AUGUST 2023
At Colorado Access, caring for you and your success is our top priority as you serve our members. This monthly Provider Update serves as a highlight of important information and resources to help you as a contracted provider with us.
Clarification on the Early Periodic Screening Diagnostic and Treatment (EPSDT) Benefit
The PHE ends May 11, 2023. The renewal process for the more than 1.75 million people covered by either Health First Colorado (Colorado’s Medicaid program) or Child Health Plan Plus (CHP+) starts in May. The Colorado Department of Health Care Policy and Financing (HCPF) estimates that 30% of enrolled people will not need to take any action to remain covered, while the other 70% will need to submit eligibility verification.
HCPF also estimates that more than 325,000 people will no longer qualify for Health First Colorado and CHP+ coverage. People who no longer qualify can apply for insurance through the state’s official marketplace, Connect for Health Colorado, online or by calling their customer service line at 855-752-6749.
As more updates become available, we will continue to share what this means for you and for our members.
In last week’s edition of our quarterly provider newsletter, “Navigator,” we highlighted the federally-mandated EPSDT benefit that is for all children and youth ages 20 and under, as well as adults who are pregnant and are enrolled in Medicaid. The article listed specific conditions that are part of our own definition of children with complex needs but did not go into detail about how much broader the benefit is. Under federal law, the EPSDT benefit covers much more than just the conditions noted in the article. The federal Medicaid website goes into more detail about the EPSDT benefit:
“The goal of this benefit is to ensure that children under the age of 21 who are enrolled in Medicaid receive age-appropriate screening, preventive services, and treatment services that are medically necessary to correct or ameliorate any identified conditions – the right care to the right child at the right time in the right setting. This broad scope supports a comprehensive, high-quality health benefit.”
Public Health Emergency (PHE) Update
The requirement to have a U modifier on depression screens delivered to members that was outlined in the January 2023 Department of Health Care Policy and Financing (HCPF) Provider Bulletin (B2300488) will not be enforced, to avoid additional barriers to accessing depression screens for members, birthing parents, and non-birthing caregivers. You can give depression screens to any caregiver of a child enrolled in Health First Colorado, as required by Senate Bill (SB) 21-137. Depression screening claims without the U modifiers will not be denied due to lack of a modifier.
2023 HCPF Health Equity Plan Public Meetings
HCPF has multiple health equity plan public meetings coming up. These meetings are for providers, members, and community stakeholders to learn more about the plan and give input and feedback.
Provider-Carrier Dispute Process Updates
We have made updates to the provider-carrier dispute process to streamline protocols and ensure compliance with Division of Insurance and Colorado Medicaid requirements. We have ensured that the processes for provider-carrier disputes and member appeals are separate. These changes will be reflected in letters that you may get from the claims appeals team for provider-carrier disputes, letters from utilization management for member appeals, information at the top of explanation of payments (EOPs), and in an updated provider manual.
Member Copay Reductions
As of July 1, 2023, most of the current Health First Colorado member copays are being lowered to $0, to comply with Senate Bill (SB) 23-222 and SB 23-214. This applies to members eligible for Title XIX, the Alternative Benefits Plan (ABP) and the Old Age Pension (OAP) Health and Medical Care Program. Other special programs administered by HCPF, such as Child Health Plan Plus (CHP+), will continue to have normal copays.
Recently Updated Billing Manuals and Fee Schedules
Revised Obstetrical Global Billing Requirements
On May 16, 2023, Governor Jared Polis signed House Bill 1236 into law, which makes administrative changes to the operation of the state’s BHA, including eliminating the Office of Behavioral Health and dividing its responsibilities between the Colorado Department of Human Services and the BHA. The new law also allows the BHA to establish regionally-informed care coordination for behavioral health administrative service organizations (BHASOs) to operate. The new law also strategically delays license issuing for behavioral health entities and mental health residential facilities to January 1, 2024.
The BHA will continue to be the central body for managing jail-based behavioral health services, and the regulatory oversight agency for the behavioral health care system, including regulating community-based providers and developing a care coordination system.
Coding Committee
The quarterly coding committee meeting facilitated by HCPF is an opportunity to discuss coding questions, policy considerations, and requested edits to the billing manual with sister agencies, managed care entities (MCEs), and providers. These meetings are advisory opportunities for HCPF to engage state policy subject matter experts, MCE representatives, and providers to review and discuss issues that impact content in the billing manual. These meetings are not intended to be forums for general billing questions from providers. Learn more about the meetings here.
New Vision Tool for Coloradans in Need
The state of Colorado has launched a new service, Aira, for Coloradans who are blind and have low vision. Aira is an app that provides live, on-demand visual interpreting. Users can get free access for up to 30 minutes per session to help them navigate state locations, websites, and applications. Learn more about Aira here.
Billing Information for CHP+ Providers
As of July 1, 2023, if a CHP+ member’s eligibility start date occurs prior to their enrollment with a Managed Care Organization (MCO), claims must be billed directly to the fiscal agent. After the member is assigned to an MCO, the claims must be billed to that MCO. Learn more here.
New Portal for the Family and Medical Leave Insurance Program
Proposition 118, passed in 2020, paved the way for Colorado’s Paid Family and Medical Leave Insurance (FAMLI) program. A system is being built for Coloradans to use to apply for paid leave benefits when they become available in 2024. It’s anticipated that health care providers will be able to register in the portal around the middle of this month to review claims submitted by patients under their care.
Registering in the system before benefits are available means that your office will be able to get direct notifications from the portal when a patient needs support. You can designate a staff member in the portal when registering to take care of paperwork. After you register, you and your staff will be able to electronically communicate the care plan to support your patients and their families.
Instructional videos and guides will be posted here. You can also sign up here to get updates about the portal.
Your Contact Information
Keeping your contact information updated in the provider web portal will help make sure that you get emails specific to your organization’s claims, such as newsletters. The email address you have in the portal associated with your mailing address will be used to communicate with you. Click here to learn how to access and update your email address that’s on file in the portal.