JULY 2023

Adult Dental Benefit Limit for Health First Colorado (Colorado’s Medicaid program)

As of July 1, 2023, Health First Colorado has removed the adult and intellectual and developmental disabilities (IDD) dental benefit maximum. Members were previously limited to $1,500 per year, but there is no limit now; all services will be covered at 100%. Frequency limits are the same. Learn more here or click to download flyers [English | Spanish].

Depression Screen Billing Changes: Adding Modifiers and Allowing Other Caregivers under Child’s ID Cancelled

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.

If you have any questions, please email morgan.anderson@state.co.us and susanna.snyder@state.co.us.

Read More >>

Public Health Emergency (PHE) Update

The PHE ended on May 11, 2023. You can learn more about which flexibilities were made permanent, and which are changing, here. HCPF will continue to communicate changes as they occur.

2023 HCPF Health Equity Plan Public Meetings

411 Behavioral Health Audit

The annual state-mandated 411 behavioral health audit has been completed, with a total of, 1233 claims across the entire state being reviewed. Documentation was audited across three behavioral health service categories – inpatient, residential, and outpatient psychotherapy. If you were involved in this audit, you will get a letter with your results this month. In the meantime, our compliance team is working to incorporate more education and training opportunities to support you. We can also support you with any remediation efforts that are required from the audit.

Provider-Carrier Dispute Process Updates

We have made updates to the provider-carrier dispute process to streamline processes and ensure compliance with Division of Insurance and Colorado Medicaid requirements. We have ensured that the provider-carrier dispute process and the member appeal process are separate. These changes will be reflected in letters that you may get from the claims appeals unit 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.

Administrative Changes Coming to Colorado Behavioral Health Administration (BHA)

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.

Multi-State Initiative to Strengthen Primary Care

The Centers for Medicare & Medicaid Services (CMS) will be partnering with the state of Colorado for a new primary care model to enhance access to, and quality of, primary care services. This collaboration on the making care primary (MCP) model will boost Colorado’s current efforts to strengthen the primary care infrastructure, and will help improve health equity and reduce health disparities across the state.

Payment Reform Updates for Family Medicine and Internal Medicine Primary Care Medical Providers (PCMPs)

We are retiring the HbA1c Testing metric and replacing it with the HbA1c Poor Control (>9.0%) metric for the state fiscal year (SFY) 2024-2025 Administrative Payment Models. This is an update to information that was previously communicated during our May 2023 PCMP Provider Forum.

Read More >>

Mifepristone Available as Pharmacy Benefit

As of July 2, 2023, mifepristone is available as a pharmacy benefit and can be dispensed by a Mifepristone Risk, Evaluation and Mitigation Strategy (REMS) Program-Certified Pharmacy. Mifepristone is available when prescribed and dispensed in compliance with the Food and Drug Administration (FDA) requirements.

HCPF Extended Encounter Policy

The new HCPF Extended Encounter policy allows you to bill two units of 90834 for sessions scheduled longer than 75 minutes for:

1. The use of evidence-based modalities that require more time than a 90837 encounter can accommodate.

2. Family therapy sessions that address dyadic or family system factors that impact the functioning of the member with family members present.

CDPHE CO-CARES Initiative

The Colorado Department of Public Health and Environment (CDPHE) has launched the free CO-CARES initiative to support public health and health care workers who continue to help Colorado through the COVID-19 response. The initiative’s resources include conversations, training, webinars, peer support development, and expert consultation to help lower burnout and stress for public health and health care workers, and create a supportive workplace environment.

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 who are 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.

Member ID Card Phone Numbers

The phone numbers of the RAEs, PCMPs, CHP+ providers and managed care providers are listed as the contact number on member ID cards, digital ID cards in PEAK, and on the Health First Colorado mobile applications. Any recent updates to the service location office phone number field made through the Provider Web Portal are now reflected on member ID cards and the Health First Colorado mobile application, as of June 15, 2023.

Recently Updated Billing Manuals and Fee Schedules

• View all published fee schedules here.

• View all published manuals here.

• View 340B policy and procedures here.

Revised Obstetrical Global Billing Requirements

There is a new billing methodology to comply with CMS to capture information about care rendered through the maternity service time frame. The new methodology will give information needed to support high-quality maternity care and help providers report provision of these critical services. Learn more here.

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.