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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.
The Accountable Care Collaborative Program is Medicaid'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 by clicking here and download consumer resources by clicking here.
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. Click here for more information about the individual mandate.
Insurance reforms and consumer protections take effect. Click here to learn more.
March 31, 2014
Deadline to purchase health insurance to avoid penalty. Click here for more information about the individual mandate.
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.
To read 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 recent Denver Post op-ed click here.
WHAT IS THE MEDICAID EXPANSION?
Colorado Medicaid is public health insurance for Coloradans who qualify. Beginning in 2014, Medicaid will cover individuals and families with up to 133%* of the Federal Poverty Level. This means more adults without children and parents will now be able to qualify for free or low cost coverage through Medicaid.
APPROXIMATE MONTHLY INCOME
to qualify for Medicaid 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 Medicaid.Medicaid and Child Health Plan Plus (CHP+) do NOT have an open enrollment period. Coloradans can apply and, if eligible, qualify for Medicaid 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 by clicking here.
Medicaid covers doctor visits, emergency care, preventative care, such as screenings and immunizations, and other procedures and treatments. To find out more about current Medicaid coverage click here.
The Department of Health Care Policy and Financing administers the Medicaid 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.
Medicaid has seen over an 8.5% increase in providers enrolling in Medicaid from 2011 to 2013 but we are always looking to expand our network.If you or your facility is interested in becoming a participating Medicaid provider, we encourage you to call Provider Services at 1-800-237-0757 or visit the Provider Enrollment web page by clicking here.
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. To learn more about the governance of Connect for Health Colorado click here.
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. To find out more about the Division of Insurance click here.
To find out more about the Connect for Health Colorado marketplace visit their site here 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).
For a full list of Division of Insurance approved health plans click here.
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).
Starting in October 2013, Coloradans can use the marketplace to shop for private health insurance plans and find out if they qualify for new financial assistance to lower their health care costs. Coverage could have began as early as January 1, 2014, if purchased by December 15, 2013. For more information click here.
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 here and consumer resources here.
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 Medicaid 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)
Medicaid Adult Dental Fee Schedule
DentaQuest Contact Information
Provider Services: 1-855-225-1731
New Federal Provider Screening Regulations
New federal regulations established by the Centers for Medicare and Medicaid Services (CMS) require enhanced screening and re-validation of providers enrolling with Colorado Medicaid. These regulations are designed to reduce the potential for Medicaid 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 Medicaid. 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).
Revised Draft Rule – The Department has revised the draft rule based on stakeholder feedback collected during November.
Summary and Response to Comments – This document summarizes formal, written stakeholder comments as well as those collected at stakeholder meetings and phone calls. In each case, the Department responds to stakeholder comments and feedback.
New! - Final 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 the bottom of page 130.
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
ICD-10 Coding Information
Starting October 1, 2015, the health care industry’s payers, providers, vendors, and all Health Insurance Portability and Accountability Act (HIPAA) covered entities will be required to use the International Classification of Disease 10th Edition (ICD-10) diagnosis codes (CM) and inpatient procedure code sets (PCS). The International Classification of Disease, 10th Edition, Clinical Modification/Procedure Coding System is a diagnosis coding system for diseases and signs, symptoms, abnormal findings, complaints, social circumstances, and external cause of injury or disease and a procedure coding system for inpatient procedures. The 10th edition of these code sets replaces the ICD-9 code sets that have been in use in the United States since 1979. ICD-10 consists of two parts:
The key differences between ICD-9 and ICD-10 include the following:
Note: Medicaid does not conduct coding training.
ICD-10 implementation is Date of Service specific:
While ICD-10 and DSM-5 are complimentary since DSM-5 uses the ICD-10 coding standards and ICD-9 and DSM-IV are similarly complementary, neither the DSM-IV nor DSM-5 is a HIPAA adopted code set and therefore may not be used in HIPAA standard transactions. It is expected that clinicians may continue to base their diagnosis decisions on the DSM-IV/DSM-5 criteria, and if so, to crosswalk those decisions to the appropriate ICD-9-CM and as of 10/1/15 (dates of service), ICD-10-CM codes.
Dates when the DSM-IV may no longer be used by mental health providers will be determined by the maintainer of the DSM-IV/DSM-5 code set, the American Psychiatric Association, www.dsm5.org.
ICD-10 News & Updates
ICD-10 Survey Closed
The Department recently surveyed the Medicaid provider community to assess general readiness for the ICD Transition
SMA ICD-10 Provider Readiness Assessment
Survey results closed on December 31, 2013
Results are currently being reviewed by CMS
National and individual states’ data summaries should be available mid-March
The Department of Health Care Policy and Financing (the Department) is currently working with the fiscal agent, Xerox State Healthcare, to implement ICD-10 into the current Medicaid Management Information System (MMIS). Starting October 1, 2015, the health care industry’s payers, providers, vendors, and all Health Insurance Portability and Accountability Act (HIPAA) covered entities will be required to use ICD-10 diagnosis (CM) and inpatient procedure code sets (PCS).
ICD-10 Phase Schedule Implementation Timeline
Communication & Awareness Plan
Supporting Vendor Evaluations
Internal Training Plan
Review Program Organization
Conduct Impact Analysis
Review Translation Options
Create ICD-10 Remediation Strategy & Plan
Code Mapping/Clinical Review
Level 1 Unit and System testing (internal)
Level 2 end to end testing (external)
October 1st 2015
October 1st 2015 - June 1st 2016
*Dates listed are tentative and may change through the progression of the Software Development Life Cycle
**Policy Remediation will be an ongoing and repetitive effort past the System Remediation implementation date
General ICD-10 Resources
There is a wealth of ICD-10 resources available to help prepare for the transition from ICD-9. Providers should contact Emdeon, Edifecs, or Optum for testing information.
Additional Coding Initiatives
National Correct Coding Initiative (NCCI)
Implemented April 1, 2013
Prevents payment errors due to improper coding
Applies only to inpatient and outpatient procedure codes, except for APR-DRG codes
All Patient Refined-Diagnosis Related Group (APR-DRG)
Expands basic DRG structure
Adds severity of illness, risk of mortality factors and is intended for all patient populations
Will be implemented with ICD-9 codes and updated to include ICD-10
The Colorado Medicaid Approved Vendor List includes vendors that have completed ICD-10 end-to-end testing with payors and are now ICD-10 compliant. If you or your organization would like to submit claims to Colorado Medicaid but are unable to submit ICD-10 compliant claims, please contact one of the vendors from this list.
Physician’s Computer Company
Cortex EDI, Inc
270-441-7337 (ext. 222)
Axiom Systems Inc
Sava Senior Care Administrative Services, LLC
Therap Services, LLC
Insurance Data Services
616-532-800 (ext. 142)
NTT Data Long Term Care Solutions, Inc.
IDX Systems Corporation/GE Healthcare
EDI Edits & Documentation Group Quadax, Inc.
EDI Sales Staff
518-507-5899 or 888-501-6266
Laboratory Corporation of America
Val Vant Hul
877-776-2872 (ext. 6424)
NTT Data LTC Solutions, Inc.
425-307-2260 or 800-426-2680
EHR Newsletter December 2014
EHR Newsletter November 2014
EHR Newsletter October 2014
EHR Newsletter September 2014
EHR Newsletter August 2014
EHR Newsletter July 2014
EHR Newsletter June 2014
EHR Newsletter May 2014
EHR Newsletter April 2014
EHR Newsletter March 2014
EHR Newsletter February 2014
EHR Newsletter January 2014
The legislation allows incentive payments for eligible Medicaid providers for the implementation and meaningful use of Health Information Technology (HIT).
Colorado has implemented the Medicaid EHR Incentive Program. This website is designed to provide you with information regarding the program.
Have questions about Meaningful Use and EHR Incentives for eligible providers?
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.
Visit the Colorado Medicaid EHR Incentive Program provider outreach page for:
Information about the program
Preparation and registration steps, and
Contact information for questions.
The Department has implemented the Medicaid EHR Incentive Program, in accordance with the State Medicaid Health Information Technology Plan.
The Department's Medicaid EHR Incentive Program implementation timeline is as follows:
CMS Approval of State Medicaid HIT Plan
Registration and Attestation System Live (Medicaid 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 Colorado Medicaid EHR Incentive Program outreach activities.
CORHIO provides a wide range of assistance with program-related questions.
Visit COHRIO's website for resources and more information, or contact the Medicaid EHR Incentive Program Coordinator at MedicaidEHR@COHRIO.org.
Questions not addressed by these resources or specific questions about the Medicaid EHR Incentive Program’s implementation in Colorado Medicaid can be sent to coHITmedicaid@state.co.us.
Targeted Medicaid 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