Attention All Assisted Living Residences

Alternative Care Facility (ACF) Targeted Rate Increase Approved

The targeted provider rate increase for ACF for the HCBS Elderly, Blind and Disabled, and Community Mental Health Supports waiver were approved by Centers for Medicare & Medicaid Services (CMS). The approved targeted rate increase (TRI) is 25% and the new rate effective October 1, 2018, is $64.90.

The fee schedules located on the Provider Rates & Fee Schedule web page have been updated to reflect the approved 25% TRI. The Department has updated rates in the Colorado interchange and reimbursement for services on or after October 1, 2018, will reflect the increased rates.

Detailed information about the annual rate updates has been published in past provider bulletins as well as on the Provider Rates & Fee Schedule web page.  The Department will continue to publish updates in these locations when CMS approval is received for additional HCBS TRIs, rates have been loaded, and mass adjustments have occurred.

“Lower of” Pricing Logic for Rate Increases

If the department implements rate increases, claims that were already billed with and paid at a rate lower than the new rate cannot be adjusted for the higher rate.  The department will always use the “lower of” pricing logic.  Providers are advised to bill their usual and customary charges.  Not all codes are listed on the Health First Colorado Fee Schedule, so providers are advised to check all fee schedules which apply to their billing practices. If a code is not listed on the Health First Colorado Fee Schedule, it may be listed on a benefit-specific fee schedule.

Contact the Provider Services call center, at 1-844-235-2387 with questions.