Navigator - Provider Newsletter from Colorado Access

Dear Health Community Colleague,

Welcome to the December Navigator. In this issue, you’ll find information about the Child Health Plan Plus (CHP+) pre-enrollment period, a new survey, updates to our provider relations department, changes impacting the Colorado Data Analytics Portal, and updates to KPI incentive payments.

If you want to learn more about anything in this issue of the Navigator or just have a question, please contact us. You can also connect with us on any of our social media channels using the links below.

In good health,
Colorado Access

A Quality of Care Concern (QOC) is a complaint made about a provider’s competence, conduct, and/or care provided that could adversely affect the health or welfare of a member. A critical incident meets a more severe threshold; it is defined as a patient safety event not primarily related to the natural course of the patient’s illness or condition that results in death, permanent harm, or severe temporary harm. Critical incidents are subject to mandatory reporting under Colorado law as well as your provider agreement. The most common categories of QOCs submitted in 2021 include “lack of coordination of care/services” and “lack of follow-up/discharge planning.”

You must report any potential QOCs and critical incidents that you identify during a course of treatment of a member, in addition to any mandatory reporting. When a potential QOC or critical incident has occurred, fill out the updated Quality of Care Concern and Critical Incident reporting form in its entirety and email it to qoc@coaccess.com. Please note that the identity of the provider reporting a potential concern or critical incident remains confidential. If you have any questions regarding QOCs, critical incidents, or reporting requirements, please email qoc@coaccess.com.

The Colorado Department of Health Care Policy and Financing (HCPF) and the Health Services Advisory Group (HSAG) work with DataStat annually to administer and collect data for the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. Member outreach begins this month for the 2022 survey and will continue until early May 2022. Members are outreached originally by mail and subsequently through computer-assisted phone calls. Survey results are anonymous and provide valuable information on how we can help improve the member experience. Historically, response rates have been low and limit the ability to use the survey results to drive improvement. If members ask you any questions about the survey, please educate them on the importance of completing this survey and reiterate the value of getting their voices heard.

To read past Health First Colorado and CHP+ CAHPS Reports, click here. To learn more about the CAHPS, click here.

Incentive payments are a central component of the State’s Accountable Care Collaborative (ACC) Pay-for-Performance program. Since the program’s inception, the State has made incentive payments on identified key performance indicators (KPIs) when entire regions meet the KPI goals set by the State. Starting this month, we have updated payments to award providers for their partnership and/or performance. Payment amounts are calculated based on methodologies we developed collaboratively with the RAE governing council.

Please visit coaccess.com/providers/resources to review the Pay-for-Performance Incentive Sharing Program document for more information. Letters with full KPI explanation of payments (EOPs) will reflect these updates and copies of these letters will also be made available on our provider portal starting this month.

State agencies, including Medicaid and social service agencies, increasingly recognize the importance of integrating individual and community voices into policymaking, especially people from communities of color who experience disparities in food security. The Robert Wood Johnson Foundation and the Center for Healthcare Strategies have released a report with recommendations for policymakers to integrate individuals with lived expertise as partners in program and policy design, implementation, and evaluation to address food insecurity more effectively. Click here to read the report.

As part of our commitment to diversity, equity, and inclusion, we have a new video series on cultural responsiveness training available on our provider learning management system. Courses include: the mistake of stereotyping, microaggression, diversity focused recruitment, overcoming unconscious bias, cultural intelligence, and diversity equals greatness.

Click here to access the series. If you need access, please email providernetworkservices@coaccess.com.

Pediatric Suicide Prevention: A Practical Care Pathway for Primary Care
Even before COVID-19, one in seven Colorado high school students said they had seriously considered suicide within the past 12 months. Primary care interventions can have a dramatic positive impact on this pediatric mental health crisis. Join the Extension for Community Health Outcomes (ECHO Colorado) for a five-session series on Wednesdays from 12:00 p.m. to 1:00 p.m. from January 12 through February 9 that will support primary care providers in the outpatient setting by offering a practical suicide prevention care pathway based on the Zero Suicide framework.

The five sessions will cover the implementation of an evidence-based screening tool, assessment, safety planning, lethal means safety, referral/resources and ongoing management follow-up plan to support youth experiencing suicidal ideation. Click here for more information and to register.

Camden Coalition COACH Training
The COACH model is a framework of techniques and tools for the care planning process. A new eight-week virtual course for frontline providers on how to implement the framework to transform patient engagement and reach goals is launching in January 2022. The course provides 10 continuing education units (CEUs) for physicians, physician assistants, nurses, nurse practitioners, pharmacists, and social workers. Click here to learn more and to register.

Adolescent Reproductive Health in Primary Care
This ECHO Colorado series offers clinically relevant topics for primary care providers who provide or are looking to build, expand, and improve care to preteens through young adults. Once completed, participants will be able to evaluate and manage common conditions in adolescent reproductive health. The course is six weekly virtual sessions on Thursdays from 7:00 a.m. to 8:00 a.m. from January 13 to February 17 and includes an overview of adolescent reproductive health issues, best practices in adolescent contraception and common adolescent gynecology concerns. Click here to learn more and to register.

Community Events

Commerce City Community Campus (C4) Open House

As part of funding distributed to community partners in 2020, we made a significant gift to Urban Land Conservancy to allow for part of this building to be used for medical space for Kids in Need of Dentistry (KIND) and Kids First Health Care. Many other community partners will also provide services in this building.

Join us on Thursday, December 16 from 2:30 p.m. to 6:00 p.m. for the open house of the new campus at South Platte Crossing (7190 Colorado Boulevard, Commerce City, CO).

If you have an upcoming community event that you'd like us to share, please email us.

Based on audit scores, case management was identified as an opportunity for improvement. The two most commonly missed audit measures included session setting/place of service and plan for next contact(s) including any follow-ups or coordination needed with third parties. Both of these measures are minimum documentation standards outlined in the Uniform Services Coding Standards (USCS) manual.

Targeted Case Management includes services designed to assist and support a patient diagnosed with or being assessed for a mental health disorder, to gain access to needed medical, social, educational, and other services as well as provide care coordination and care transition services. Assessing service needs, service plan development, referral and related activities to obtain needed services, and monitoring and follow-up are all allowable services included in Targeted Case Management.

Please review the Uniform Services Coding Standards (USCS) manual for additional information on minimum documentation requirements and allowable services for T1017 Targeted Case Management. If you have specific questions relating to Targeted Case Management, please email qualityimprovement@coaccess.com.

Colorado House Bill 21-1258 established a temporary program to provide access to mental health and substance use disorder services for youth, including addressing needs that may have resulted from the COVID-19 pandemic. Youth and their parents can visit I Matter at imatter.org to take a confidential survey about their mental health and schedule sessions with a licensed behavioral health clinician over telehealth. All Colorado youth ages 18 and younger, or 21 and younger if they are receiving special education services, are eligible to receive these free services.

Text2Quit is a SMS-based smoking cessation program that supports members in preparing to quit smoking and maintaining their quit status. Members receive text messages and emails in both English and Spanish that are tailored to their current stage in the quit program. Messages will regularly encourage members to prepare for quitting, set a quit date, deal with cravings, learn techniques to maintain their quit status, and will also provide support and motivation along their journey.

The pre-HMO enrollment period is a period of time when members who are determined eligible for CHP+ are not yet enrolled with their chosen HMO. If a CHP+ member’s eligibility start date occurs prior to their enrollment with a CHP+ MCO, any services provided during the retro-eligibility period must be billed for fee-for-service (FFS). FFS claims must be submitted to the Colorado interChange and pharmacy claims must be submitted to Magellan. Any services provided after the start date of a member’s enrollment into an MCO must continue to be submitted to the MCO for reimbursement.

All CHP+ eligible members will be mandatorily enrolled into a participating CHP+ MCO. Members will be enrolled into an MCO based in part on the county in which they live. Enrollment into an MCO will occur on the date the member’s CHP+ eligibility determination is received from the Colorado Benefits Management System (CBMS) by the Colorado interChange, which may result in a member’s date of enrollment into an MCO being different as their CHP+ eligibility start date.