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The following are short-term projects which are in the process of being implemented. Please refer to the appropriate topic for further information. If a project was listed here before, please refer to the Provider Information web page for further information.
As part of the Colorado Medicaid Management Innovation and Transformation (COMMIT) project, the Department of Health Care Policy and Financing launched several new provider-facing systems on March 1, 2017.
The Accountable Care Collaborative Program is Health First Colorado's primary health care delivery model. ACC Primary Care Medical Providers (PCMPs) are key to the success of the ACC. Learn more about the ACC.
This is a resource center for health care providers and is designed to provide key information regarding Affordable Care Act, Medicaid expansion and Connect for Health Colorado. The page and resources below will be updated as new information becomes available.
Webinar for Nurses on the ACA & Talking To Patients About Their New Coverage Options
Webinar for Other Health Care Providers on the ACA
Colorado.gov/Health – Colorado’s consumer site for information about health care reform and health & wellness
Material for download and placement in your waiting rooms
For more information about Connect for Health Colorado, the new insurance marketplace, you can download partner resources and consumer resources.
For more information about private insurance and consumer protections see the Department of Regulatory Affairs, Division of Insurance.
For information on the federal health reform law visit Healthcare.gov.
Key Dates to Know
Connect for Health Colorado marketplace opened.
Medicaid expansion population could begin to apply.
Coverage purchased through Connect for Health Colorado and Medicaid expansion coverage began.
Individual mandate began.
Insurance reforms and consumer protections take effect.
March 31, 2014
Deadline to purchase health insurance to avoid penalty.
Connect for Health Colorado 2014 open enrollment period closes.
November 15, 2014
Connect for Health Colorado 2014 open enrollment period opens.
Employer Mandate begins
February 15, 2015
Connect for Health Colorado 2015 open enrollment period closes.
Long term care benefit is available.
Federal tax on high-value benefit packages begins.
HOW IS COLORADO IMPLEMENTING THE LAW?
As a result of the Affordable Care Act (federal health reform law), Colorado passed three laws to help expand health insurance access to more residents and provide a frame work for more Coloradans to be able to purchase health insurance.
Senate Bill 13-200 was signed into law in 2013 and expanded Medicaid coverage for low-income Coloradans to up to 133 percent of the Federal Poverty Level (FPL) (some earning more may still qualify) beginning on January 1, 2014. To learn more about the Medicaid expansion please refer to the What is Medicaid Expansion section below and visit the Department of Health Care Policy and Financing web page.
Senate Bill 11-200 was signed in to law 2011 and created what is now the Connect for Health Colorado insurance marketplace. To learn more about Colorado's new marketplace please refer to the What is Connect for Health Colorado section below and visit Connect for Health Colorado.
House Bill 13-1266, Alignment of Health Insurance Laws, was signed in to law in 2013. The law aligns Colorado health insurance laws with federal law, providing consumers, insurance carriers, agents, and other stakeholders with one set of health insurance rules. It also creates the regulatory environment to support Connect for Health Colorado in becoming a new marketplace for health insurance. For more information about the Division of Insurance and their role in implementing health care reform in Colorado, please refer to the What is the Division of Insurance section below and visit the Department of Regulatory Affairs, Division of Insurance.
The Department works closely with the Colorado Department of Public Health and Environment, Department of Human Services, Department of Regulatory Affairs and Connect for Health Colorado to implement health care reform in a way that meets the needs of Coloradans.
Learn how the Department of Health Care Policy and Financing, Division of Insurance and Connect for Health Colorado are working together to cover more Coloradans in a Denver Post op-ed.
WHAT IS THE MEDICAID EXPANSION?
Health First Colorado (Colorado's Medicaid Program) is public health insurance for Coloradans who qualify. Beginning in 2014, Health First Colorado began covering individuals and families with up to 133%* of the Federal Poverty Level. This means more adults without children and parents now qualify for free or low cost coverage through Health First Colorado.
APPROXIMATE MONTHLY INCOME
to qualify for Health First Colorado beginning January 2014
up to $1,250*
Family of 2
up to $1,700*
Family of 3
up to $2,150*
Family of 4
up to $2,600*
*Those with higher incomes may still qualify for Health First Colorado.Health First Colorado and Child Health Plan Plus (CHP+) do NOT have an open enrollment period. Coloradans can apply and, if eligible, qualify for Health First Colorado and CHP+ at any time.
Consumers can apply online, over the phone, in person, or by mail. To find out more visit our How to Apply page.
Health First Colorado covers doctor visits, emergency care, preventative care, such as screenings and immunizations, and other procedures and treatments. Find out more about what Health First Colorado covers.
The Department of Health Care Policy and Financing administers the Health First Colorado and Child Health Plan Plus (CHP+) programs as well as a variety of other programs for qualified Coloradans. The Department works closely with Connect for Health Colorado by providing a single application for medical assistance and shares data, but does not regulate or oversee Connect for Health Colorado. For more information about Connect for Health Colorado and its governance please refer to the What is Connect for Health Colorado section below.
Health First Colorado (Colorado's Medicaid Program) has seen over an 8.5% increase in providers enrolling from 2011 to 2013 but we are always looking to expand our network.If you or your facility is interested in becoming a participating Health First Colorado provider, we encourage you to call Provider Services at 1-800-237-0757 or visit the Provider Enrollment page.
WHAT IS CONNECT FOR HEALTH COLORADO?
Connect for Health Colorado is a new health insurance marketplace for Colorado. The new insurance marketplace is geared towards:
Small businesses with 2-50 employees,
Coloradans who buy their own health insurance, an
Those who are uninsured or don’t have access to affordable coverage through an employer.
Beginning in October 2013, consumers can shop and purchase health insurance through the Connect for Health Colorado marketplace. The Connect for Health Colorado marketplace is the only place where Coloradans can access new federal financial assistance, based on income, to reduce the cost of health insurance. Through the marketplace, Coloradans will be able to see if they qualify for a new kind of tax credit to lower the cost of premiums and reduce co-pays and deductibles.
Connect for Health Colorado has a board of directors appointed by the governor and state legislature, and is governed by a special subcommittee of the state legislature.
The insurance plans for sale on the Connect for Health Colorado marketplace, like all health insurance plans in Colorado, are regulated by the Department of Regulatory Affairs, Division of Insurance. Find out more about Division of Insurance.
To find out more about the Connect for Health Colorado marketplace visit their website or call 1-855-PLANS-4-YOU (1-855-752-6749).
New tax credit to reduce the cost of premiums
Health plans with lower co-pays and deductibles
Individual earning about $15,000 to $45,500/year
Couple earning about $21,000 to $62,000/year
Family of four about $32,000 to $94,000/year
Applied by IRS
Amount tied to cost of benchmark plan
Individuals earning about $15,000 to $28,500/year
Couple earning about $21,000 to $38,000/year
Family of 4 earning about $32,000 to $58,500/year
Three levels of reductions based on income
To find out more about the Connect for Health Colorado marketplace visit connectforhealthco.com or call 1-855-PLANS-4-YOU (1-855-752-6749).
See the full list of Division of Insurance approved health plans.
To find out more about the Connect for Health Colorado marketplace visit their website or call 1-855-PLANS-4-YOU (1-855-752-6749).
Starting in October 2013, Coloradans can use the marketplace to shop for private health insurance plans and find out if they qualify for financial assistance to lower their health care costs.
You can apply for financial assistance to help you buy insurance through Connect for Health Colorado. Open enrollment started October 2013 and ended March 31, 2014. Coverage started as early as January 1, 2014.
Outside of open enrollment, you can still shop for insurance but cannot apply for financial assistance to help lower the costs of your plan unless you have a qualifying life event.
To find out more about the Connect for Health Colorado marketplace visit their site or call 1-855-PLANS-4-YOU (1-855-752-6749).
For more information about Connect for Health Colorado, you can download partner resources and consumer resources.
Outside open enrollment, individuals and families can enroll in a private insurance plan through the Connect for Health Colorado Marketplace only if they have Qualifying Life Event that gives them a special enrollment period.
They can apply for Health First Colorado or the Children’s Health Plan Plus (CHP+) any time and they can enroll right away if determined eligible.
Get more information from ConnectforHealthCO.com or contact Connect for Health Colorado at 1-855-752-6749 / TDD 1-855-346-3432.
WHAT IS THE DEPARTMENT OF REGULATORY AFFAIRS, DIVISION OF INSURANCE?
The Department of Regulatory Affairs, Division of Insurance regulates the insurance industry and assists consumers and other stakeholders with insurance issues. For over 100 years, Division of Insurance has ensured a regulatory environment that supports a competitive marketplace for insurance companies in Colorado. Additionally, the Division of Insurance ensures all individuals who sell insurance directly – insurance agents – are licensed and regulated.
Connect for Health ColoradoThe insurance plan listed in the Connect for Health Colorado marketplace, like all health insurance plans in Colorado, are regulated by the Department of Regulatory Affairs, Division of Insurance. The Division of Insurance has reviewed the rates for plans offered in this marketplace, and ensured that the health plans are solvent, so that claims can be paid. The Division of Insurance also plays an active role advising Connect for Health Colorado.
Regulating Insurance PlansThe Department of Regulatory Affairs, Division of Insurance regulates the insurance industry and assists consumers and other stakeholders with insurance issues.
Protecting ConsumersThe Division of Insurance answers thousands of questions from consumers every year. If you need information or have any questions about your policy, your rights and protections, or a potential agent or insurer, contact the Division of Insurance.
The Division of Insurance does not recommend companies or producers, but can give information as to whether a company or producer is licensed to do business in Colorado. You can call the Division of Insurance at 303-894-7490, email your questions to email@example.com or fill out the on-line Request For Assistance form.
Reservations are required for all workshops.
Email reservations to: firstname.lastname@example.org or call the Reservation hotline to make reservations: 1-800-237-0757, extension 5.
Leave the following information:
All the information noted above is necessary to process reservations successfully. Look for a confirmation e-mail within one (1) week of making a reservation. Reservations will only be accepted until 5:00 p.m. the Friday prior to the training workshop to ensure there is adequate space available. If a confirmation has not been received at least two (2) business days prior to the workshop, please contact the Department’s fiscal agent and talk to a Provider Relations Representative.
Dental Provider Enrollment Standard Application Guide (5/14)
Dental Provider Enrollment Standard Application Example (5/14)
Dental Provider Enrollment Rendering Application Guide (5/14)
Dental Provider Enrollment Rendering Application Example (5/14)
Provider Recruitment Webinar
Frequently Asked Questions (FAQs)
Provider Frequently Asked Questions (04/14)
Post Eligibility Treatment of Income (PETI): Provider Frequently Asked Questions (04/14)
Health First Colorado Adult Dental Fee Schedule
DentaQuest Contact Information
Provider Services: 1-855-225-1731
New Federal Provider Screening Regulations
This month, Health Care Policy and Financing (the Department) made an emergency change to the provider screening rule to remove the March 31, 2016 deadline for providers to revalidate with Health First Colorado. The next step is to make the rule emergency rule permanent. The Department values the input of the community and our partners. To that end, comments about our emergency change and pending permanent change are welcome.
The changes are viewable in this document; please direct comments to ProviderScreeningComments@state.co.us
New federal regulations established by the Centers for Medicare and Medicaid Services (CMS) require enhanced screening and re-validation of providers enrolling with Health First Colorado. These regulations are designed to reduce the potential for fraud, waste, and abuse. The Department is seeking stakeholder feedback on how to implement these federal regulations.
Most providers will see very little change in their enrollment process but some may be required to undergo additional screening before they can be enrolled or re-enrolled in Health First Colorado. CMS has developed three levels of provider screening rigor based on the potential risk of waste, fraud and abuse. CMS has previously determined the particular risk level of most major provider types (e.g., physicians, clinics, hospitals, community mental health centers).
Provider Screening Rule - This link will direct you to the Colorado Secretary of State website. From there you will need to click on the link under "Current version"; the Provider Screening Regulation is section 8.125 and begins on page 135.
Provider Resources Page - The Department has created this dedicated web page for revalidation & screening instructions and FAQs.
Updated rule approved and posted - late May 2015
Outpatient Hospital Payment ReformAs part of the HB 09-1293 provisions, the Department of Health Care Policy and Financing (the Department) is authorized to develop and implement improvements to the current hospital payment methodologies, including but not limited to the development of incentive payments, implementation of new payment systems, and rate reform.
The Department contracted with the Public Consulting Group, Inc. (PCG) to assist on the multiple projects the hospital payment reform entitles. Among those projects, PCG is providing support with the selection of a new outpatient hospital payment methodology.
Methodology Selection Timeline
Q & A's
Our meeting has a standing location:
Agenda & Minutes
March 11 ,2014
Outpatient Rate Reform Agenda/ Presentation
Outpatient Rate Reform Memo
Colorado Outpatient Hospital Rate Reform Analysis
January 21, 2014
January 7, 2014
The legislation allows incentive payments for eligible providers for the implementation and meaningful use of Health Information Technology (HIT).
Visit the EHR Incentive Program overview website from the Centers for Medicare and Medicaid Services for information on eligibility and meaningful use requirements for both Medicare and Medicaid programs.
The Department has implemented the Health First Colorado EHR Incentive Program, in accordance with the State Medicaid Health Information Technology Plan.
The Department's Health First Colorado EHR Incentive Program implementation timeline is as follows:
CMS Approval of State Medicaid HIT Plan
Registration and Attestation System Live (Provider Registration Begins)
March 5, 2012
Incentive Payments Begin
Need help understanding meaningful use or technical assistance implementing EHR technology into your practice?
The Colorado Regional Health Information Organization (CORHIO) is the state-designated entity for all Health First Colorado EHR Incentive Program outreach activities.
CORHIO provides a wide range of assistance with program-related questions.
Visit the CORHIO website for resources and more information, or contact the Health First Colorado EHR Incentive Program Coordinator at MedicaidEHR@CORHIO.org.
Questions not addressed by these resources or specific questions about the Health First Colorado EHR Incentive Program’s implementation in Health First Colorado can be sent to coHITmedicaid@state.co.us
Targeted Health First Colorado (Colorado's Medicaid Program) Rate Increases were approved by the General Assembly for the 2015-2016 fiscal year to mitigate rate inequities, improve access to care, and improve health outcomes. Approved Across-the-Board increases, if applicable, may also apply to provider rates. Below are links to the Fact Sheet and Frequently Asked Questions for both types of rate increases.
Rates & Fee Schedules