Old Age Pension Rate Information
The following provider payment rates are effective for dates of service on or after July 1, 2014, and will remain in effect until further notice:
- Inpatient Hospital services reimbursed at 10% of the Medicaid rate.
- Outpatient services (including services received in outpatient hospital settings, federal qualified health centers, rural health centers and dialysis centers) reimbursed at 100% of the Medicaid rate.
- Practitioner services reimbursed at 100% of the Medicaid rate.
- Emergency Transportation services reimbursed at 100% of the Medicaid rate.
- Home Health services (including Hospice services) and supplies reimbursed at 100% of the Medicaid rate.
- Dental services reimbursed at 100% of the Medicaid rate.
- Emergency Dental services reimbursed at 100% of the Medicaid rate.
- Laboratory and X-ray services reimbursed at 100% of the Medicaid rate.
- Medical supply services reimbursed at 100% of the Medicaid rate.
- Pharmacy services reimbursed at 100% of the Medicaid rate.
Clients will have a Medical Identification Card. Please continue to verify client eligibility through CMERS, FAXBack or Web Portal. Clients covered by the OAP Health and Medical Care Program are identified by the following message:
“This client is enrolled in the Old Age Pension Health and Medical Care Program. Not Medicaid eligible. Benefits may be limited and payments may be reduced.”
As a reminder, the current rules for the OAP Health and Medical Care Program include:
- Maximum annual client co-payment of $300.00.
- Co-payment amounts for services are the same as the co-payment amounts under Medicaid.
- There are no retroactive benefits (client can only be eligible from date of application).
- If claim overpayments are made in error, recoveries will be made retroactively.
OAP Health and Medical Care Program clients are eligible to apply for the CICP and may be enrolled in the OAP Health and Medical Care Program and the CICP at the same time. This does not apply to Old Age Pensioner clients who are receiving Medicaid. CICP participating providers can document any payment received by the OAP Health and Medical Care Program as a Third Party Liability on their CICP Summary Spreadsheet.
The CICP is only available through participating hospitals and community health centers. The CICP promotes access to health care services for low-income individuals by helping to defray provider costs of furnishing uncompensated care and by limiting the amount that low-income patients must pay. To the extent of available appropriations, the program serves persons with income and assets at or below 250% of the federal poverty level, who are not eligible for Medicaid or the Child Health Plan Plus. The CICP is not an insurance plan under State law because it does not provide individuals with a policy that defines a list of benefits to which they are entitled; rather, the program is a financing mechanism through which the State reimburses participating providers for a portion of costs incurred in treating eligible individuals. In turn, providers must adhere to state-established limits for amounts charged to eligible individuals.
Clients are instructed to contact the Department’s Customer Contact Center for more information at 1-800-221-3943.
Health care providers may email CICPCorrespondence@state.co.us for more information.