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

In the August 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. 

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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.

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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.

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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.

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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 chris.lane@state.co.us.

EPSDT Services

Under federal law 42 U.S.C. § 1396d(r), state Medicaid programs are required to provide EPSDT benefits for members under age 21. Health First Colorado is required to cover any services for members under age 21 that are 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.

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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.

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