AUGUST 2026

At Colorado Access, caring for you and your success is our top priority as you serve our shared members. This monthly Provider Update serves as a highlight of important information and resources to help you as a contracted provider with us. 

Benefits, Billing, and Code Updates 

Implementation of New Limits on Support Services 

Effective August 1, 2026, new policies focusing on the utilization of Support Services were implemented. This includes daily limits and same-day billing limits related to codes outlined in the table below. Annual limits for Support Services will not be implemented as previously required by the Department of Health Care Policy and Financing. Specifically, annual limits will NOT be applied to procedure codes H0038, H2014, and T1017.

For information on PTPs, MUEs, and NCCI edits go here:
https://hcpf.colorado.gov/bh-policies#NCCIedits
https://hcpf.colorado.gov/bh-policies#COMUEsandCOPTP 

Centers for Medicare & Medicaid Services (CMS) Ends Federal Medicaid and Children's Health Insurance Program (CHIP) Funding for Sex-Rejecting Procedures for Children and Youth 

CMS finalized a rule prohibiting Medicaid and the (CHIP) from covering certain gender-affirming care (GAC) services for youth beginning October 13. Proposed earlier this year, the final rule ends federal funding for hormone therapy, puberty blockers, and related procedures for transgender youth. Psychotherapy will remain covered under these programs. 

Under the final rule, federal Medicaid and CHIP funding will be available for a tapering-off period of up to six months from the effective date of the final rule for children currently on hormone therapy.

See the CMS press release here.  

Emergency Alert 

The State of Colorado has declared wildfire emergencies for the Willow, Gold Mountain, and Aspen Acres fires burning across the state. Covered persons impacted by these active wildfire emergencies, or any wildfire emergency declared in 2026, will be granted access to replacement Durable Medical Equipment (DME) and prescription drug early refills, if needed. These will not require a new prior authorization, Colorado Access will honor previously approved authorizations for these replacement items beginning July 14 and through September 12, 2026. 

New State Behavioral Health Services Billing Manual  

A new state behavioral health services billing manual was published on August 1, 2026.

Please review the manual and tracking form here.

Eligibility and Enrollment 

Health First Colorado Eligibility Changes Due to H.R. 1  

Colorado Access is working with the Department of Health Care Policy and Financing (HCPF) to help providers and members understand and respond to eligibility changes resulting from the federal H.R. 1 law (the One Big Beautiful Bill Act). New federal rules will mostly affect members ages 19 to 64. Some lawfully present immigrants will lose Health First Colorado (Colorado's Medicaid program) coverage on October 1, 2026. This includes refugees and asylees, people granted humanitarian parole, and others. For details, see Health First Colorado’s website about changes to eligibility due to H.R. 1. 

We’re gathering feedback about H.R. 1 material needs. We'd love to hear from you about what you need to help communicate these changes. This simple form should only take a few minutes to complete.

Training and Assistance

Colorado Access Behavioral Health Town Hall Meetings  

Please join us for our monthly Behavioral Health Provider Town Hall Meetings, where we share updates, provide information and training, and answer your questions.

Register here for the Town Hall Meetings.  

For questions, contact the Behavioral Health team at Behavioral.Health@coaccess.com.  

Provider Credentialing Rights 

All providers have the right to review information submitted to support their credentialing application, including information obtained from outside sources (e.g. malpractice insurance carriers, state licensing boards). Colorado Access is not required to make available references, recommendations, or peer-review protected information.  

Providers have the right to correct erroneous information such as actions against your license, malpractice claims history, or board certification status. When correcting erroneous information is through the verification process, credentialing staff sends up to three email attempts over 21 business days. Information may be sent back to the individual who made the initial outreach, or responses and documentation may be sent to credentialing@coaccess.com. All documentation and communication are saved in the provider’s electronic credentialing folder. Colorado Access is not required to reveal the source of information that was not obtained to meet verification requirements or if federal or state law prohibits disclosure.  

All providers have the right to receive the status of their credentialing or recredentialing application, upon request. The requests can be sent to credentialing@coaccess.com and an approval/effective date will be provided, or the provider will be notified of the missing information needed to complete the primary source verification process. 

News and Announcements 

Colorado Access Urges Reconsideration of Medicaid Work Requirements Interim Final Rule  

Colorado Access submitted official comments to the Centers for Medicare & Medicaid (CMS) on its interim final rule (IFR) regarding operational guidelines and implementation rules of community engagement, or “work,” requirements for the Medicaid expansion population as established by H.R. 1. In our comment letter, we urged CMS to reissue this rule and emphasized the significant risk of coverage loss due to the IFR’s administrative burden. The rules went into effect on July 31, the same day as the comments were due.  

Learn more about the comments submitted here. 

People First Behavioral Health Alliance (PFBHA) Launches 

Colorado Access, alongside eight organizations from across the behavioral health spectrum, joined together to launch the People First Behavioral Health Alliance (PFBHA). This cross-sector coalition brings together payers, providers, and advocates to build policy and create change that helps people first. This coalition includes Signal Behavioral Health Network, Paragon Behavioral Health Connections, Servicios de La Raza, AllHealth Network, Mental Health Colorado, Vail Health, Colorado Cross Disability Coalition, and Innovela Consulting Group. 

PFBHA’s priorities are system accountability, integrated support, and equitable care. The goals include ensuring that every rule, contract, and dollar is accountable to outcomes for Coloradans; aligning behavioral health and physical health; and making care within reach of everyone it is meant to serve. Each is a multi-year effort developed across sectors to develop reforms to outlast a single budget year or administration.

Learn more here.

Feedback for the Colorado Commission on Medicaid 

The Colorado Commission on Medicaid wants to hear from people who use, provide, pay for, or work in the Medicaid program. The Commission will deliver its final recommendations in December to implement a sustainable Medicaid program.

The survey is here.

Introducing Access Community Connect!  

Colorado Access has partnered with findhelp to launch Access Community Connect, an online social care network that helps connect community members to social services and resources. Members and providers can use the platform to search for community resources based on individual needs. This is a great tool for providers to share with their patients and for provider staff to use when helping patients find community resources. Colorado Access is also building a trusted provider network of community partners willing to participate in closed-loop referrals through findhelp. This means participating agencies can respond to referrals and close the loop with Colorado Access directly within the platform. 

Child Health Plan Plus (CHP+) Formulary Updates 

The CHP+ Formulary changes on a monthly basis.

View the recent updates that went into effect this past month here.