1410 Grant St Suite B302

Denver, CO

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Phone

(303) 263-5422

Email

contact@calaonline.org

Medicaid Decrease 2020

Purpose and Audience:

The purpose of this Informational Memo is to inform Providers and Case Management Agencies of changes to rates for Home and Community-Based Services (HCBS) offered through HCBS Waivers.

Information:

The Colorado General Assembly approved a 1 percent across the board reduction to provider rates in the Long Bill (HB20- 1360), including most fee-for-service Home and Community-Based Services (HCBS) rates. The Long Bill also rebalances rates for behavioral health and Residential Child Care Facility (RCCF) fee-for-service rates, aligned dialysis rates with Medicare rates and increased RCCF per diem rates for the Children’s Habilitation Residential Program (CHRP) waiver.

The new rates will be effective July 1, 2020 for all non-negotiable HCBS rates except for Consumer Directed Attendant Support Services (CDASS). CDASS rates will be decreased no sooner than September 1, 2020. All new rates and spending limits will be posted to the Department of Health Care Policy & Financing’s (the Department’s) Provider Rates & Fee Schedule web page.

The rate reduction will affect services differently. Some providers may have to contact the member’s case manager, depending on the service.

Set Rate Services
• The Department will update rates in the Bridge and Interchange.
Post Eligibility Treatment of Income (PETI)-Adjusted Rate Services (ACF: T2031 and SLP: T2033)
• The Department will be updating existing PETIs and Prior Authorization Requests (PAR) service lines by June 30, 2020.
• Existing PETIs and PAR lines will be end dated for June 30, 2020, and new PETIs and PAR lines will automatically be created with the decreased rate beginning July 1, 2020.
• Providers should verify the rate in the DXC Provider Portal or contact the member’s case managers after July 1, 2020 to obtain the new rate.
• For newly enrolled or soon to be enrolled members, providers should contact the member’s case managers regarding these services.
Negotiated Rate or Manually Priced Services
• These rates and service lines are not subject to the 1 percent rate reduction and will not be adjusted.
• Providers should continue to bill the approved rate on the Prior Authorization.
Support Plan Authorization Limit (SPAL) for the HCBS Supported Living Services (SLS) Waiver
• The SPAL will also be adjusted to reflect the rate decrease.
• Providers should consult the July 1, 2020 HCBS Rate Schedule on the Provider Rates & Fee Schedule web page for more information.
Overall Waiver Spending Limits for the HCBS Supported Living Services (SLS) and Children’s Extensive Supports (CES) Waivers
• The overall spending limit will be adjusted to reflect the rate decrease.
• Providers should consult the July 1, 2020 HCBS Rate Schedule on the Provider Rates & Fee Schedule web page for more information.

When posted, providers are encouraged to review the HCBS Rate Schedule effective July 1, 2020 on the Department’s Provider Rates & Fee Schedule web page.

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