Department of Health Care Policy and Financing Updates

January 2015 Changes to 5% Disregard: Beginning January 1, 2015, the Department will implement changes to the manner in which the 5% income disregard is applied to individuals applying for Medicaid and CHP+.

The 5% income disregard will be applied when countable income exceeds the limit for MAGI populations under Medicaid or CHP+. The 5% income disregard will not be applied to every MAGI eligibility determination; it will be applied as a last step in determining eligibility when an individual exceeds the income limit, but is within the income standard if the 5% disregard were applied.

For more information on this change taking effect January 1, 2015, please see the FAQs on Colorado.gov/HCPF/ACAResources > Fact Sheets & Frequently Asked Questions.

Payment for Office Visits and Vaccine Administration Increased Rates: Beginning January 1, 2015, the Colorado Medical Assistance Program (Medicaid) will reimburse covered office visit procedure codes (E&M codes) and the vaccine administration procedure codes for all providers at a rate equal to 100% of Medicare’s December 2014 reimbursement rate. The new rate will be available to all enrolled providers that submit fee schedule claims for office visits or vaccine administrations. The new reimbursement rate will be in place until June 2016.

Please note that this rate increase is not a continuation of the previous 1202 Primary Care Supplemental quarterly payments.  This increase does not require providers to attest to providing primary care and the higher rate is paid for each claim submitted.  Please also note that Medicaid will not be changing its reimbursement for E&M codes on a quarterly basis, as Medicare does.  E&M codes will be paid at the December 2014 Medicare rate, regardless of whether Medicare raises or lowers its reimbursement of these codes over the coming months.

Click here to view the Department’s response to the Join Budget Committee’s Request for Information #4 regarding the Accountable Care Collaborative.

View the November 26 and December 4  issues of HCPF’s ACA Implementation News.

Click here to view the November edition of At A Glance. [Source: HCPF]