health insurance plans and sign
up on a secure online platform. Thanks to a new Colorado law passed in 2021, every
company that sells health insurance in the state has to offer plans with a specific set of
lower, fixed costs and make them available to everyone – no matter their
documentation status. We strongly encourage folks to sign up with the help a certified
expert who can walk them through the application and help them understand
how to use their health insurance, all free of charge. To learn more about OmniSalud
Web and print versions of our resources on Connect for Health Colorado and
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Update on the Federal Public Health Emergency |
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Update your PHE Staffing Plan
Use your previously submitted PHE Staffing Plan and update it with the most recent information; this includes the number of staff you anticipated hiring and the number of staff that have been actually hired. This will help quantify the deficit between the number of staff you anticipated needing vs. the number of staff that will be available to process cases.
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Reevaluate the number of staff needed
While updating your plans, we highly encourage you to revisit the conversation around how many resources you anticipated were necessary. I’ve attached recent data that details the anticipated number of cases requiring redetermination, from January to December 2023, by county. Based on this information, consider whether you need to update your PHE Staffing Plan if you believe additional resources are needed.
The data reflects the number of cases (not individuals) requiring redetermination, and assumes that none of those would go through the redetermination ex parte process, which allows for the redetermination to be completed without human touch. Currently, just over 30% of redeterminations are going through the ex parte process.
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Accelerate hiring of staff funded by the PHE county administration appropriation
If you are at a deficit in the number of staff you anticipated hiring, or have held off on hiring due to the frequent extensions of the PHE, now is the time to proceed with or accelerate the hiring of those staff.
We understand that hiring has been an ongoing challenge, so if any counties have some recent recruitment and retention successes to share, please let us know so we can pass along. Or, if you’d like to reach out to us so we can discuss how we can help, send us an email at HCPF County Relations.
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Reduce the number of Pending and Backlog Cases as tracked on the MAP Dashboards
Please review the number of Medical Assistance pending applications and redeterminations you have; this information can be found on the MAP Application Dashboard and the MAP Renewal Dashboard; this information is also available for frontline workers through the CBMS County Dashboard. The Dashboards provide the most recent month’s pending, and also tracks previous months and whether these are upward or downward trends.
If your pending numbers are trending upward, staff funded by PHE county administration funding should be redirected to reduce those numbers as much as possible before the PHE ends. If you need help with catching up on your pending cases in the near term, the Overflow Processing Center can help.
This data is found under the following performance measures:
Pending
Found in the Manager-level on the MAP Application Dashboard
- Cases Pending
- Non-Disability Pending: Data Entry Not Complete
- Pending Not Due Disability
Found in the Manager-level on the MAP Renewal Dashboard
- Pending Member in Cert Period No EDBC
- Pending Member in Cert Period EDBC
Backlog
Found in the Manager-level on the MAP Application Dashboard
- Pending EPG 45 Days
- Pending EPG 90 Days
Found in the Manager-level on the MAP Renewal Dashboard
- Pending Member Past Cert No EDBC
- Pending Member Past Cert EDBC
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Access Available Resources
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We are continuously updating our County COVID-19 webpage with PHE-related information
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View recordings of our Continuous Improvement Learning Sessions, which include tips for managing pending on the MAP Dashboard and integrating renewal revamp into your business processes
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If you need processing assistance as you work through pending and backlog, consider asking the Overflow Processing Center for help
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MAP Dashboard Resources, including SOP and Desk Aids for Ongoing Maintenance (Changes), Pending Data, and Researching Untimely Members in the County Dashboard.
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Ask for Help
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For PHE Staffing Plans, county administration funding and staffing, submit a County Relations ticket or email HCPF County Relations
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For questions regarding your MAP Dashboard, contact HCPF MAPDashboards
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For support on Continuous Improvement Learning Sessions or Continuous Improvement support, submit a request form or email HCPF Performance Improvement
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FY 2023-24 HCPF Budget Update |
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Overview
HCPF’s proposed annual budget for FY 2023-24 is $14.9 billion in total funds, including $4.43 billion General Fund, and would cover an average of 1.5 million Coloradans who are Medicaid and CHP+ members. Today, we cover about 1.7M Coloradans, so this budget assumes that the PHE will have come to a close and that we will return to our standard operating procedures of disenrolling members who no longer qualify upon their renewal.
Overall, the request is an increase of nearly $673 million in total funds, including $346 million in General Fund from the baseline. The vast majority of the increase is to account for:
- $177.9M GF: normal year-over-year growth in the Medicaid program, especially in the waivers and other long-term care programs
- $69.8M GF: provider rate increases requested as part of the R-7 request (see below)
- $72.4M GF: annualization of provider rate increases implemented in FY 2022-23, including backfilling the $15/hr base wage increase funded initially by the American Rescue Plan Act (ARPA)
Decision Items
This year, HCPF’s decision items are focused on improving health equity for our members, stakeholder engagement, improving quality and compliance, supporting children and youth with complex needs, supporting the new Behavioral Health Administration claims processing, increasing provider rates and improving case management to align with federal and state requirements. Although there are no county-specific decision items this year, here are a few that may be of interest:
Increase provider rates R7 - across provider areas ($192.2 Million TF, $69.8 million GF)
R7 reflects our Provider Rate Adjustments request for this cycle. We’re requesting funding to provide an across-the-board provider rate increase of 0.5%. We are also requesting resources to eliminate Medicaid all co-pays for our members, except for emergency room co-pays. This reduces provider administration costs and improves provider reimbursements, as often co-pays are not collected. As well, as recent research shows, even small co-pays act as barriers to care for low-income families. Therefore, the elimination of co-pays will help us achieve our shared goal of improving quality and reducing health disparities for low-income Coloradans. We are also requesting targeted rate adjustments for specific providers including nursing facilities rural providers, rural hospitals (defined as critical access hospitals and rural health clinics) and rebalancing rates based on the annual Medicaid Provider Rate Review Advisory Committee (MPRRAC) rate review process, which follows the committee’s recommendation.
Please note: HCPF county administration was included in the provider rate review and will receive an increase of $440,000 from the current FY 2022-23 appropriation.
Support children and youth with complex needs R10 ($3.9 million TF, $200,000 GF)
The Department has requested funding to enhance critical services for children and youth with complex and co-occurring needs. The resources in this request are necessary to ensure the Department is able to:
- Expand access to respite services by providing two new benefits, skilled and therapeutic respite, for children with high needs;
- Ensure access to care for children enrolled in Medicaid with Autism Spectrum Disorder by adding ASD as a covered diagnosis for mental health and substance use disorder services that are currently covered by the Regional Accountable Entities (RAEs); and
- Ensure compliance with federal requirements for EPSDT and improve benefit navigation and clinical care coordination.
Resources
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Nonemergency Medical Transport (NEMT) Provider List |
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NEMT provider list has received an update! This update has added more providers in the counties outside of the Denver Metro area, with more joining every day.
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Telephonic Signature FAQs |
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How-to/training and any reference documentation
There is training on the current CBMS functionality in CoLearn. Search "CDHS & HCPF
Telephonic Signature (SNAP Project CPPM - 4208)." Additional training is in the pipeline for the new enhancements that are being implemented in the February 2023 CBMS build.
Script - regarding recording a conversation
Information about the script is in the current training (listed above) and will be included in the new training.
Point of contact for process questions
Process-type questions will be addressed in an operational memo that HCPF will publish closer to the system build date. Any policy clarification can be sent to the Medicaid Eligibility Inbox. Any questions about the trainings and/or materials can be sent to the SDD inbox.
Walkthrough process
There will be a demo scheduled later in the project schedule before the February 2023 release date. If you’d like to attend, the team can add you to the invite.
Are there any forthcoming demonstrations planned? Several felt like they could use a more thorough walkthrough of the process.
See the response above. This project follows the general build process so counties will be notified of the training schedule, demonstration, etc. September's demonstration to the counties is posted to the HCPF website.
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PHE Unwind Phase 1 Communications Toolkit - Live on the HCPF site! |
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Phase 1 of the PHE Unwind communications toolkit is live on the HCPF website. This toolkit will equip partners to understand the renewal process so that they are well prepared to help our members when the PHE unwinds. The toolkit is based on examples and research from CMS and other states, but includes original content and design that was tested with members and reviewed with stakeholders.
Included in the toolkit:
We're especially grateful to the Eligibility and Member Experience teams for their close collaboration on this. We'll be releasing Phase 2 of the toolkit when we receive 60 days notice that the PHE is ending; this will have more member-facing content to encourage action when it's time to renew.
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HCPF & County Directors Leadership Monthly Meeting |
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The upcoming call will take place on:
Tuesday, Dec. 20, 2022
1-2:30 p.m.
Topic: HCPF/County Directors Leadership Monthly Support Call
Time: Dec 20, 2022, 1 p.m. Mountain Time (US and Canada)
Join Zoom Meeting
Meeting ID: 857 8199 1367
Passcode: 140393
Dial by your location
719 359 4580 US
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To view previous meeting details, please follow the below link. |
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Recent Memo Series Issued to Counties |
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HCPF OM 22-057
This letter is meant to advise counties and 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.
HCPF OM 22-056
The purpose of this memo is for the Department of Health Care Policy & Financing (the Department) to notify 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.
HCPF OM 22-055
The purpose of this Operational Memo is to provide guidance to county departments of human/social services (counties) on how to operationalize the FY 2022-23 County Incentives Program Accuracy Incentive. The County Incentives Program creates performance-based benchmarks and deliverables for county departments of human/social services to achieve certain performance standards related to County Administration and Medical Assistance Eligibility. The Accuracy Incentive states the Contractor shall comply with monthly Eligibility Quality Assurance (EQA) case reviews to monitor the accuracy and timeliness of eligibility determinations for Medical Assistance made by the Contractor, with cases pulled monthly for quality review. Results of the EQA reviews are displayed on the MAP Accuracy Dashboard.
HCPF OM 22-054
The purpose of this Operational Memo is to provide guidance to county departments of human/social services (counties) on how to operationalize the FY 2022-23 County Incentives Program Performance Compliance Incentive. The County Incentives Program creates performance-based benchmarks and deliverables for county departments of human/social services to achieve certain performance standards related to County Administration and Medical Assistance Eligibility. The Performance Compliance Incentives states the Contractor shall comply monthly with the Director-level MAP Dashboard measures. The performance measures include timeliness of applications/redeterminations, timeliness of long-term services and supports (LTSS) applications/redeterminations, timeliness of case changes, etc.
HCPF OM 22-053
The purpose of this Operational Memo is to promulgate sub-regulatory guidance requiring the implementation and alignment of Eligibility Site Quality Assurance Programs with the State Quality Assurance Program. In addition, this Operational Memo informs eligibility sites of operational instructions to meet regulatory requirements at 10 CCR 2505-5 1.020.3.4.a regarding internal controls for quality and accuracy.
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Department Contacts & Resources
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