SEPTEMBER 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.”
Substance Use Disorder (SUD) Provider Forum
The Department of Health Care Policy and Financing (HCPF) is partnering with the Behavioral Health Administration (BHA) to run quarterly joint forums for SUD providers. The next forum is on Wednesday, October 4th from 2:00 p.m. to 3:00 p.m.
Click here to register. Learn more about the SUD benefit here and here. Sign up for HCPF’s email list here.
No-Cost Air Quality and Ventilation Assessments
The Colorado Department of Public Health and Environment (CDPHE) is seeking workplaces for a no-cost air quality and ventilation assessment, specifically those who employ or serve a high-risk or underserved population, are located in a socially vulnerable area, and are in an industry where there is a high COVID-19 risk. If you are, or can connect them with, a behavioral health facility who qualifies, please fill out their interest form in English or Spanish. After they receive the form, someone will follow up to get more information, determine eligibility, and answer questions.
These studies are funded by the National Initiative to Reduce COVID-19 Health Disparities Among Populations at High-Risk and Underserved (OT 21-2103) by the Centers for Disease Control and Prevention (CDC), which aims to reduce disease risk and improve overall health outcomes related to common indoor air pollutants and respiratory pathogens, such as SARS-CoV-2 (the virus that causes COVID-19).
Any information given during the assessment is for informational purposes only and will not be shared with other agencies. It will not result in penalties or citations.
Maternity Care Providers: Share Your Feedback
If you provide prenatal, birth, and/or postpartum care, HCPF would like to hear your thoughts about providing perinatal care in your community in their upcoming regional provider listening sessions. These sessions are a follow-up to their Maternal Health Equity Reports, and your input will inform the next report on maternal health care experiences and outcomes for Medicaid members in Colorado.
Join the session on Monday, September 25th from 1:00 p.m. to 2:00 p.m. Click here to register.
Help Design New Behavioral Health Services In Colorado
The BHA is seeking help to build a new framework for behavioral health services in Colorado. If you are a behavioral health professional, advocate, potential bidder, or current provider, and are interested in helping, respond to their request for information (RFI) with your feedback.
To access the RFI:
1. Go to colorado.gov/vss
2. Select either “Register” or “Public Access” on the left
3. In the keyword search box, type “Behavioral Health Administrative Service Organizations RFI”
The RFI opened on August 28, 2023 and will close to responses on October 13, 2023 at 12:00 p.m.
Extension for Community Health Outcomes (ECHO) Colorado Training
Join ECHO on Friday, October 6th from 12:00 p.m. to 1:00 p.m. for an overview of fall 2023 vaccine recommendations, including respiratory syncytial virus (RSV), COVID-19, and influenza for both adult and pediatric patient populations.
Click here to register.
Provider Options Following Prior Authorization Adverse Determination: How to Request a
Peer-To-Peer Review
Last year, the peer-to-peer review process was improved. Ordering providers may now request a peer-to-peer review to discuss a case with Acentra Health’s reviewing physician within 10 business days (five calendar days for Physician Administered Drugs (PAD)) after an adverse Prior Authorization Review (PAR) determination.
The reviewing physician will discuss the medical necessity determination of the case. They will not explain Health First Colorado (Colorado’s Medicaid program) benefit coverage specific exclusions or inclusions. If you have a policy question or a request for help, email [email protected].
Learn more in HCPF’s September 2023 provider bulletin.
Colorado Department of Regulatory Agencies (DORA) Licenses Changes
Licensure data issues by DORA for enrollments, revalidations, or maintenance request applications in the HCPF provider web portal previously had to be entered in manually, which led to errors that increased application returns and processing times. Changes include automatic verification and auto-population.
Learn more in HCPF’s September 2023 provider bulletin.
Gender-Affirming Care Policy Updates
This policy was updated on August 30, 2023 to align coverage with the most recent standards of care and allow members easier access to gender-affirming services. Learn more in the Gender-Affirming Care Billing Manual. If you have any questions, email Chris Lane at [email protected].
EPSDT Services
Under federal law 42 U.S.C. § 1396d(r), state Medicaid programs are required to provider EPSDT benefits for members under age 21. Health First Colorado is required to cover any services for members under age 21 that is medically necessary “to correct or ameliorate a defect, physical or mental illness or a condition identified by screening,” whether or not the service is covered under Health First Colorado. The service must be covered if it is medically necessary to either improve or maintain the member’s overall health, even if the service will not cure their condition.
Learn more in HCPF’s September 2023 provider bulletin.
Share With Your Patients – Health First Colorado Listening Sessions
HCPF is hosting listening sessions for Health First Colorado members and family members who are impacted by the criminal justice system. They want to hear about member experiences and gather feedback to help identify gaps in services and needs of this community. Staff will ask questions about experiences enrolling in Health First Colorado and using Health First Colorado benefits.
Both virtual and in-person sessions will be offered. Members can join as many sessions as they want. There will also be opportunities to give anonymous feedback.
Upcoming Virtual Sessions
- Wednesday, September 27th, 9:00 a.m.
- Wednesday, October 11th, 9:00 a.m.
- Wednesday, October 25th, 9:00 a.m.
- Wednesday November 8th, 9:00 a.m.
Upcoming In-Person Sessions
Longmont: Wednesday, September 27th, 3:00 p.m.
The Reentry Initiative
402 Kimbark Street, Longmont, CO 80501
Colorado Springs: Wednesday, October 11th, 4:30 p.m.
Penrose Aspen Room at Penrose Library
20 N. Cascade Ave, Colorado Springs, CO 80903
Auxiliary aids and services for individuals with disabilities, as well as language services for individuals whose first language is not English may be provided on request. Members who need these services should email Hannah Hall at [email protected] or the civil rights coordinator at [email protected] at least one week before the session they are attending to arrange for these services.
Provider Credentialing
We follow the National Committee of Quality Assurance (NCQA) credentialing standards for credentialing and recredentialing of all participating providers who are contracted to provide health care services, and who fall under the scope of credentialing. Recredentialing takes place at least every three years.
We use the Council for Affordable Healthcare (CAQH) profile, which needs to be re-attested to every 120 days. Please maintain a current copy of your professional liability insurance and DEA (Drug Enforcement Administration) number (if applicable). Keeping this profile updated will help the recredentialing process go smoothly. If you need help with your CAQH profile, please call them at 888-599-1771.
If you have any questions for us, please call 800-511-5010 or email [email protected]. You can also learn more online at coaccess.com/providers/resources/contracting.
To add a provider to your contracted clinic, please complete the clinical staff update form. This form can be found online at coaccess.com/providers/forms under “General Forms.”
You will soon be able to check a provider’s credentialing status on our provider portal.