JULY 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 

Child Health Plan Plus (CHP+)

Effective for dates of service on or after July 1, 2026, providers should bill the new stand-alone vaccine counseling CPT codes: 90482 (3–10 minutes), 90483 (>10–20 minutes), and 90484 (>20 minutes) for visits where a provider counsels a member or family about vaccination but no vaccine is administered that day. This matches Medicaid billing. 

The temporary HCPCS counseling codes G0310, G0311, G0312, G0313, G0314, and G0315 will no longer be reimbursed for dates of service after June 30, 2026. 

• Only one counseling code may be billed per member per date of service. Providers should not bill a counseling code and a vaccine administration code on the same date of service when the administration code already includes counseling.

CHP+ Coverage Reminder 

CHP+ Primary Care Providers are required to provide CHP+ members with covered preventive services they request; this includes immunizations.  

Provider Enrollment Changes for Supportive Services Effective August 1 

A policy change requiring enrollment as Provider Type 77 was announced in the April Health First Colorado Behavioral Health Updates newsletter. This requirement will be implemented on August 1, 2026. 
 
The Provider Type 25- Non-Physician Practitioner Group (PT 25) and Provider Type 16- Clinic Practitioner (PT 16) enrollments do not allow the Department to differentiate between providers who primarily deliver behavioral health services and those who primarily deliver medical or integrated care services.  
 
Provider Type 77- Behavioral Health Group (PT 77), was created effective January 1, 2024, to define more network specificity for group practices who deliver behavioral health services.  
 
Providers who deliver behavioral health supportive services and team-based behavioral health services must enroll as PT 77 in order to continue billing for those services beginning on August 1, 2026.  
 
The list of impacted codes will be published here in the Updates/News section.  
 
More information will be published in a future edition of the State Behavioral Health Services Billing Manual. 
 
Email hcpf_bhbenefits@state.co.us with any questions regarding this guidance. 

 
Updated policies can be found here:

• Changes to Billing Provider Eligibility for Supportive Services
  

• Additional PTPs for August 1, 2026
  

• Supportive Service MUEs and PTPs for August 1, 2026
  

New Billing Policies for Supportive Services Starting August 1, 2026 

Starting August 1, 2026, HCPF is implementing new billing policies for some supportive services codes.  

Supportive services are wrap-around, non-clinical services that can be part of a multidisciplinary approach to substance use disorder (SUD) or mental health treatment. They are not intended to replace treatment or to be provided at the same intensity or duration as outpatient clinical services.  

Supportive Service Billing Changes as of August 1, 2026 

These new Colorado Medically Unlikely Edits (MUEs) and Procedure-to-Procedure (PTP) edits address concerns about inappropriate utilization and unsustainable cost growth. 

View the full chart here. 

These limits apply only to services covered under the Capitated Behavioral Health Benefit. They do not apply to the 1115 Health Related Social Needs (HRSN) Waiver, the 1115 Reentry Waiver, or Home and Community-Based Services (HCBS) Waivers. 

Why These New Billing Policies?  

Costs associated with these services have continued to grow despite policy and program integrity changes made during the last year. These new measures are part of HCPF’s broader efforts to address unsustainable Medicaid cost growth, which has been further complicated by federal fiscal changes under H.R. 1 (the One Big Beautiful Bill Act). 

Clinical Oversight and Medical Necessity 

The Rendering Provider overseeing a member’s treatment remains responsible for determining the appropriate level of care, medical necessity, and whether services are aligned with a member’s diagnosis and individualized treatment plan. 

Extended or intensive use of supportive services may indicate the need for a higher level of care. In alignment with the Behavioral Health Administration (BHA) rules and best practice standards, supportive services remain integral to team-based treatment models such as Assertive Community Treatment (ACT), Intensive Outpatient Programs (IOP), and Partial Hospitalization Programs (PHP). 

For more information, please contact hcpf_bhbenefits@state.co.us or clinical@coaccess.com.

Dollar Limits Removed from (CHP+) Benefits

Starting July 1, 2026, (CHP+) benefits will no longer have a dollar limit. This change affects three benefits: durable medical equipment (DME), organ transplants, and vision hardware (eyeglasses). 
 
The $2,000 dollar limit for DME has been removed, and the $1 million lifetime limit on transplants has also been removed. There is no other change to these services, and they are still available to members based on medical necessity.  
 
Members no longer have a $150 dollar limit for eyeglasses. Instead, the vision benefit covers one pair of prescribed eyeglasses per year from an in-network provider, and prior authorization is required for contact lenses or replacement glasses. 
 
For questions or assistance with finding in-network providers, please contact us at 800-511-5010 (State Relay: 711). 

Training and Assistance

Navigate to New Knowledge: 
Training for Patient Navigators and Community Health Workers 

For organizations interested in building care coordination capacity, Colorado offers a pathway to become a Colorado Department of Public Health and Environment (CDPHE)-credentialed Community Health Worker (CHW). CHWs, patient navigators, health navigators, care coordinators, and similar roles help individuals overcome barriers to care, connect with community resources, and navigate the healthcare system. Colorado currently recognizes four pathways to credentialing, including completion of a CDPHE-recognized training program and a state assessment. There are four CDPHE-recognized training programs available across the state, offering flexible options to gain the skills and competencies needed for this role. Below, we are highlighting the Patient Navigation and Community Health Worker Training Program (PNCT). 

The Patient Navigation and Community Health Worker Training program (PNCT) provides comprehensive training and professional development for patient navigators, (CHWs), care coordinators, and other related roles. The program equips participants with the skills needed to help individuals navigate the healthcare system, access community resources, coordinate care, and improve health outcomes. Online and in-person courses available; courses also held in Spanish. Participants can choose to take one course or the full 75-hour pathway to qualify for the state CHW credential. Pricing varies by course; bulk pricing is available. PNCT also has a library of free, self-paced courses that can be accessed at any time. Topics include Health Insurance Basics, Trauma-Informed Care, Mental Health 101 and more.

For more information, visit patientnavigatortraining.org or email admin@patientnavigatortraining.org. 

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.  
 
The state has mailed letters to members who may no longer be eligible for benefits as of October 1, 2026. The letter encourages members to complete medical appointments and fill prescriptions before October 1, and ensure that their information is updated so they can stay updated.  
 
Other adults will be affected by work requirements and more frequent renewals starting in early 2027. In addition, every member of a household will have different renewal dates.  
 
HCPF is sharing messaging toolkits to help RAEs, providers, and community organizations keep members informed through this change. Access the H.R. 1 communication toolkits here.

Additional materials will be added as they are finalized. Please help us to raise awareness. The most important action members can take is to keep their contact information updated so the state can reach them with essential and timely information. If you have questions about these eligibility changes, we are here to help. Call us at 800-511-5010 (State Relay: 711). Please help us to raise awareness. The most important action members can take is to keep their contact information updated so the state can reach them with essential and timely information. If you have questions about these eligibility changes, we are here to help. Call us at 800-511-5010 (State Relay: 711).  

HCPF is moving ahead with work requirement implementation planning following federal guidance in the Interim Final Rule released June 1, 2026. Key updates include: 

• Medical frailty: HCPF will accept self-attestation for medical frailty in 2027 to help mitigate coverage losses. Medical frailty determinations will be accepted for 12 months, even though members may be redetermined every 6 months.  

• HCPF is hosting a Medical Frailty Definition and Exemption Webinar on July 29, 2026, at 1:00 p.m. Register here.

• Student, volunteer, and work program participation: HCPF will allow self-attestation in 2027. Applicants and members may still be asked for information through a verification checklist or new form, but they will not need an official, such as a school or nonprofit representative, to verify and sign off on the information. 

• Short-term hardship exemptions: HCPF is still considering whether and how to implement the four short-term hardship exemptions allowed under H.R. 1. These exemptions relate to presidentially declared disasters, high unemployment counties, acute services, and travel for serious or complex care. 

• Work requirement verification: HCPF will accept self-attestation for work requirements in 2027. Beginning in 2028, members will likely need to provide proof to verify they meet work requirements. 

• Members who may be subject to work requirements should respond to requests for information and watch for updates about exclusions, exceptions, and verification processes. 

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 

New Non-Emergent Medical Transportation Program Provider   

Starting July 1, 2026, Health First Colorado (Colorado's Medicaid Program) members in the nine-county Denver metro area have  a new Non-Emergent Medical Transportation (NEMT) program provider. MediDrive is operating the program: medidrive.com/facilities/co. 

The nine counties include the four counties in our Medicaid region, Adams, Arapahoe, Denver and Douglas, as well as Boulder, Broomfield, Jefferson, Larimer, and Weld counties. 

 Appointments should now be  scheduled with MediDrive. Providers can set up a provider portal account with MediDrive to help schedule rides for their patients.  Instructions for enrolling your facility can be found here: https://medidrive.com/facilities/co/medical-facilities. Colorado Access has enrolled as a facility, so our care coordination team can also assist members with scheduling rides when needed. 

Please see the updated MediDrive training materials below.  

Training Videos: 

• How to Add a Member or Book a Trip   

• How to Book Standing Orders  

• How to Book Out-of-State Trips 

Additional resources can be accessed on the MediDrive website.  

Some tips: 

When searching for a provider or facility to schedule a ride, using the NPI number works best. Searching by facility name does not always result in finding the facility, while searches by NPI number have been successful. 

If a member’s address or phone number is missing, it cannot be updated in the portal. To request an update, email facilityco@medidrive.com. Trips cannot be scheduled without a member's phone number or home address. 

Behavioral Health Providers

Telehealth fields have been added to the Clinical Update Form and Provider Application/Appendix. Please update your telehealth information to help Colorado Access maintain accurate provider information and support member access to care.

Rural Health Transformation Program Request for Applications is Live 

The Rural Health Transformation Program (RHTP) Request for Applications (RFA) is live! Organizations interested in strengthening health care access and improving health outcomes in Colorado's rural and frontier communities can now apply for grant funding through the RFA.
  

The RHTP was authorized by H.R. 1 Section 71401 of Public Law 119-21, to provide grants totaling $50 billion in federal funds from Federal Fiscal Year (FFY) 2026 through FFY 2030 ($10 billion per year) to States (territories and Washington D.C. are excluded). Colorado was awarded $200,105,604.17 in budget year one. 

To support applicants, HCPF has launched a new RFA Applicant Guidance section with application templates, guidance documents, and other helpful resources. Applications are due by 11:59 p.m. on August 3, 2026. This program is supported by CMS. For full funding details, and to learn more and access the RFA, visit https://hcpf.colorado.gov/rural-health-transformation-program.

Eligible Rural Health Providers  

Qualified Rural Health Care Providers may apply directly for a RHTP grant as a single applicant or in partnership with multiple health care providers and/or partner organizations.  

Qualified Rural Health Care Providers include:  

• Critical Access Hospitals (CAHs)  

• Rural Emergency Hospitals (REHs)  

• Rural Prospective Payment System (PPS) Hospitals  

• Sole Community Hospitals and other CMS-designated rural hospitals  

• Federally Qualified Health Centers (FQHCs)  

• FQHC Look-Alikes  

• Rural Health Clinics (RHCs)  

• Comprehensive Safety Net Providers (CSNPs) 

• Certified Community Behavioral Health Clinics (CCBHCs)  

• Opioid Treatment Programs (OTPs)  

• Private Physician Practice or Non-Physician Practitioner Group  

• Emergency Medical Services (EMS) organizations 

Not sure whether you are eligible? You can learn more here.  

If you are submitting an application and would like to request a letter of support from Colorado Access, you can email policy@coaccess.com. Letters will be considered if the request is received by July 287 and if the requester provides a draft letter. 

Member Rights and Responsibilities  

Below are the rights and responsibilities for Colorado Access members.  

Members have the right to:  

• Receive information about Colorado Access, our services, practitioners and providers, member benefits, and member rights and responsibilities, in the member’s language and in a way the member can easily understand.  

• Be treated with respect and recognition of their dignity and right to privacy. A member’s personal information will only be released to others when the member gives permission or when allowed by law.  

• Participate in decisions about their care, including the decision to refuse or stop treatment, except as provided by law.  

• Receive clear information and have candid discussions about their condition and appropriate or medically necessary treatment options and alternatives, regardless of cost or benefit coverage, presented in a manner appropriate to the member’s condition and ability to understand.  

• Select or request a change to any primary care provider in the Colorado Access network.  

• Get care that is medically necessary from an adequate network of providers  

• Receive family planning services and family planning-related services directly from any licensed or certified provider, without referral.  

• Receive services from a provider that provides reasonable accommodation and equipment, in the Member’s language or with free interpretation services.  

• Access to care within timely appointment standards.  

• Receive care for emergency conditions from any provider, in- or out-of-network, 24 hours a day, seven days a week.  

• Get a second opinion on their diagnosis or treatment.  

• Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience, or retaliation.  

• Receive written notice of any decision Colorado Access makes to deny or limit services.  

• File complaints or appeals about Colorado Access, care it provides, its practitioners and providers, or decisions about the member’s care.  

• Request and receive a copy of their medical records and request that they be corrected.  

• Freely use their rights without adverse treatment by Colorado Access or its providers.  

• Recommend changes to this member rights and responsibilities policy.  

• Exercise all other rights guaranteed by law.  

Members have the responsibility to:  

• Use providers in the Colorado Access network, except in an emergency.   

• Follow the Colorado Access rules and the rules described in the member handbook.  

• Tell Colorado Access if they have other health coverage, including Medicare. This also includes coverage from a claim or action against a third party responsible for your illness or injury.  

• Work with their providers and be respectful to providers and Colorado Access staff. 
  

• Pay any copays.  

• Keep their personal information updated.  

• Keep scheduled appointments and reschedule or cancel if they cannot make the appointment.  

• Give Colorado Access and their practitioners and providers any information needed to provide care, to the best of their ability.  
  

• Follow the plans and instructions for care that the member has agreed to with their provider.  
  

Understand their health problems and participate in creating mutually agreed-upon treatment goals, to the best of their ability.