Colorado s Accountable Care Collaborative

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1-855-4MY-RCCO www.vccc.co

Colorado’s Accountable

Care Collaborative

Provider Manual

Region 2

Region 3

Region 5

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Getting Started

Welcome to the Accountable Care Collaborative (ACC)

The Accountable Care Collaborative (ACC) is a new Medicaid program to improve clients' health and reduce costs. Medicaid clients in the ACC will receive the regular Medicaid benefit package, and will also belong to a "Regional Care Collaborative Organization" (RCCO). Medicaid clients will also choose a Primary Care Medical Provider (PCMP).

What is a Regional Care Collaborative Organization (RCCO)?

The RCCO connects Medicaid clients to Medicaid providers and also helps Medicaid clients find community resources and social services in their area. The RCCO helps providers to communicate with Medicaid clients and with each other,

so Medicaid clients receive coordinated care. A RCCO will also help Medicaid clients get the right care when they are returning home from the hospital or a nursing facility, by providing the support needed for a quick recovery. A RCCO helps with

other care transitions too, like moving from children’s health services to adult health services, or moving from a hospital to nursing care.

What is a Primary Care Medical Provider (PCMP)?

A primary care medical provider (PCMP) is a Medicaid client's main health care provider. A PCMP is a Medicaid client's “medical home,” where he/she will get most of their health care. When a Medicaid client needs specialist care, the PCMP will help him/her find the right specialist. All clients enrolled in the ACC have a PCMP.

What are the Goals of the RCCO Program?

By assisting Medicaid clients in getting connected to a PCMP as their Medical Home and by ensuring the medical, specialty, mental health care and other related services are well coordinated, clients’ experience in the health care system will improve. Clients will be the primary “drivers” of their healthcare decisions, but will have the support and assistance they need to achieve their personal healthcare goals. In addition, by having a primary source of medical

care that attends to both sick care and wellness and prevention activities, the overall health of Medicaid clients will improve. Finally, when clients are more satisfied and empowered in their healthcare decisions and overall health improves, the total cost of care is reduced.

Colorado has chosen to measure three specific health care activities as indicators of program success. Those measures include:

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1. Emergency Room Visits: Medical care in an emergency room is costly, disruptive, and not always necessary for

every condition. By helping Medicaid clients understand what alternatives they have for using the emergency room for non-emergent conditions, unnecessary use of emergency rooms will be reduced.

2. Inpatient Readmissions Within 30 Days: Inpatient care is necessary for many healthcare conditions and

circumstances, and as such is an essential component of the healthcare continuum. However, rapid readmission to inpatient care can often be avoided if Medicaid clients get the assistance they need to ensure timely post-discharge after care with their PCMP, understand their discharge instructions and medications, and have adequate supports to make a successful and sustained transition out of the hospital.

3. High Cost Imaging: This refers to costly diagnostic procedures such as MRIs and CT scans. While these are

valuable, necessary tools, they are often unnecessarily repeated when multiple providers are involved in a client’s care. By ensuring better communication and coordination of care between providers, some of these duplicative services can be eliminated.

The following table details the performance measures associated with the above healthcare costs and activities.

Measurement Areas Performance Target

Emergency Room Visits per 1,000 full time enrollees

(FTEs)

Level 1 Target: Utilization shows grate than 1.0% but less than 5.0% Improvement

Level 2 Target: Baseline utilization minus 5.0% or more

Hospital Readmissions per 1,000 FTEs

Level 1 Target: Utilization shows greater than 1.0% but less than 5.0%

Outpatient Service Utilization per 1,000 FTEs

(MRI, CT scans, and X-ray tests) per 1,000 FTEs

Level 1 Target: Utilization shows greater than 1.0% but less than 5.0% improvement

Overall Program Goal: Reduce total cost of care by $20/per member per month

Sources: http://www.colorado.gov/cs/Satesllite/HCPF/HCPF/1233759745246 http://www.colorado.gov/cs/Satellite/HCPF/HCPF/1251599759807

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What is the structure of the Colorado RCCO Program?

The State’s Accountable Care Collaborative has divided the counties across the state into regions called Regional Care Collaborative Organizations (RCCO). The RCCO helps manage care of those ACC members living in the counties within their region. Colorado Access is the RCCO for Regions 2, 3 and 5.

The table below shows the counties served by each RCCO. Colorado’s Accountable Care Collaborative Organization Map

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Colorado Access Regional Contract Managers & Additional RCCO Staff

Each RCCO is required to have key personnel available if you have questions or need assistance. Please do not ever hesitate to call any one of us if needed. We are here to help you serve your RCCO Medicaid clients.

Region 2

Contract Manager & Community Liaison Dave Rastatter 970-350-4665 [email protected] Medical Director Dr. Mark Wallace 970-350-4674 [email protected] Region 3

Contract Manager & Community Liaison Molly Markert 720-744-5415 [email protected] Medical Director Dr. Deb Parsons 720-744-5411 [email protected] Region 5

Deputy Director, Medicaid & Contract Manager & Community Liaison

Julie Holtz 720-744-5427 [email protected]

Vice President, Medical Services & Senior Medical Director Region 5

Dr. Genie Pritchett 720-744-5408 [email protected]

Additional RCCO Staff

Executive Director Medicaid April Abrahamson 720-744-5410 [email protected]

RCCO Project Manager Amy Akapo 720-744-5425 [email protected]

RCCO Program Services Manager Drew Kasper 720-744-5428 [email protected] RCCO Program Services Coordinator Michelle Pryor 720-744-5424 [email protected] RCCO Instructional Design Developer Glenda Robertson 720-744-5430 [email protected]

As a contracted PCMP, you may be providing services to Medicaid clients who live in other RCCO regions. Below is information regarding key contact information for the other four Colorado RCCOs. Please feel free to contact the RCCO who is responsible for your client who resides in another geographic area. They want to hear from you if you have questions or need assistance.

Notes

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Medical Home Model Principles

The Accountable Care Collaborative Program administered by the State of Colorado’s Department of Health Care Policy and Financing outlines the following Medical Home Model Principles in their Contract with Colorado Access for the Regional Care Collaborative Organization.

The following are the principles of the Medical Home Model: 1) The care provided is:

a) Member/family-centered;

b) Whole-person oriented and comprehensive; c) Coordinated and integrated;

d) Provided in partnership with the Member and promotes Member self-management; e) Outcomes-focused;

f) Consistently provided by the same provider as often as possible so a trusting relationship can develop; and g) Provided in a culturally competent and linguistically sensitive manner.

2) A PCMP that is:

a) Accessible, aiming to meet high access-to-care standards such as: b) 24/7 phone coverage with access to a clinician that can triage;

i. Extended daytime and weekend hours; ii. Appointment scheduling within:

1. 48 hours for urgent care,

2. 10 days for symptomatic, non-urgent care 3. 45 days for non-symptomatic routine care; and iii. Short waiting times in reception area.

c) Committed to operational and fiscal efficiency.

d) Able and willing to coordinate with its associated RCCO on medical management, care coordination, and case management of

Members.

e) Committed to initiating and tracking continuous performance and process improvement activities, such as im proving tracking and follow-up on diagnostic tests, improving care transitions,

and improving care coordination with specialists and other Medicaid providers, etc.

f) Willing to use proven practice and process improvement tools (assessments, visit agendas, screenings, Member self-management tools and plans, etc.).

g) Willing to spend the time to teach Members about their health conditions and the appropriate use of the health care system as well as inspire confidence and empowerment in Members’ health care ownership.

Notes

The Contractor’s PCMP network shall provide for extended hour on evenings and weekends and alternatives for emergency room visits for after-hours urgent care. The Contractor will determine the appropriate requirements for the number of extended hours and weekend availability based on the needs of the Contractor’s Region, and submit these requirements to the Department for approval. The Contractor shall assess the needs of the Contractor’s Region on a regular basis, no less often than quarterly, and submit a request to theDepartment to adjust its requirements accordingly.

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h) Focused on fostering a culture of constant improvement and continuous learning. i) Willing to accept accountability for outcomes and the Member/family experience.

j) Able to give Members and designated family members easy access to their medical records when requested.

k) Committed to working as a partner with the RCCO in providing the highest level of care to Members.

Attribution

Attribution is the process of using claim data to identify which Medicaid clients are linked to PCMPs. This information is based on HCPF claim data from the past three years. The claim information included is office visits with the Colorado primary care providers. The intent of attribution is to preserve PCMP-patient relationship and to ensure member choice of providers.

HCPF sent the letter on the next page to all contracted PCMPs to explain and clarify how Medicaid clients are enrolled in the RCCO Program.

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The Statewide Data and Analytics Contractor (SDAC), Treo Solutions, is responsible for enrolling clients into the ACC program as of October 2011. This document addresses frequently asked provider questions about how the SDAC enrolls clients into the ACC program and connects them to a primary care medical provider (PCMP).

Which clients are not currently able to enroll in the ACC program?

Only people who are currently eligible for Medicaid are able to enroll in the ACC program. Clients sometimes gain and lose eligibility many times in a given year. This means that a person who is part of your patient panel may have been Medicaid-eligible three months ago but is no longer eligible for Medicaid.

Certain clients will not be enrolled into the ACC program at this time. Some of these groups may be enrolled starting next summer (2012). These include:

• Clients already enrolled in a Medicaid managed care program • Clients eligible for both Medicare and Medicaid

• Clients residing in an institutional setting (for example, a nursing facility) within the last 3 months

• Clients residing outside of the ACC “focus communities” whose usual source of care is not known or is not a participating ACC provider

What is a “focus community” and where are the focus communities located?

Until the program expands statewide, it is limited to certain areas that the Regional Care Collaborative Organizations (RCCOs) have identified as having the infrastructure to support the ACC program. For the purposes of program

enrollment, this designation is limited to the county of residence of the eligible client. The program began in the following counties: Larimer, Moffat, Weld, Adams, Arapahoe, Bent, Otero, Prowers, Pueblo, Denver, Boulder, Jefferson, and El Paso. However, we are expanding rapidly and expect more counties to be included in the coming months.

How does the SDAC enroll eligible clients into the ACC program?

The remaining clients (who have not been excluded from enrollment based on the factors described above) are the pool of Medicaid clients from which the SDAC selects clients for the ACC program. Enrollment is closely tied to client

“attribution” to a PCMP because the PCMP is an essential part of the program.

The Department’s objective is to maintain existing client-provider relationships. To meet this objective, the SDAC looks at a Medicaid client’s past 36 months of Medicaid claims for Evaluation & Management (physician) codes to determine the medical provider the client has seen most frequently. This process has one of four outcomes:

Accountable Care Collaborative

Client Selection Methodology

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1. The client has a clear pattern of using a certain primary care provider and the provider is participating in the ACC. In this case, the client will be enrolled into the program, and the identified provider will be the client’s PCMP. 2. The client has a clear pattern of using a certain primary care provider but the provider is not participating in the

ACC. In this case, the client will not be enrolled into the ACC program.

3. The client has a clear pattern of using two or more providers equally. In this case, the client will be connected to the provider visited most recently. If this provider is participating in the ACC program, the client will be enrolled into the ACC program with that provider as the PCMP.

4. The client has no clear pattern of using any primary care provider. In this case, if the client has a family member with an identified PCMP, the client is enrolled into the ACC program with that PCMP. If the client does not have a family member with a PCMP, he or she will be enrolled without a PCMP, and given the opportunity to select a PCMP after enrolling into the program.

Is enrollment mandatory? Do clients have to stay in the program once the SDAC has selected them for enrollment?

No, enrollment is not mandatory. Medicaid clients are enrolled into the ACC program through a process called “passive enrollment.” With passive enrollment, clients are automatically enrolled into the program but may choose to “opt out” of the program. The clients selected for enrollment receive a letter informing them they will be enrolled into the ACC program in 30 days, and may opt out of the ACC program during this time. The letter also states that, once they are enrolled, they will have an additional 90 days to opt out of the program.

This letter also includes the name and contact information for the RCCO in which the client is enrolled (based on where the client lives), and the name of the group practice, clinic, Federally Qualified Health Center, or individual provider that will be the client’s PCMP.

Clients are allowed to choose a different PCMP if they wish. If a client was not attributed to a PCMP, it is the RCCO’s responsibility, along with the enrollment broker, HealthColorado, to reach out to the client to help with choosing a PCMP. I still have Medicaid clients on my panel that are eligible for the ACC but have not been enrolled. Why?

The Department is currently trying to maintain a ratio of two-thirds adults to one-third children in the ACC program. Because the Medicaid population is roughly the inverse of that (two-thirds children to one-third adults), this narrows the pool of potential enrollees. As a result, there are children who are otherwise eligible for ACC program enrollment and connected to a participating provider, but are not enrolled.

CONTACTS: Program, Jerry Smallwood 303-866-5947

Media, Joanne Zahora: 303-866-3144

Improving access to cost-effective, quality health care services for Coloradans www.chcpf.state.co.us

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Passive Enrollment

“Passive Enrollment” is the term used to describe how Medicaid clients are enrolled in the RCCO Program. A Medicaid client who is eligible for enrollment in the RCCO Program receives a letter to advise them of their enrollment and who their assigned PCMP is (if available). Passive enrollment refers to the fact that a member must choose to decline participation in the program, or, “opt out”. If the client takes no action to decline participation, they are automatically enrolled. The client has 30 days from the date of the Passive Enrollment letter to opt out.

HealthColorado is the organization (called the Enrollment Broker”) that assists members in the process of enrollment and selecting a PCMP. Each month HealthColorado sends out letters to members that have been passively enrolled in the ACC Program. The members do not need to do anything if they wish to remain in the program.

The Passive Enrollment letter will indicate the client’s assigned PCMP as determined by the attribution process described above. The member must call HealthColorado if they want to select another contracted PCMP or if they want to opt out of the Program. If the member has no clear connection to a PCMP as described the attribution process above, the Passive

Enrollment letter will indicate that they need to call HealthColorado to select a PCMP.

The client receives a current RCCO Provider Directory and a RCCO Client Handbook when they receive the Passive Enrollment letter. The Provider Directory lists all contracted PCMPs from which the member makes their PCMP selection. The Client Handbook provides detailed information about the RCCO program. Clients are informed that they may opt out off the RCCO Program without cause 90 days after enrollment and may change their PCMP selection at any time while

enrolled in the program.

Colorado Access and PCMPs may not make the call to the enrollment broker on behalf of the member, but can assist the member with making the call.

Notes

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Fax Enrollment Form

HCPF has created a form that will help clients when they visit your office and have not chosen your practice as their PCMP. You may only give this form to Medicaid clients who are designated in the Web Portal as:

1. Accountable Care Collaborative Program members; and

2. “Unattributed” (does not have a PCMP). For clients enrolled in the Colorado Access RCCO programs, the Medicaid 3. eligibility web portal will indicate that their PCMP is “Colorado Access”.

If a client already has a PCMP and wishes to change, the client must call HealthColorado directly at 303-839-2120 in the Denver metro area, or 1-888-367-6557 outside metro Denver. You may not use the fax enrollment form for the purpose of switching from one assigned PCMP to another.

You may only give this form to Medicaid clients who come in for an appointment. You may not mail or email this form to Medicaid clients to recruit them to choose your practice.

Please fax this form to HealthColorado at (303) 832-8352 once the client has completed it. As an alternative,may mail it to:

HealthColorado

303 E. 17th Ave, Ste. 105 Denver, CO 80203

PCMP Practitioner Information Worksheet

The PCMP Practitioner Information Worksheet procees is extremely important. Colorado Access submits these worksheets to HCPF who in turn submit them toHealthColorado. Proper updates to this worksheet maximize a PCMPs ability to receive new attribution. These worksheets are not only used for Attribution, but also for Colorado Access & HCPF Provider Directories.

Notes

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Page 13 Dates to Remember

 20th: You will receive your PCMP Practitioner Information Worksheet quarterly in March, June, September and December.

 25th: Once you receive this worksheet, any additions, deletions or updates need to be made and the worksheet will need to be returned to [email protected] no later than the 25th of the respective month

*If either of these dates fall on the weekend or a holiday, be sure to send in the information the Friday before.

Changes to PCMP Practitioner Information Worksheet will not require contract revisions with either Colorado Access or the Department.

Key information to be included on this spreadsheet • Organization Legal and DBA names

• Organization & Practitioner Medicaid Provider ID#s • Organization Location(s)

• Whether Organization or Individual provider should be listed on Passive Enrollment Letter • RCCO the Practice is located within All Practitioner Names

• Practitioner Information: o Gender

o Provider type and designation (ie. MD, DO, PA, NP) o Board Certification

o Specialty population interest o Languages spoken

o Office Hours

o Medicaid Panel Size Limit

o Participation in the ACC and/or taking new Medicaid patients

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How To Update, Delete and Add Clinics/Providers to Worksheet

The following provides more detailed instructions about how to add, delete and update information for your practice on the PCMP worksheet. Screen shots of the spreadsheets are provided below.

ADD – Used to add an existing provider/clinic entry. You would want to use the ADD function any time a new provider started working in your clinic or practice.

1. Scroll to the end of your provider/clinic entries

2. Select ‘ADD’ from drop down in first column for the first empty row after your entries. 3. Enter your clinic and provider information for the row.

4. Save the Excel Worksheet.

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UPDATE – Used to modify an existing provider/clinic entry. You would use the UPDATE function if any of the data fields for one of your providers had changed. For example, if one of your providers has become fluent in another language, you would want to update that information in the “Languages Spoken” field.

1. Select ‘UPDATE’ from drop down in first column for the row that you want to update. 2. Make any changes you need to the row.

DELETE – Used to remove an existing provider/clinic entry. You would use the DELETE function any time a provider left your practice.

1. Select ‘DELETE’ from drop down in first column for the row that you want to delete. 2. Do not delete the row; we will do that for you.

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Getting Paid

How will I be paid for the medical services I provide to RCCO clients?

Nothing has changed in the RCCO Program in terms of how you bill and are paid for the Medicaid covered services you provide for Medicaid clients. You will continue to be paid by Fee-For-Service (FFS) Medicaid in the

same way you always have.

HCPF publishes a guide to Medicaid billing called “The Little Billing Book” This booklet contains general Colorado Medical Assistance Program billing information. Use this booklet as a guide to the comprehensive billing information in the Provider Manual sections. The layout of the booklet allows providers print the pages front-to-back.

Click the image to the right to view, “The Little Billing Book.”

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Issue date: January 19, 2012

Changes submitted through the Colorado Medical Assistance Program Web Portal (Web Portal)

Effective February 1, 2012

Beginning February 1, 2012, (B1200311) for more information. Supply and Medical PARs may no longer be submitted through the Web Portal. Please refer to the January 2012 Special PAR Bulletin.

Also beginning on February 1, 2012, Dental PARs will not be accepted through the Web Portal.

The PAR option will not be available from the Web Portal Main Menu during this temporary change, and is anticipated to be unavailable for up to six weeks. During this time, Dental PARs will need to be submitted on paper to the fiscal agent, ACS at:

ACS P.O. Box 30

Denver, CO 80201-0030

Related questions should be directed to ACS Provider Services at 1-800-237-0757. The Department of Health Care Policy and Financing will communicate any updates as they become available.

There will be no disruption to the PAR Status Inquiry or the PAR Letter services through the Web Portal.

• Users will still be able to submit a PAR Status Inquiry on any PAR that has been submitted to the

ColoradoPAR Program Web Portal (CareWebQI) or to ACS.

• Users will continue to receive PAR Letters via the File and Report Service (FRS) in the Colorado Medical Assistance Program Web Portal.

You may continue to check Provider Services in the Providers section of the Department’s Web site at

colorado.gov/hcpffor Medical Assistance Program news and updates.

Accountable Care Collaborative

Prior Authorization Request (PAR)

Notes

See Appendix E for a Special PAR Bulletin.

See Appendix F for an Outpatient Bulletin,

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www.chcpf.state.co.us

Notes

July 17, 2012

The Accountable Care Collaborative program will no longer require that specialists get

an

administrative referral from the Primary Care Medical Provider

.

This means that the

PCMPs

Provider Billing ID is not needed on a specialty claim for the claim to be paid.

This policy will be

officially effective after new RCCO contracts are

executed.

Based on stakeholder feedback, the Department has decided that

an administrative

referral or a claims based referral for specialist services is not necessary. Instead, the

Department will work

with

RCCOs to ensure that PCMPs

&

Specialists establish

protocols for

a

clinical referral process. A clinical referral process would ensure there is

coordination and an appropriate exchange of information between

specialists

and

Primary Care Medical Providers but would not be tied to payment.

The Statewide Data

and

Analytics Contractor will develop data to help RCCOs and

PCMPs understand where clients

are

going

and

build

processes

for

sharing

clinical

information.

If you

are

interested in providing input on the clinical referral process, please contact

Leslie Weems

at

303-866-3393

[email protected]

for information about our

next Provider and Community Relations Subcommittee meeting.

Accountable Care Collaborative

Program Referral Requirement

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Care Management

Who Should I Contact for Care Management?

Notes

General Contact Number

(Follow phone prompts based on purpose of call)

1-855-4MY-RCCO (1-855-469-7226)

TTY

(deaf or hard of hearing)

1-888-803-4494

Email

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RCCO Care Management Categories

Category #1: Routine and Intensive Care Management

The primary functions of Routine and Intensive Care Management Category include:

• Stratification of Delegate’s Member population according to care needs identified through HRAs, Care Plans, and

other relevant sources.

• Health Risk Assessments (HRAs) involve performance of outreach (to the applicable population) for the purpose of

administering RCCO HRAs. Delegate shall do HRAs on the Delegate’s Member population after initial enrollment unless the RCCO has communicated completion of an HRA through mailing or telephonic outreach. HRAs allow for immediate identification of significant Care Management needs.

• Individual needs assessments for attributed Members after enrollment and at other necessary times. This would

include screening for special health care needs (e.g. behavioral health, high-risk health problems, functional problems, language or comprehension barriers; and other complex health issues). Individual needs assessments shall involve a comprehensive collection, analysis and sharing of information about a Member’s physical, emotional and

psychosocial conditions used to determine areas of risk, educational opportunities, and service gaps. The HRA could be considered a part of this process.

• Development of individual Care Plans, as necessary, based on the needs assessment and other relevant

sources. Care Plans shall establish treatment objectives, treatment follow-up, outcomes monitoring, and a

processes to ensure the Care Plan is revised as necessary. The Care Plan shall reflect the Member’s desires and provide a professionally established, Member-focused “road map” of Interventions to increase a Member’s self management skills, awareness of warning symptoms of disease instability/progression, and to increase the Member’s understanding and course of his/her chronic condition(s). At least one Goal, on the Care Plan, should be Member identified, as the Member’s desired intention.

• Assisting with access to care issues such as transportation, referrals for care and appointment scheduling,

connecting Members to community resources, and distributing health promotion information.

• Assisting Members who may require coordination of health care services from multiple providers, facilities and

agencies, to obtain those services and to coordinate with the behavioral health organizations, non-Primary Care Providers (e.g. specialists) and social services provided through community agencies and organizations. Includes facilitating referrals, assisting new Members in continuity of care and Care Coordination (inc. Medicaid/Medicare), and in attaining non-health care services.

• Intensive Care Management to the relevant Member population with Intensive Care Management needs.

Examples of Intensive Care Management Member characteristics:

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Page 21 1) Members with complex medical needs and treatment regimens.

2) Members who need additional assistance in managing their medical care.

3) Members having difficulty contacting other physicians or obtaining medical equipment or medications. 4) Members who lack adequate social support systems.

5) Members with both physical and behavioral health needs.

Category #2: Transitions of Care

Providing assistance during care transitions from hospitals or other care institutions to home or community-based settings; or during other transitions, such as the transition from child health services to adult health services, or from hospital or home care to care in a nursing facility. This assistance shall promote continuity of care and prevent unnecessary re-hospitalizations. Process includes documentation and communication of necessary information about the Member to providers, institutions and individuals involved in the transition.

Delegation of RCCO Care Management

The RCCO-HCPF contract defines certain terms of Care Management delivery that Colorado Access can provide for your RCCO patients. When a PCMP is capable of providing Care Management functions, as defined in the RCCO-HCPF contract, Colorado Access may delegate those functions to the PCMP.

• Full Delegation – PCMP is delegated for both categories of RCCO Care Management

• Partial Delegation – PCMP is delegated for one category of Care Management. Colorado Access does the remaining Care Management category

• No Delegation – Colorado Access handles both categories of RCCO Care Management

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If I want to pursue delegation of RCCO Care Management, where do I start?

PCMP fills out Pre- Delegation Questionnaire and emails to Drew Kasper at RCCO (optional step) Dialogue underway. When ready, PCMP fills out their section of the Pre-Delegation Audit

Tool and sends to RCCO with supporting

documents

RCCO reviews information and schedules visit to PCMP

site (by Program Services Manager and

RCCO Contract Manager), to review the

tool and Care Management program in

detail.

RCCO reviews the findings of the pre-delegation audit and provides PCMP with a formal follow-up response. Agreement is completed, including designation of Care Management Categories for Delegation, and agreement on transition processes. Customized Transition Process Notes

While this represents the typical process flow, Colorado Access wants to

accommodate your individual practice needs. For instance, we would be happy to

walk through the pre-delegation audit tool with you, as a first step, if you prefer.

Please let us know, what works best for you.

To access the RCCO Care Management Pre-Delegation Questionnaire or Audit Tool,

please contact your RCCO Contract Manager, or the RCCO Program Services Manager,

Drew Kasper at [email protected], 720-744-5428.

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Other Helpful Information - Colorado Access Portal

Notes

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Page 24  When searching by name you may receive multiple results

 Scroll through the list until you locate the correct member.

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How Do I Apply for a Username and Password?

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Link to HCPF Eligibility Portal: https://sp0.hcpf.state.co.us/Mercury/login.aspx

The screen sub-heading that previously read “Prepaid Health Plan” will now read

“Accountable Care

Collaborative”. If the client is enrolled in the ACC program, one of the following phone numbers will be at the bottom of the last screen under the heading “Prepaid Health Plan or Accountable Care Collaborative Contact Phone Number”

• RCCO 2 855-267-2094 • RCCO 3 855-267-2095 • RCCO 5 855-384-7926:

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Statewide Data Analytics Contractor (SDAC)

The Statewide Data Analytics Contractor (SDAC) is responsible for providing secure

electronic access to clinically actionable data to the Regional Care Collaborative Organizations (RCCOs) and Primary Care Medical Providers (PCMPs) to help them meet the goals of the Accountable Care Collaborative (ACC), which is to improve client health and reduce costs.

The SDAC help RCCOs and PCMPs by allowing PCMPs and RCCOs to better coordinate Medicaid clients’ care by providing secure access to diagnoses, prescription, and other health information. They also provide reports to PCMPs and RCCOs to help eliminate avoidable and duplicative procedures. In addition, the SDAC analyzes claims to identify potentially

preventable health events (e.g. ER visits, hospital readmissions).

The SDAC currently provides numerous reports however, they are currently working to provide profiles of individual clients based upon predictive modeling, identification of areas for clinical process improvement at the client, provider, and RCCO levels. They are also working towards providing aggregate reporting of cost and utilization performance indicators.

If the client is enrolled in the ACC program with Colorado Access, “Colorado Access” will be listed next to the “RCCO Name” and if the member is unattributed, the “PCMP Name” will be blank. If the member is attributed to a PCMP their name will be listed next to “PCMP Name”. Notes See Appendices H, I, J, and K for: • SDAC Dashboard Portal Access Request Form • Colorado SDAC Dashboard User Guide • Colorado SDAC: Dashboard Quick Reference Guide • Colorado SDAC Frequently Asked Questions (FAQ)

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Are there any transportation benefits for Medicaid RCCO clients?

Yes, non-emergency transportation to healthcare appointments is a benefit covered under the Medicaid program. HCPF contracts with a vendor called First Transit – Colorado NEMT (Non-Emergency Medical Transportation).

The letter on the next page describes First Transit and the process by which Medicaid clients can arrange for transportation to and from their non-emergency medical appointments.

Notes

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Page 29 Dear Medicaid Client:

Beginning January 1, 2012, all Medicaid Non-Emergency Medical Transportation (NEMT) will be provided through Colorado Medicaid’s new transportation broker, First Transit – Colorado NEMT. Call Colorado NEMT at the new number below for all of your non-emergency medical transportation trips in 2012. You can call us at this number to schedule your 2012 trips starting Monday, December 19, 2011:

1-855-CO4-NEMT 1-855-264-6368 First Transit is the new Medicaid NEMT broker for the counties of

Adams Arapahoe Boulder

Broomfield Denver Douglas Jefferson

Larimer Weld

First Transit is committed to ensuring that you receive the best possible service. After January 1, 2012, if you have a concern regarding the services you receive or would like to compliment someone for his or her efforts, please call our Comment Line at:

1-855-NEMT-1ST 1-855-636-8178

First Transit is working with transportation providers from around the region to make sure that your transportation experience will meet our standards for performance. You will receive quality transportation from trained and skilled drivers who are trained in exceptional customer service driving safe and clean vehicles that have been inspected by our own mechanics. We use a reservations and scheduling system that works with many local providers including the RTD’s Access-a-Ride service.

As the General Manager for First Transit Colorado NEMT, I will do everything I can to make your Medicaid NEMT service a customer-focused, comfortable experience. We look forward to serving you beginning in 2012.

Rob Andresen General Manager

First Transit – Colorado NEMT www.medicaidco.com

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Nurse Hotline

Notes

See Appendix M for a

printable version of this

flyer.

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Informational Website Links

Health Care Policy and Financing Informational Web Links: Health Care Policy and Financing Website

http://www.co.gov/hcpf Information About RCCOs

http://www.colorado.gov/cs/Satellite/HCPF/HCPF/1251599759791 ACC Provider Information

http://www.colorado.gov/cs/Satellite/HCPF/HCPF/1251599759802

Colorado Access Informational Web Links: Colorado Access RCCO

http://www.coaccess-rcco.com

Colorado Access RCCO Provider Information http://www.coaccess-rcco.com/providers Colorado Access RCCO Member Information http://www.coaccess-rcco.com/members

Colorado Access WeCARE (Colorado Access Resource Exchange) http://www.coaccess-rcco.com/wecare

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Appendices

Appendix A – Colorado RCCO Contact List Appendix B – Passive Enrollment Letter (English) Appendix C – Enrollment Letter (Spanish)

Appendix D – Fax Enrollement Form Appendix E – Special PAR Bulletin Appendix F – Outpatient Bulletin

Appendix G – Colorado Access Portal Access Request Form Appendix H – SDAC Dashboard Portal Access Request Form Appendix I – Colorado SDAC Dashboard User Guide

Appendix J – Colorado SDAC: Dashboard Quick Reference Guide Appendix K – Colorado SDAC Frequently Asked Questions (FAQ) Appendix L – NEMT Transportation Flyer

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Colorado s Accountable Care Collaborative

1-855-4MY-RCCO www.vccc.co