Thursday, December 7, 2017

Latest from the CO Dept. of Health Care Policy & Financing (HCPF)

Provider Buzz
Here's a look at hot topics for providers and others:
Related to the Colorado interChange:
  • Over the last several weeks, leadership at the Department has been meeting with RCCOs and others to learn more about resources and supports that continue to be needed to assist providers through the transition to the Colorado interChange. In response to feedback from those meetings, the Department is developing additional educational materials and working with DXC to schedule provider training sessions. A schedule for those sessions will be available here in the coming weeks.
  • You may have heard from some providers that crossover claims for services that are covered by Medicare but not Medicaid were denying inappropriately, specifically crossover claims filed by Federally Qualified Health Centers for certain services. The Colorado interChange should have reimbursed these claims based on the Medicare assigned coinsurance and deductible. Providers were previously advised to continue to submit these claims, and resubmit them now that the issue is resolved.
  • Effective today, November 30, 2017, the Eligibility page on the Provider Web Portal will require users to complete a CAPTCHA human verification step by identifying which images fit the given description. This change is intended to minimize issues and slowness affecting all portal users. This email communication was sent to providers in response to increased call volume. 
Other hot topics from the Department
  • The Department is moving forward with the implementation of the Alternative Payment Model for Primary Care (APM). The survey to select measures in the model is now open. A link to the survey is available on the Department's website. The website also has pre-survey instructions, links to resources including the APM Survival Guide and a short video demonstrating how to use the APM model. The survey will remain open through January 31, 2018. As the Department moves forward with the APM, a workgroup is forming to assist with the implementation of the APM. Similar to the process used to design the APM, the Department is looking for representation from primary care physicians, primary care practice coordinators, office managers, and Regional Care Collaborative Organization representatives. The group would provide feedback and input on how best to implement the APM and help the Department understand the impact of operational decisions. 
  • The next phase of the Accountable Care Collaborative (ACC) seeks to leverage the proven successes of Health First Colorado's (Colorado Medicaid's program) programs to enhance the member and provider experience. The goals of the next phase are to improve health and life outcomes of members while using state resources wisely. Learn more here. The Department is pleased to announce the protest period associated with the Request for Proposal for the Regional Accountable Entities (RAEs) for the next iteration of the Accountable Care Collaborative (ACC) has ended. The entities listed below will be awarded contracts. The Department has made available online the proposals from each of the awarded entities on

News You Can Use

Provider Resources for the Colorado interChange

As you continue to learn how the Colorado interChange works for your organization, many resources are available to assist you. While no resource can answer every question, many new resources are being added regularly to help. You can also subscribe to receive emails from the Department that address hot topics and ongoing issues.

Other resources include:

· The Read Your RA Quick Guide. The Department is also working to publish a webinar with more dynamic explanation of the document.

· Interim payments for providers experiencing financial difficulties are still available. You can learn more information from this document.

· Timely Filing has been a topic of confusion for many providers. A clarifying article in the October 2017 edition of the Provider Bulletincan help as well as finding answers to frequently asked questions.

A variety of resources, including step-by-step instructions with screenshots for frequent tasks and Provider Web Portal training videos, related to using the Provider Web Portal

Colorado interChange Numbers
Since March 1, 2017...

· More than $5.8 billion paid to providers
· 37 million claims have been processed

In our latest financial cycle on Friday, Nov. 24 ...

· $94 million paid to providers
· 645,000 claims processed

As a reminder, the Department frequently updates its Known Issues & Updates web page with new issues, work arounds and resolution ETA.

Negotiations happening now on future of the National Health Service Corps.

Update from the Association of Clinicians for the Underserved:

Urge Your Senator to cosponsor S. 1899 to Strengthen the NHSC.
Email, tweet and/or call today!

"Negotiations are Happening NOW!
While the House passed their version of funding for the National Health Service Corps (NHSC) back on November 3, we know that House and Senate leaders are working together on a final bill that the Senate can pass and that the House would then accept as final.

Final passage of any NHSC funding legislation has been delayed as Congress works on Tax Reform, but we are optimistic that a deal can be enacted this month. But we need your help to make it happen.

The more cosponsors we can get on S. 1899, the Community Health Investment, Modernization and Excellence Act (CHIME), the stronger our hand is that the NHSC will be included and strengthened in any final package. The CHIME bill calls for 5 years of funding for the NHSC, with modest increases in years 2 through 5. ACU is strongly supportive of the Senate CHIME bill and we need your help getting more cosponsors on the bill to show support.

Please take action today, and pass it along to as many people as you can. Until the bill is passed, and the NHSC secure, we need to push Congress to do the right thing for our communities in need.

While we hope you will send an email, please also make a call or tweet at your Senator to have an even greater impact and let your them know how important the NHSC is to your community. Urge them to cosponsor S. 1899."


CHIP Coalition Update:

"Policy Update
Action on CHIP has been further delayed until later in December, due in large part to the fact that Congress has been focused on resolving other issues related to the short-term continuing resolution (CR) to keep the government funded after December 8. Some reports indicate that the short-term CR will go until December 22, but other reports indicate that it could go until later December or even mid-January. Most folks think that CHIP legislation will have to ride with must-pass government funding legislation. Despite the uncertainty around the government funding timeline, Congressional leaders continue to state that there will be action on CHIP by December 22.

As we noted in an earlier update this week, the U.S. House released proposed legislation that would give the federal Centers for Medicare & Medicaid Services (CMS) flexibility to provide relief to states running out of federal CHIP funds the fastest. It provides legal authority to CMS to redistribute funds through the end of the year. It is not clear at this point what this would mean for Colorado, but does not appear to change current contingency plans for the state so far.

Lieutenant Governor Meeting
Members of the CHIP Coalition, together with health care providers, the Medicaid Department, and families of kids who use CHP+ for their insurance, met with the Lieutenant Governor this afternoon. We shared our concerns about the lack of funding for the CHIP program at the Federal level and asked the Lieutenant Governor to continue her advocacy with our federal delegation and to express to them the uncertainty that this is creating for families and the urgent need to address this issue. Families discussed the importance of the CHIP program in covering the health care needs of their kids, including ensuring access to medications required to manage chronic health conditions, the importance of vision coverage, and importance of knowing that if a child falls or gets sick, they can be taken to their regular doctor.

Advocacy Materials
Click here for new CHIP messaging, including updated talking points and social media content. For those organizations who are able, please use and share with your networks."

CHP+ Update and Resources from HCPF:

Child Health Plan Plus (CHP+): Latest Resources and How You Can Help
As you may be aware, if Congress does not renew federal funding, CHP+ in Colorado will end on January 31, 2018. Congress can pass a law at any time to renew federal funding for CHP+, but there is no guarantee that they will.
As of today, there are no changes to CHP+ benefits, eligibility or enrollment.
The Department has developed resources to help you answer questions from CHP+ applicants and members. We encourage you to bookmark and subscribe to our Future of CHP+ updates here.

New FAQs Available Online Now
The Department has published new frequently asked questions (FAQs) on

Member Communications
In late November, CHP+ members received an informational notice. The sample correspondence is available on
If Congress does not act by mid-December 2017, CHP+ members will receive an Eligibility Notice of Action in late December. A sample of this letter will be available soon.

Upcoming Informational Webinars
The Department will be hosting two informational webinars in December. The first will be for providers and managed care organizations. The second webinar will be co-hosted with Connect for Health Colorado for eligibility partners, counties and stakeholders. The purpose of the webinars is to provide additional policy and operational information to our partners regarding the possible end to CHP+. The webinars will provide an opportunity for participants to ask questions via chat. The webinars will be recorded and posted on
  • Provider & CHP+ Managed Care Organization Webinar: December 12, 2017  1:30-2:30 p.m.
    • Registrants will be emailed a link to join the webinar the day before the webinar.
    • There is a limit of 500 participants.
    • Register Here.
  • Stakeholder, Advocate, County and Eligibility Partner Webinar: December 13, 2017   12:00-1:00pm.
    • Registrants will be emailed a link to join the webinar the day before the webinar.
    • There is a limit of 500 participants.
    • Register here.
  • Additional training for counties & CBMS Users will be available through the Staff Development Center. You will need to log into you CO.Learn account and search for 'CHP+ Sunset'. 

November 20 Future of CHP+ Recorded Webinar: The Department has made available a recorded webinar on facilitated by Gretchen Hammer, Medicaid Director. The webinar provides members, providers, stakeholders, advocates, eligibility partners and counties information about the future of CHP+. The information in this recording is current as of November 20, 2017.
CHP+ Member Messaging: The Department has developed CHP+ member messaging that is available on These resources include talking points, phone hold messaging, social media posts, newsletter content, FAQs, etc.

​How You Can Help
We ask that you utilize your CHP+ member communication vehicles to inform CHP+ members of the possible end to the program and help educate members of what they can expect. CHP+ member messaging is available on

Wednesday, November 29, 2017

#FundCHIPColorado - Tomorrow Day of Action to Save CHIP

This week, tens of thousands of Colorado families who use the Children’s Health Insurance Program (CHIP) in Colorado to access quality, affordable health care for their children were given notice that the program will end in January 2018 if Congress does not act to extend the program’s funding. We must stand with these families to ensure that their kids get the healthy start they deserve.

We need your help to let the Colorado delegation know that the 90,000 kids and pregnant women who use CHIP in Colorado and the nine million kids who use CHIP nationwide should not be hurt because Congress has failed to act. Groups across the country that care about kids are mobilizing to make Nov. 30 a national day of action to fund CHIP. Join us and make your voice heard! Call your Senators and Representatives and let them know you expect them to keep CHIP funded and to keep our kids out of politics. (click here for social media content.)

Additional talking points for you to use when contacting your Senators and Representative:
  • Congress needs to pass legislation to extend current funding for CHIP for five years and maintain the bipartisan history of the program.
  • CHIP funding expired about two months ago. It should not take children losing their health insurance for Congress to act.
  • Real children and families are facing the implications and the ongoing uncertainty about whether or not they will be able to access the health care they rely on.
  • 90,000 children and pregnant women from working families in Colorado use CHIP for their health insurance every year.
  • Because CHIP funding has not been extended, Colorado families using the program have started getting notice that their child’s health will be at risk in January 2018, when Colorado will be forced to end the program.
  • The program is designed around what children need. It has a strong pediatric provider network and covers all of the services kids need to stay healthy. 
  • Maintaining funding for the CHIP program is crucial to protecting Colorado’s budget.
  • Children with chronic conditions deserve certainty in their medical coverage. And pregnant women should not be forced to scramble for a new doctor mid-pregnancy.
  • Kids with health coverage are less likely to drop out of high school, more likely to graduate from college, and have higher incomes as adults.
Contact Information for Colorado’s U. S. Senators

Senator Michael Bennet
Local office (303) 455-7600 National office (202) 224-5852

Senator Cory Gardner
Local office (303) 391-5777 National office (202) 224-5941

Contact Information for Colorado’s U.S. Representatives

Representative Coffman
Call if you live in Aurora, Centennial, Highlands Ranch, Brighton
Local office (720) 748-7514 National office (202) 225-7882

Representative Tipton
Call if you live in Grand Junction, Durango, Pueblo, Gunnison
Local office (970) 259-1490 National office (202) 225-4761

Representative Buck
Call if you live in Greeley, Fort Collins, Longmont, Brush, Burlington, Fort Morgan, Stratton, Julesburg, Holyoke
Local office (970) 702-2136 National office (202) 225-4676

Representative Lamborn
Call if you live in Salida, Buena Vista, Colorado Springs, Monument, Fountain, Canyon City, Woodland Park
Local office (719) 520-0055 National office (202) 225-4422

Representative Polis
Call if you live in Lafayette, Niwot, Boulder, Fort Collins, Lyons, Loveland, Granby, Breckenridge, Silverthorne, Kremmling 
Local office (303) 484-9596 National office (202) 225-2161

Representative Perlmutter
Call if you live in Lakewood, Arvada, Westminster, Thornton, Northglenn
Local office (303)274-7944 National office (202) 225-2645

Representative DeGette
Call if you live in Denver
Local office (303) 844-4988 National office (202) 225-4431

Latest from the CO Dept. of Health Care Policy & Financing (HCPF)

What's next at the national level with health care reform?

Nov. 29, 2017 CO Health Policy Coalition Update:

"Congress has returned from Thanksgiving with a long to-do list and a short timeline for action. This article from The Hill does a nice job summarizing the various issues that competing for attention and action before the end of the year (which is only about 15 working days for members of Congress). The list includes: government funding, tax reform, health care and immigration.

The topic most directly relevant to the work of this coalition is the Senate proposal to eliminate the Affordable Care Act's individual mandate, which is embedded in the Senate tax reform bill. That measure passed the Senate Budget Committee with unanimous Republican support yesterday. It remains unclear if Senate Republicans have the necessary support among their caucus to pass the measure on the floor, but negotiations are underway to win support from holdouts. One of those key Republican Senators is Susan Collins of Maine who is seeking a deal to include policies aimed at stabilizing the health care markets in return for her support of the tax bill. A vote of the full Senate could come as early as Thursday. If that happens, the House and Senate would then need to reconcile their bills before sending a measure to President Trump. You can read coverage of the progress of the tax bill, including specifics on the provision to repeal of the individual mandate, from the news outlet of your choice, including: ReutersWashington Post, The HillPolitico. Links to resources analyzing the potential impacts of mandate repeal are available below my signature line. 

The provision to eliminate the individual mandate has been met with strong opposition from most health care stakeholder groups, including hospitals, physicians, health plans and consumer advocacy organizations. Many organizations have sent letters and / or released Action Alerts and other tools to make it easier to weigh in with their Senators on this issue. Here are links to a few example letters and Action Alerts you can access if you and / or your organization want to weigh in on this issue today or tomorrow

Analysis of Mandate Repeal Impacts: 
The Congressional Budget Office has estimated that repealing the mandate will: 
--reduce the number of insured Americans by 13 million, 
--drive up insurance premiums for individuals by as much as 10 percent and
--reduce federal spending by $338 billion over 10 years.

Analysis released in the L.A. Times on Monday, shows how repealing the individual mandate would further reduce access to coverage and drive up costs in rural communities in particular. The article includes a number of interesting maps which illustrate the potential impact in western Colorado.

The Center for Budget Policy and Priorities released a memo analyzing the potential implications if repeal of the individual mandate moves forward along with market stabilization policies including those contained in the Alexander-Murray proposal. "
"Protect Health Care from the GOP Tax Heist!
The Senate could vote this week on a tax bill that will leave low-income and middle-class Americans worse off and gut health care programs! The House has passed their version of this terrible bill, which means we must now fight to stop it in the Senate. While Americans were enjoying time with family and friends over the holiday, the Senate GOP has continued to push their tax bill forward. While there are some differences between the House and Senate bills, the overarching impact is very similar. The Senate tax bill cuts taxes for the wealthiest 1% and big multinational corporations permanently, harms low-income and middle-class families over time, and adds $1.4 trillion to the deficit over 10 years. We know from the GOP budget that they plan to pay for this increase in deficit by gutting Medicaid by nearly $1 trillion, Medicare by over $400 billion, and slashing other programs that hard-working American families rely on. The Senate GOP tax bill also includes repeal of the ACA's individual responsibility provision, which will lead to double-digit premium spikes every year and 13 million fewer Americans having health insurance. We need your help to send Senator Cory Gardner a clear message that this bill is bad for Coloradans. This tax heist:
  • Will lead to even more disastrous cuts to health care than we've seen in the devastating Republican health care repeal bills that failed due to enormous public pressure.
  • Will disproportionately benefit millionaires and large profitable corporations, not small businesses or the middle-class.
    • 80% of the tax cuts go to the top 1% and big corporations
  • Will devastate Colorado's state budget and lead to cuts in state programs and services that help families get by and get ahead.
The Congressional Budget Office just released their analysis of the bill. You can read more about that here. You can also read the recent editorial from the Denver Post that calls out this bill for being what it is, a lie.

Call our Senators and tell them to oppose this tax scam!
Senator Gardner-Denver:(303)391-5777 DC: (202) 224-5941
Senator Bennet-Denver:(303)455-7600 DC: (202) 224- 5852

Social Media: We are using the hashtags #TrumpTaxScam, #GOPTaxPlan, #GOPTaxScam, and #NotOnePenny to talk about the tax bill.
  • @SenCoryGardner Oppose the #GOPTaxPlan that leaves 13 million more uninsured, increases deficit by $1.5 trillion, gives the wealthiest big tax cut while hurting the middle class #TrumpTaxScam
  • @SenCoryGardner The ACA provides 600K Coloradans with quality health insurance. Fix it, don’t repeal  through #TrumpTaxScam
  • @SenCoryGardner Don't increase the deficit, give 80% of tax cuts to top 1%, or gut the ACA/Medicaid/Medicare to pay for it. #VoteNo on #GOPTaxPlan
  • Health care cuts shouldn't be used in the GOP tax heist to cut taxes for the wealthiest 1%, sticking middle-class Americans and future generations with a $1.5 trillion bill over 10 years. #VoteNo on #GOPTaxScam @SenCoryGardner
  • @SenCoryGardner You've said you don't want to increase the deficit. Prove it and #VoteNo on #GOPTaxScam. Don't use health care cuts to pay for tax cuts for millionaires.
  • @SenCoryGardner Voting for "skinny" repeal in the #GOPTaxScam will raise premiums on Coloradans and leave thousands without insurance. #VoteNo."

Wednesday, November 22, 2017

Latest from the CO Dept. of Health Care Policy & Financing (HCPF)

Colorado interChange: Resources for your Membership
Week of November 16, 2017
We'll use this newsletter to provide you with updates on the implementation of the Colorado interChange, including topics you might be hearing from your members as well as content for your membership newsletter and general updates on progress. 
Provider Buzz
Here's a look at hot topics for providers and others:
  • You may have been hearing a lot about "the Bridge" from case managers. The Bridge is a system used by case managers for Home and Community Based Services (HCBS) to submit Prior Authorization Requests (PARs)-- the Bridge is not used for medical PARs. Only after a PAR is approved is it transmitted to the Colorado interChange for processing. It takes at least one day, after the PAR is approved in the Bridge, to appear in the Colorado interChange and be available for claims processing. 
  • In early October, the Department made initial awards for seven Regional Accountable Entities (RAEs) for the next iteration of the Accountable Care Collaborative (ACC). Following those awards the Department received formal protests. In accordance with State procurement rules, the Department is prohibited from discussing the solicitation, contract awards and negotiations until all protests and appeals are resolved. The Department is continuing to prepare for the implementation of the next phase of the ACC as these protest are resolved. Read more about implementation goals and timeline.
  • If Congress fails to act on funding for the Children's Health Insurance Program, or Child Health Plan Plus (CHP+) in Colorado, the program will end on January 31, 2018. Prior to that, families using the program will begin receiving information about the potential program end in late November. As of today, there are no changes to CHP+ benefits and providers are urged to keep serving CHP+ members at their practices. Even if Congress does not act to renew CHP+ funding, enrollment and redetermination of CHP+ members will continue through the planned program end on January 31, 2018Resources are available to help providers communicate with their CHP+ patients about the status of the program.
News You Can Use
Here's some content for membership newsletters:

New help for provider revalidation and enrollment  
Providers still struggling with revalidation or enrollment-- the first step to successfully using the Colorado interChange for claims -- can get additional help with issues they face. The Colorado Department of Health Care Policy and Financing recently released a new webinar aimed at answering common questions and issues with the process. The hour-long webinar tackles topics like revalidation documentation, web portal registration, best practices as well as solutions for the top five reasons revalidation and enrollment will deny. Following the webinar, participants were able to ask questions. 
Colorado interChange Numbers
Since March 1, 2017...
  • More than $5.5 billion paid to providers
  • 35.6 million claims have been processed 
In our latest financial cycle on Friday, Nov. 10 ...
  • $130 million paid to providers
  • 953,345 claims processed
As a reminder, the Department frequently updates its Known Issues & Updates web page with new issues, work arounds and resolution ETA.