At a Glance is a Department of Health Care Policy & Financing (HCPF) publication that provides information on major initiatives, policy changes and program updates. Feel free to share At a Glance with your colleagues. Find previous editions of At a Glance on our website. Thank you for your interest!

Important HCPF February Forecast Information and Materials from our Feb. 26 Medicaid Behavioral Health Webinar

HCPF provides the Joint Budget Committee with caseload and budget forecasts in November and February of each year. This Feb. 15 forecast included updates to our fiscal years 2023-24 and 2024-25 Health First Colorado (Colorado’s Medicaid Program) and Child Health Plan Plus (CHP+) enrollment, leveraging a more expansive public health emergency (PHE) unwind period of insights based on actual renewal data. The new forecast for fiscal year 2023-24 estimates a net 519,000 member enrollment reduction. This reflects the net of individuals losing Health First Colorado and CHP+ coverage through the PHE unwind and those who newly enroll. Providers and partners should plan on a post unwind enrollment that more closely aligns with pre-pandemic levels. 

We began our PHE unwind process with March notices for May 2023 renewals, meaning April 2024 reflects the last month of the 12-month unwind period. This new estimate takes into account the actual enrollment changes we have experienced thus far, historic norms, and our projected changes through the next year given current economic conditions. Consider the following specifics:

• As a result of our collaborative efforts to get Coloradans covered during the COVID-induced economic downturn, when so many lost their employer-sponsored coverage, Health First Colorado enrollment grew by more than 40% compared to national growth of about 31%, as measured through January 2023 results, before the PHE unwind began. Further, Colorado’s unemployment rate has been lower (3.4%) than the national average (3.7%) through the pandemic and as of December 2023, indicating the state recovered faster than the nation from the COVID-induced economic downturn. Last, the Colorado economy has recovered faster than anticipated, and faster than national norms. As people regain employer-sponsored coverage through the economic recovery, more disenroll from Health First Colorado. 
• We anticipate the PHE unwind will cause the emerging, aggregate composition of our members to more closely resemble pre-pandemic norms, where historically eligible members with higher medical needs stay covered, while the vast majority of those who enrolled during the COVID-induced economic downturn — a generally healthier population — no longer qualify.
• HCPF has underscored the importance of analyzing the 90-day reconsideration period, as covered members leverage this period to submit their renewal information late. This February forecast considers information through December, while relying heavily on the data through September, which incorporates the impact of this 90-day reconsideration period.
• We have also been tracking PHE unwind data compared to historic norms (calendar years 2018 and 2019), which shows that PHE unwind renewals are tracking within 2% of pre-pandemic norms, while disenrollments are within 3% of pre-pandemic norms. However, our procedural denials are higher than historic, pre-pandemic levels, while our income based and other qualified eligibility based denials are far below historic (about half). To verify income, Colorado sends a renewal packet to all individuals who did not meet eligibility income criteria through the ex parte process. If the recipient does not verify their income through this added process, it is considered a procedural denial, even if the individual is over income and simply not responding to renewal inquiries. We are implementing short-term and long-term solutions to improve the overall eligibility process, and appreciate your partnership.

To achieve our shared goal to Keep Coloradans Covered, we ask that all stakeholders please read our updated website, reporting webpage and newsletters, as well as use toolkits to help members and partners complete the renewal process or transition to other affordable health coverage. These are available in the top 11 languages spoken by our members: Update Your Address, Understanding the Renewal Process and Take Action on Your Renewal. Flyers have been developed for employers to distribute to employees to remind them to look for their Health First Colorado renewal packet and where appropriate, how to transition to employer-sponsored coverage, and the importance of doing so in a timely manner. 

Thank you to the approximately 700 who joined our webinar on Medicaid behavioral health transformation, policy changes, how changes are impacting communities, and what is coming next. Recordings and materials are on our website. This webinar was hosted jointly with the Behavioral Health Administration (BHA). While Dannette R. Smith, the new BHA Commissioner was unable to co-host, we welcome her March 18 start date and the ability to leverage her vast experience, positivity, and passion to transform Colorado's behavioral health system in partnership.

Ordering, Prescribing, Referring (OPR) Providers Enrollment Requirement:

Providers are reminded to include Ordering, Referring or Prescribing (OPR) providers on claims and to ensure the OPR provider is currently enrolled with Health First Colorado.

The OPR field on the CMS 1500 claim form is 17b.

Claims with services requiring OPR providers will post Explanation of Benefits (EOB) 1997 - "The referring, ordering, prescribing or attending provider is missing or not enrolled. Please resubmit with a valid individual NPI in the attending field" if the OPR provider is not enrolled with Health First Colorado.

This EOB is an informational message at present, but it will cause claims to deny in the future if claims are not compliant.

Professional Claim Services or items that require an OPR NPI:

• Audiology services
• Durable Medical Equipment/Supplies
• Laboratory services
• Radiology services
• Pediatric Personal Care services
• Physical, Speech and Occupational Therapies

Refer to the program billing manuals on the Billing Manuals webpage for more information and visit the Ordering, Prescribing, and Referring Claim Identifier Project webpage to see what provider types are eligible to be an OPR provider.

eConsult Platform Updates:

Health First Colorado providers can access a free, secure, statewide electronic consultation platform through ColoradoMedicaideConsult.com. The platform allows for quicker access to specialty advice to enable primary care medical providers (PCMPs) to provide the highest standards of care for members. eConsult allows participating providers to seek clinical guidance in several specialty fields.  

Available specialties for clinical guidance include:

Safety Net Connect (SNC), HCPF's vendor partner, is actively recruiting and training Colorado providers. Contact SNC at Coloradosupport@safetynetconnect.com to learn more about how to participate.

eConsult Reimbursement:

Refer to the Telemedicine Billing Manual to learn more about eConsult reimbursement.

For more information, visit the eConsult Platform webpage or email the eConsult team at HCPF_econsult@state.co.us.

Recovery Audit Contractor (RAC) Provider Training:

Providers are strongly encouraged to register for training opportunities regarding the RAC program, including:

• What to expect if audited by the Colorado RAC
• Audit timelines
• Usage of the Health Management Systems, Inc. (HMS) Colorado RAC provider portal for audit tracking, record uploads & transparent reporting
• Information on provider rights & responsibilities

HMS and HCPF have created quarterly meetings for different audit types including:

• Complex Audits, Medical Records Reviews
• Hospice Specific Complex Audits, Medical Records Reviews
• Automated Audits, Data & Claims Reviews

Colorado RAC 101: Complex, Medical Records Reviews Training

May 15, 2024, 11 a.m. to 12 p.m. MST Registration Link

Colorado RAC 101: Hospice, Medical Records Reviews Training

June 18, 2024, 2 to 3 p.m. MST Registration Link

Colorado RAC 101: Automated, Data & Claims Reviews Training

April 16, 2024, 10 to 11 a.m. MST Registration Link

Recorded training and presentations for the HMS Colorado RAC 101 and for the HMS Colorado RAC Provider Portal are on the HMS Colorado RAC website at under the tab on the left titled “Resources & Informational Documentation.”

Reminder: Resources to Support Eligibility Renewals Related to the Public Health Emergency (PHE) Unwind:

With the end of the public health emergency (PHE), members are once again required to have their Medicaid eligibility renewal on an annual basis. This is a new process for many members and requires the timely completion of a renewal packet. The following resources are available to support members through the renewal process:

• A guide specifically for helping LTSS members through the renewal process.

• The Renewal Education toolkit can be used by members or partners to familiarize themselves with the basics of the renewal process.

•  Members can learn more about renewals and find FAQs on the Health First Colorado website. Content is available in English and Spanish.

• The KeepCOCovered Toolkit includes information about other health insurance options. 

• FAQs about the end of the Public Health Emergency, including specifics for the LTSS population.

Additionally, HCPF is leveraging flexibility from the Centers for Medicare and Medicaid Services (CMS) to provide a 60-calendar-day extension to complete the renewal process for our vulnerable populations, including long-term care (LTC), members on waivered services, and buy-in recipients who have not returned their renewal packet on time during COVID unwind.

This extension also allows HCPF to do additional outreach to these members when they are up for renewal, while providing extra time for the members to return the information and the counties to process it.

The extension is in effect Sept. 5, 2023, through the remainder of the unwind period, June 2024. It does not affect members who have already submitted their renewal packet to the county or those who have completed the renewal process.

If a member has already turned in their renewal packet and still needs to submit additional information, the county may grant additional time through a Good Faith Extension for a member to turn in this information.

For more information about the extension and frequently asked questions please see the HCPF updates.