What's happening on the national level with health care - we know more than we did last week!

The American Health Care Act (AHCA), the ACA replacement plan from the Congressional House Republicans, was finally introduced earlier this week. They are seemingly trying to push the bill through prior to the Congressional Budget Office releasing its score which ultimately shows how much it will cost and its impact. The plan essentially eliminates the individual mandate and Medicaid expansion. Below are a few sources of information that outline some of the specifics:

• Vox - The American Health Care Act: the Republicans’ bill to replace Obamacare, explained
• Politico - GOP unveils Obamacare replacement amid sharp party divide
• Colorado Health Institute - ACA vs. AHCA: How They Stack Up
• Colorado Center on Law and Policy (CCLP) - GOP HEALTHCARE PLAN – WHAT IT WOULD MEAN FOR COLORADO

The Colorado Consumer Health Initiative's Protect our Care Colorado Campaign coalition met on Tuesday to learn more about what is happening on the national level, check out the following presentations:

• Devin Zatorski (TRP): ACA Repeal & Replace: Where Do We Stand?
• Elisabeth Arenales (CCLP) : Medicaid & ACA Repeal and Replace

You can take action at ProtectOurCareCO.org 

Colorado Senator Cory Gardner joined three other Republican Senators in signing a letter to Senate Majority Leader Mitch McConnell addressing proposed Medicaid changes. This article from The Hill summarizes the letter.

State Legislative session continues!

Thanks to a contract with Frontline Public Affairs, community safety net clinic directors are receiving periodic email updates on the activities in the current 2017 State of Colorado Legislative Session. Click here to view a 2017 bill tracker specifically for community safety net clinics.

Part of the state legislature's work includes the 17/18 State Budget (aka the long bill). The Colorado Primary Care Alliance continues its efforts to ensure that the partial bump for Medicaid primary care continues for the next fiscal year, and so far so good. We do anticipate this will be the final year of this bump as the State is moving toward alternative payment models for primary care.

Colorado Children's Healthcare Access Program: Practice Manager Newsletter

New Medicaid Fee Schedule Effective July 1, 2016

"The new and complete Medicaid provider rate fee schedule has just been released for dates of service effective July 1, 2016.

Medicaid reimbursed these codes at a Medicare equivalent rate to comply with Section 1202 of the Affordable Care Act (ACA) for Calendar Year 2013 and Calendar Year 2014 and temporarily extended the Medicare equivalent rate through June 2016.

Effective July 1, 2016, evaluation & management (E&M) and vaccine administration services will be reimbursed at the December 2012 level, except as noted below. From July 1, 2016 through June 30, 2017, through the efforts of HCPF and provider associations, one year of additional funding is authorized to reimburse important E&M code categories and vaccine administration codes at somewhat higher rates. 

Click here for common Medicaid July 2016 codes for Pediatrics.  

Click here for the entire Medicaid July 2016 fee schedule.

The E&M categories with temporary funding are standard office visits, preventive care office visits, newborn visits, neonatal and pediatric critical care visits, and counseling visits. These rates are scheduled to return to the December 2012 level on July 1, 2017."

Check out the CCHAP newsletter for more information on:

• Next CCHAP Practice Manager Meeting
• New Vaccine Resources Available
• SIM Cohort 2 Information

[Source:  CCHAP]

Medicaid Training Offered

"As the improvements to the Medicaid program brought about by the Affordable Care Act take full effect, the information provided in this workshop will give providers and their managers new tools to work effectively with clients who are applying for or currently enrolled in Medicaid.

Designed for those new to Medicaid as well as more experienced providers, the day is broken into two sessions we're calling Medicaid 101 and Medicaid 202. You can register for the 101 session alone (half day) or both sessions (full day).

Medicaid and Beyond
Basic: Sept. 15, 9 a.m. -12:30 p.m.
Advanced: Sept. 15, 1 - 5 p.m.
Denver Rescue Mission Administration & Education Building
6100 Smith Road, Denver, CO 80216
For more information and online registration, please visit: Medicaid Basic and Advanced."

[Source:  COPrevent]

Annualized Income Policy Change for Medicaid/CHP+ Eligibility

HCPF will implement a policy change effective July 1, that will consider annualized income for some types of variable income, (specifically income that is from self-employment, seasonal employment, or commission-based employment) when the household income is above the income threshold for Medicaid or CHP+.  More information is available in a webinar for community-based organizations hosted by HCPF and the PEAK Outreach Team, available here.
[Source: CKF Coalition]

The State Legislative Session is over!

Click here to review a Legislative Session Summary provided by Frontline Public Affairs.

You may recall the Governor's proposed FY 2016-17 budget did not initially include the continuation of the enhanced payments for Medicaid primary care services. However, thanks to the grassroots advocacy, media efforts, and direct lobbying of the Colorado Primary Care Alliance (a coalition of 20+ organizations), the Legislature authorized the transfer of $20 million in funds for the continuation of rate enhancements (87.3% of Medicare) for the following selected codes only:

• Office Visit  (99201-99205, 99211-99215)
• Preventive Medicine visits  (99381-99397)
• Newborn (99460-99465, 99477-99486) 
• Immunization Administration (90460-90461, 90471-90474)
• Counseling and Health Risk Assessments (99401-99414, 99417-99429)
• Critical Care Visit - Neonatal and Pediatric (99466-99476)

These funds are one-time and not built into the Medicaid rate base. Be sure to read HCPF's May 2016 Provider Bulletin for an official announcement!  The Alliance will be meeting to debrief on this year’s efforts and develop a go-forward strategy for FY 2017-18. Thank you to the many ClinicNET affiliates and partner organizations that participated in the advocacy efforts!

Questions? Contact Brooke Powers at brooke.powers@clinicnet.org 

Primary Care Medicaid Rates 16/17

You may recall the Governor's proposed FY 2016-17 budget did not include the continuation of the enhanced payments for Medicaid primary care services. However, thanks to the grassroots advocacy, media efforts, and direct lobbying of the Colorado Primary Care Alliance (a coalition of 20+ organizations), within the last couple of weeks the Legislature has authorized the transfer of $20 million in funds for the continuation of rate enhancements (87.3% of Medicare) for the following selected codes:

• Office Visit  (99201-99205, 99211-99215)
• Preventive Medicine visits  (99381-99397)
• Newborn (99460-99465, 99477-99486) 
• Immunization Administration (90460-90461, 90471-90474)
• Counseling and Health Risk Assessments (99401-99414, 99417-99429)
• Critical Care Visit - Neonatal and Pediatric (99466-99476)

These funds are one-time and not built into the Medicaid rate base. Be sure to read HCPF's May 2016 Provider Bulletin for an official announcement!  The Alliance will be meeting to debrief on this year’s efforts and develop a go-forward strategy for FY 2017-18. Thank you to the many ClinicNET affiliates and partner organizations that participated in the advocacy efforts!

Questions? Contact Brooke Powers at brooke.powers@clinicnet.org 

 

ACC Chronic Pain Disease Management Program

The second year of ACC Chronic Pain Disease Management Program will start in April and May with two options:

o Chronic Pain Telehealth Program: Connect PCMPs with a multi-disciplinary team of chronic pain specialists, including behavioral health professionals and pharmacists, to review client cases and learn evidence-based interventions for treating clients with complex conditions.

o Buprenorphine Telehealth Program: Providers licensed to prescribe Buprenorphine/Suboxone will connect with specialists to gain greater insights and experience in treating clients with opioid addiction.

Here is the link to the ECHO flyer on both programs and how practices can get involved!

New Look to Medicaid Cards Coming in March

“Starting May 2016, Medicaid will be called “Health First Colorado.” Click here for more information on the name change. Beginning as early as March 20, 2016, cards printed from Colorado.gov/PEAK will have the Health First Colorado name and logo. In June 2016, all hard copy cards sent to newly enrolled members will reflect the Health First Colorado name and logo. Current cards are still valid; clients do not need to request new cards. As a reminder, clients are only required to show their photo ID at appointments. Health First Colorado cards are not required to receive services. Providers should verify a client’s identity and eligibility at each appointment.” [Source: HCPF]

Medicaid Tobacco Cessation Benefits Webinar Recording

“On Jan. 28, 2016, the Colorado Medicaid Tobacco Cessation project team hosted a webinar about what tobacco cessation benefits are covered by Medicaid and who is using them. A recording of this webinar is now available. In addition, tobacco cessation tools are also available.” [Source: HCPF]

IMPORTANT: Deadline for Medicaid Provider Revalidation

“Although the Centers for Medicare and Medicaid (CMS) has extended its deadline for states to complete provider revalidation, it is important that Colorado providers complete revalidation and/or enrollment as soon as possible. By completing the revalidation and enrollment process as soon as possible through the Online Provider Enrollment (OPE) tool providers will not experience any delay in payment. The Department is launching its new claims management system, the Colorado interChange, on November 1, 2016. Starting on that date, claims and encounters submitted by providers who have not enrolled and/or revalidated will be denied. For more information, contact Provider.Questions@state.co.us.

Providers must utilize the Online Provider Enrollment (OPE) tool to complete their applications. Provider resources, including training, an enrollment reference guide, and several FAQs, are available online on the Medicaid Provider Resources page. Providers are urged to review these resources prior to beginning the revalidation process! [Source: HCPF]

Colorado Medicaid and CHP+ Provider Revalidation & Enrollment - available tools

"New federal regulations established by the Centers for Medicare and Medicaid Services (CMS) require enhanced screening and revalidation for all Medicare, Medicaid, and CHP+ providers. All Colorado providers who want to continue, or begin, providing services to Medicaid and CHP+ members after March 31, 2016, are required to be validated and enrolled under new federal enrollment screening criteria. To meet these new requirements, as well as to ensure enrollment in the new claims processing system, Colorado providers must revalidate using the new Online Provider Enrollment (OPE) tool. Colorado Medicaid asks that providers complete your revalidation during your assigned revalidation and enrollment wave. The enrollment application is the same whether you are newly enrolling or revalidating.

• Click here for application instructions.
• Click here for an introduction to the application process" [Source: HCPF]

Medicaid Provider Revalidation & Enrollment Update

“New federal regulations established by the Centers for Medicare and Medicaid Services (CMS) require enhanced screening and revalidation of all Medicare, Medicaid, and CHP+ providers. All Colorado providers who want to continue, or begin, providing services to Medicaid and CHP+ members after March 31, 2016 are required to enroll and revalidate their licensure and business information under new federal enrollment screening criteria.

Click here for detailed instructions and Frequently Asked Questions for the new Colorado Online Provider Enrollment (OPE) tool. Click here for Top 5 Reasons Your Application Will be Returned for Correction. More Questions? Email Provider.Questions@state.co.us” [Source: HCPF]

IRS Form 1095-B: new requirement impacts Medicaid and CHP+ members

“This new requirement impacts Medicaid and CHP+ members:
IRS Form 1095-B is a new federal tax document that the Department is required to send to individuals who were enrolled in Medicaid or Child Health Plan Plus (CHP+) for even one day in 2015.  The Department will start mailing these forms in mid to late January 2016. All forms are scheduled to be mailed by February 1, 2016.

Under the Affordable Care Act, most individuals are required to have MEC, or pay an IRS federal tax penalty, the Individual Shared Responsibility Payment. Nearly all Medicaid and CHP+ programs count as MEC.  Form 1095-B is proof that individuals had qualifying health coverage, known as minimum essential coverage (MEC), during the month(s) they were enrolled in Medicaid or CHP+ in 2015.

Want to learn more about Form 1095-B?
There is an introductory webinar and a fact sheet for stakeholders, including eligibility partners! These resources are posted here under IRS Form 1095-B: Health Coverage. For Medicaid and CHP+ member information, go to Colorado.gov/Health/IRSForm1095B.  The Department will be posting more resources for stakeholders and members to these websites, as they become available. Please email Nina Schwartz at Nina.Schwartz@state.co.us with any questions.” [Source: HCPF]

HCPF develops county-by-county Medicaid fact sheet

“The Department of Health Care Policy and Financing offers a new resource that provides information about the impact of Medicaid expansion and Medicaid spending by county.  The county fact sheets contain Medicaid caseload information and the local RCCO and BHO data.  Medicaid funding is broken out by medical spending on children, Non-Expansion and Expansion adults. The Department will update the fact sheets on an annual basis.  The next update will likely be in late March/early April 2016 (after claims run out for the 2015 calendar year).” [Source: HCPF]

CDPHE policy for providing information about Medicaid or Connect for Health Colorado

“Please see the memo creating a standard policy that all Colorado Department of Public Health and Environment (CDPHE) contractors that provide direct clinical services provide Colorado Medicaid and Connect for Health Colorado information to clients presenting for services at their agencies.” [Source: CDPHE]

Medicaid Updates: Governor’s budget proposal, ACC Phase II updates, reattribution of ACC patients

“Medicaid Proposed Budget for 2016-2017 and Provider Rate Impact: Last Monday, November 2nd, Governor John Hickenlooper released his 2016-17 state budget proposal. Because of TABOR amendment limits on state spending growth, the legislature will be forced to cut more than $370 million from the state’s budget for the next state fiscal year. While the Governor’s proposal calls for cuts across all budget categories, there are particularly deep cuts called for in the Medicaid program, including cuts to the primary care reimbursement rates.

Accountable Care Collaborative Phase II Concept Paper: The Accountable Care Collaborative (ACC) is the core delivery system for Colorado Medicaid, with more than 940,000 members enrolled as of August 2015. Since its inception, the ACC has been intended to be an iterative program, driving a steady and sustainable shift in the delivery system from one that incentivizes volume to one that incentivizes value. The Regional Care Collaborative Organization (RCCO) contracts expire in July 2017, creating an opportunity to evolve the program during Phase II of the ACC. In mid-October, HCPF released the ACC Phase II Concept Paper, inviting dialogue with the community. HCPF has organized numerous opportunities to solicit public feedback. Click here to read the Concept Paper, stakeholder forum schedule and more information about the development of ACC Phase II.

Reattribution of Medicaid ACC Patients is Happening Now: Beginning in October 2015, Medicaid has begun to run the attribution algorithm on all systematically-attributed ACC clients on a quarterly basis and allow the system to assign those clients to PCMPs based on claims history over the most recent 12-month period. Clients will be notified of the change to their PCMP assignment via normal notification processes (a letter to the client informing them of the assignment which is sent before the effective date).

This process will initially result in the reassignment of about 78,000 clients. Recognizing the potential financial impact of these reassignments on some providers, Medicaid will be providing the RCCOs with lists of the approximate total number of reassignments by each provider ID. It is anticipated that in subsequent quarters the number of clients reassigned will be significantly lower. Read the entire Policy Statement here for more details.

Read the full Colorado Children’s Heathcare Access Program’s Practice Manager Newsletter for more information on:

• Medicaid Provider Revalidation & Enrollment Update
• Psychiatric Consultation for Children
• Cavity Free at Three Training Opportunity
• ECHO Colorado Learning Series Opportunities” [Source: CCHAP]

ICD-10 and Medicaid Updates

Medicaid Provider Billing Workshops:

Provider billing workshops include both Colorado Medical Assistance Program billing instructions and a review of current billing procedures. Class descriptions and workshop calendars are also posted in the Provider Training section of the Medicaid website.

ICD-10 Updates from Medicaid: 

External end-to-end testing has confirmed that Medicaid's systems are integrated, operable, and ready to accept the new ICD-10 codes and formats on October 1, 2015. Effective October 1, 2015, ICD-10 is now active and replacing ICD-9 diagnosis codes. Providers should note the ICD-10 implementation is Date of Service (DOS) specific:

• ICD-9 diagnosis and surgical procedure codes will be required on claims that contain DOS or dates of discharge (DOD) on or before September 30, 2015.

• ICD-10 diagnosis and surgical procedure codes are required on claims that contain DOS or DOD on or after October 1, 2015.

Claims submitted with both ICD-9 and ICD-10 codes will be rejected.
Medicaid billing manuals have been updated ICD-10 codes. Click here to access the manuals.
Appendix R – Provider Claim Report Denial/Error Codes Update for ICD-10. Click here to find this document under "Appendices" 

Please contact the Department’s fiscal agent, Xerox State Healthcare at 800-237-0757 with billing questions. Please contact Sean Gagnon at Sean.Gagnon@state.co.us or 303-866-3467, or Shawna Tye at Shawna.Tye@state.co.us or 303-866-2347 with questions regarding the ICD-10 implementation project.

HCPF's Provider Bulletin:

Click here to view the October Provider Bulletin. The bulletin covers topics of interest to providers and billing professionals.

HCPF's At a Glance:

Click here to view the September edition of At a Glance. This publication provides information on major initiatives including policy changes and program updates.

Promote Preventive Services For Your Medicaid Clients

“The Centers for Medicare & Medicaid Services is offering a set of engaging materials to help Medicaid and CHIP beneficiaries understand and access preventive services available to them. Living Well is a set of outreach and education materials that connects preventive care in the clinical setting with everyday life. Click here to view the toolkit, posters, factsheets, social media graphics, and image library.” [Source: COPrevent]

Medicaid Smoking Cessation Resources

"Click here to view the comprehensive explanation of the Colorado Medicaid Tobacco Cessation Policy: the benefits, requirements, and prior authorization process.  All members in fee-for-service Medicaid are eligible for two 90-day treatment sessions each year. Please make this information available to any Medicaid member who is interested in quitting tobacco.  For questions about this information, please contact Chris Ukoha at (303) 866-358 or Angela.Ukoha@state.co.us." [Source: HCPF]