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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!
Please note:
The monthly editions of At a Glance did not go out as planned during the months of September, October, and November due to an internal issue. We are sending these back issues now and they are on our website. You can also subscribe to our HCPF newsletters and see the monthly message from Executive Director Kim Bimestefer. We apologize for the error and any inconvenience this may have caused.
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A Message from the Executive Director | |
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HCPF’s FY 2024-25 Budget, Public Health Emergency Update, Community Engagement
On Nov. 1, the Governor released the proposed budget for FY 2024-25, which takes important steps toward bold goals, builds on the successful work of these last five years, and reflects the voices of Coloradans from across our state with important investments in housing, public safety, education, workforce development, saving people money on health care, and achieving our renewable energy goals.
HCPF’s proposed budget for FY 2024-25 is $16.4B Total Fund and $5.0B General Fund, assuming an average of 1.6M covered lives over the fiscal year. This represents about 38% of the state’s Total Fund operating budget and about 31% of the state’s General Fund operating budget.
Our budget proposal includes a 1% across the board (ATB) provider reimbursement rate increase (representing about $29M in General Fund investment). This is on top of the 3%, 2% and 2.5% ATB increases in the three previous fiscal years during the period of unprecedented distribution of federal stimulus dollars; this year’s ATB increase is more than double the less than 0.5% normative or average ATB increase between FY 2010-11 and FY 2020-21 (shown in the table below).
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The budget also includes $103M Total Fund and $25.9M General Fund in targeted rate increases. Recall that HCPF and the Joint Budget Committee (JBC) collaborated last year to increase the frequency of these targeted provider rate increases, including the access analysis, rate comparison to benchmarks, and related stakeholder engagement that occurs as part of the Medicaid Provider Rate Review Advisory Committee (MPRRAC) process. The frequency of the reviews has now moved from every 5 years to every 3, meaning more provider types are going through the process each year.
This FY 2024-25 budget reflects the first increase in the number of provider types moving through the MPRRAC process based on the 3-year cycle and includes Pediatric Behavioral Therapies, ambulatory surgical centers (ASCs), surgical, behavioral health, maternal health, dental services and anesthesiology. Visit our legislator resource center to review the entire MPRRAC report. In addition, HCPF’s budget also includes an off-cycle investment of $53.9M Total Fund and $13.6M General Fund in base wages to the direct care workforce, who serve Health First Colorado members through Home and Community-Based Services (HCBS). It further includes a $5M General Fund one-time investment to support eligibility processing and health care information technology and innovation advances within the state’s largest safety net provider, Denver Health, as well as an investment in the primary care fund.
HCPF’s budget also seeks to modernize our eligibility and claims systems, advance provider tools to improve whole-person health (sometimes called the social health information exchange or Phase II of the Prescriber Tool), improve access to services for members with complex needs, and maintain the compliance and support needed to effectively run our programs.
Our proposed budget makes significant investments to continue transforming the behavioral health system, including working with the legislature on unprecedented commitments to support the families of youth with high-acuity behavioral health needs. Overall, HCPF’s budget includes about $1.2B Total Funds allocated to behavioral health.
The budget further adds Autism Spectrum Disorder (ASD) treatment coverage into the Child Health Plan Plus (CHP+) program and accounts for Colorado expanding Health First Colorado coverage to pregnant adults and children who are DACA recipients, pending federal requirements.
In addition to reviewing the budget submission with stakeholders, answering questions and securing the appropriate allocation to advance our safety net coverages and programs, another top HCPF priority continues to be to Keep Coloradans Covered, now that Colorado has resumed regular eligibility reviews for people with Health First Colorado and CHP+ after a 2+ year pause during the COVID-19 public health emergency (PHE). Thank you for your active engagement with members, community partners, and advocates leading up to and during the unwind period and for your continued dialogue to improve the renewal process. Based on stakeholder feedback, we have made the following changes:
- Renewal packets are shorter and a colored Colorado State seal has been added to help mitigate it being mistaken for junk mail.
- HCPF is leveraging additional flexibility from the federal government 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. This flexibility will remain in place through June 2024.
- We’re improving the PEAK and Health First Colorado app user experience by making it easier to submit renewal materials and monitor the status of a submitted renewal.
- HCPF has created and advanced extensive partner toolkits to help members and partners complete the renewal process or transition to other affordable health coverage; these are now available in the top 11 languages used 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, the means to transition to employer-sponsored coverage, and the importance of doing so in a timely manner. We ask that all stakeholders leverage these tools.
Thank you to the more than 150 partners, advocates, and stakeholders who joined our Oct. 25 quarterly PHE Unwind webinar. All related materials are on our website. Our reporting webpage is updated monthly. Thank you for continuing to visit our websites and reporting pages to secure updated information and tools.
Over the last few months, I visited with partners and industry leaders in many communities. During these visits, we discussed efforts to Keep Coloradans Covered, expand the health care workforce, drive affordability, transform behavioral health, advance care and support for individuals with disabilities and older adults, propel health equity and innovations, refine the Accountable Care Collaborative Phase III concepts, improve our capabilities and partnerships, and more. Thank you to the many chambers and employer groups, legislators, hospitals, community health centers, mental health centers, Regional Accountable Entities, counties and other key partners who met with me and HCPF leaders across Pueblo, Colorado Springs, Grand Junction, Denver, Northern Colorado and the Eastern Plains. We truly appreciate your feedback and collaborative efforts to achieve shared access, quality, equity, and affordability goals.
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Accountable Care Collaborative:
The Accountable Care Collaborative (ACC) is our Health First Colorado delivery system to meet members’ health needs. We are in the process of designing Phase III of the ACC, a critical part of HCPF’s efforts to improve care quality, service, equity and affordability, which will begin July 1, 2025. Phase III will build on investments, innovations and advances to improve member experience, access to care, health equity, home and community-based care, behavioral health, the health care workforce and affordability. Thank you to the more than 3,500 stakeholders across 75 stakeholder meetings to date who have contributed to shaping our Phase III priorities.
We are pleased to announce that we have officially published the ACC Phase III Concept Paper on the ACC Phase III webpage. This Concept Paper outlines the overall vision and design for Phase III and discusses several proposed policies and programs in detail, such as behavioral health transformation, care coordination, payment structure, and more. The proposals in this paper combine extensive research completed by several internal work groups as well as the feedback from stakeholders captured in the ACC Phase III Vision Stage Summary. Please join upcoming meetings to share feedback on these proposals. More information about upcoming meetings is on the ACC Phase III Stakeholder Engagement webpage.
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COVID-19 Public Health Emergency (PHE) Unwind:
Colorado has resumed regular eligibility reviews for people with Health First Colorado (Colorado's Medicaid program) and CHP+ after a 2+ year pause during the COVID-19 PHE.
New Federal Guidance on Ex Parte Process
All states received guidance from the Centers for Medicare & Medicaid Services (CMS) on August 30, 2023, that requires a change to the ex parte (automation) process for renewals. Instead of renewing members with ex parte at the household level (all members of a household receiving Health First Colorado or CHP+ benefits reviewed for eligibility at the same time), as has been done in the past, CMS is requiring states to perform ex parte automation reviews on an individual basis, meaning each person in the household is reviewed and approved separately.
A short-term system change was implemented in mid-October to have the system identify individuals who were determined eligible during ex parte and approve them regardless of whether the household returns a renewal packet or renewal signature. This change will continue until a longer-term change is implemented in the future.
Reinstatement
To fully comply with CMS guidance, coverage is retroactively being reinstated for members who were identified as eligible at ex parte in the renewal months prior to September 2023, but who lost coverage because a packet was requested and not received from the household. Around 10,000 individual members were initially identified as affected by this change. Letters are being sent to affected members starting the week of Oct. 30, 2023, and early November is the target for most members to be reinstated.
- Some members will remain eligible prospectively for a program for which they were approved at ex parte.
- Some members may be reinstated to a program for which they passed during ex parte but then transitioned to another program. This may occur due to members reapplying and the highest applicable coverage being provided.
- Some members may no longer be eligible prospectively (November 2023, and forward) if they re-apply or report a change in circumstances.
Impact to Providers
Claims that were denied in the period when members were having coverage reinstated will need to be resubmitted directly to HCPF as fee-for-service claims for Health First Colorado or CHP+. This includes both physical and behavioral health claims.
If medical bills are incurred by a member during the time that household members showed as not covered, members can call customer service and let them know about these bills so that claims can be paid:
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Health First Colorado members: 800-221-3943 (State Relay: 711)
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CHP+ members: 800-359-1991 (State Relay: 711)
Additional FAQs about ex parte reinstatement and the return to regular renewal processes are in the PHE Resource Center. Providers may contact the Provider Services Call Center with any questions.
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Help Patients Receive Paid Medical Leave in Colorado:
It’s go time! Colorado has spent nearly three years establishing a paid Family and Medical Leave Insurance (FAMLI) program, and a special online portal for health care providers is now live and ready for you to log in and get ready to make paid medical leave a reality for Colorado workers.
We’ve built this exclusive portal to help busy providers cut down on paperwork and deliver an elevated patient experience. In the portal, called My FAMLI+, you'll be able to track and manage patient claims and ensure that approved, licensed health care providers are making treatment decisions impacting a patient's ability to work. And your patients won’t have to worry about bringing you paperwork to sign!
Licensed health care providers will play a vital role in making sure that the FAMLI program is an accessible and meaningful benefit for workers across Colorado.
When you register in the health care provider portal, you can designate a staff member to manage all your patients’ claims—so that when your patients start applying for benefits at the end of the year, your office will get direct notifications from the portal when a patient needs support. Providers that register, will streamline their communication with the FAMLI Division and provide a better experience for your patients during stressful life events.
Check out FAMLI’s step-by-step user guide and how-to videos online to support you and your staff through the process. Also, subscribe to get updates related to the health care provider portal directly from the FAMLI Division as soon as they are available.
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Update on Enhanced Lactation Benefit:
House Bill 22-1289, known as the Cover All Coloradans bill, includes an enhanced lactation benefit that provides electric breast pumps, related supplies, and lactation support services to Health First Colorado and CHP+ members. The comprehensive lactation support benefit, which is still under development at HCPF, will allow Health First Colorado and CHP+ to cover lactation counseling services. HCPF is currently developing a stakeholder engagement strategy for the lactation support services benefit. The stakeholder engagement will begin in early 2024!
If you want to stay up to date with the latest lactation benefit news, sign up for the Maternal, Child, and Reproductive Health Newsletter. For any questions about this new benefit, please send an email to our Maternal, Child, and Reproductive Health inbox: hcpf_maternalchildhealth@state.co.us. We are excited to share this opportunity with you. Please stay tuned for further updates!
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Upcoming Stakeholder Meetings:
HCPF is holding three virtual meetings for stakeholders to provide feedback to inform the implementation of upcoming changes.
Topic: SB23-174 Policy Coverage Stakeholder Meeting
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When: Nov. 17, 2023, 12:30 p.m. Mountain Time (US and Canada)
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The Colorado Legislature passed Senate Bill (SB) 23-174 in 2023, which requires the HCPF to provide access to a limited set of behavioral health services to members under the age of 21 without a covered diagnosis. The services will include an array of outpatient psychotherapy services. The policy will go into effect July 1, 2024. The legislation requires that HCPF seek stakeholder input regarding the scope of services that should be covered under this policy as well as key information that should be included in the annual report to the legislature. The SB23-174: Coverage Policy webpage was created with reference materials for this policy.
Topic: Psychological Testing Billing Changes
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When: Nov. 17, 2023, 1:30 p.m. Mountain Time (US and Canada)
- HCPF is inviting psychologists to participate in a forum regarding the upcoming changes to billing for Neuro/Psychological Testing to take effect Jan. 1, 2024. We will also address any questions regarding billing psychotherapy services for Autism Spectrum Disorder to the RAEs effective Jan. 1, 2024.
Topic: Stakeholder Opportunity for SB23-1200 - Single Case Agreements
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When: Nov. 17, 2023, 3 p.m. Mountain Time (US and Canada)
- HCPF is inviting interested stakeholders to participate in a forum regarding the implementation of SB23-1200. In addition to reviewing Contract language for implementation on Jan. 1, 2024, we are soliciting feedback on how quickly the RAEs and Denver Health must complete single case agreements.
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