HCPF Updates: Enhanced rates for E&M and ACC Model Details and Policy Decisions

The Department of Health Care Policy and Financing (HCPF) is pleased to announce enhanced rates for E&M and vaccination codes are now loaded! Effective this week, any qualified E&M or vaccination claim will be paid at the December 2014 Medicare rate.  Providers are not required to attest to providing primary care. Our fiscal agent will also mass adjust all qualified claims paid since January 1st, and repay them at the higher rate.  Due to a limit on how many mass adjustments can be processed at a time, this process will take place over the next few weeks until all providers have been “made whole” for claims submitted since January 1st.

Please note that, although Medicare rates may be adjusted on a quarterly basis, Colorado Medicaid rates will not be adjusted to match these changes. HCPF will keep you posted if the rate benchmark changes.

ACC Model Details and Policy Decisions: Click here to view a document that summarizes three of the key structural decisions that will be in place starting July 1, 2017.  Over the next year, HCPF plans to continue stakeholder outreach and conduct additional research to continue developing the program model.

Parent and Caretaker Relative Eligibility Change FAQ Now Available: Beginning April 1, 2015, the income eligibility level for the Parent and Caretaker Relative MAGI Medicaid category was lowered from 107 percent of the Federal Poverty Level (FPL) to 68 percent FPL. Through a mass update in the Colorado Benefits Management System (CBMS), most parents and caretaker relatives who were enrolled in this category were administratively moved to the Adult MAGI Medicaid category (the category for adults ages 19 to 64 with FPLs up to 133 percent FPL). Parents and caretaker relatives with Medicare are not eligible for the Adult MAGI Medicaid category, but will likely be eligible for the Medicare Savings Program (MSP). A small number of people may not be eligible for MSP, but they will be eligible to apply for private insurance through a SEP through Connect for Health Colorado. HCPF created a Parent/Caretaker Relative Federal Poverty Level Changes Frequently Asked Questions (FAQ) document about this eligibility change.

MSB Recruiting New Member: The board is currently seeking applications for a vacant position and is looking to expand its pool of applicants for consideration. Coloradans who meet the general requirements outlined below are strongly encouraged to submit an application through the Governor’s Office of Board and Commissions:

• Board members must have knowledge of Medical Assistance programs;
• Board members may include a person or persons who have received services through programs administered by HCPF;
• No more than six members can be of the same political party;
• At least one member shall be appointed from each congressional district;
• Membership shall include representation by at least one member who is a person with a disability, a family member of a person with a disability, or a member of an advocacy group for persons with disabilities, provided that the other requirements are met. [Source: HCPF]