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Colorado Children’s Healthcare Access Program (CCHAP)
And The Colorado Department of Health Care Policy and Financing (HCPF)
14 Support Services For Colorado Primary Care Practices
To Provide a Medical Home for Medicaid and CHP+ Children
Administrative Supports
Enhanced Provider Reimbursement – The Colorado Department of Health Care Policy and Financing (HCPF), which oversees state Medicaid, is working with CCHAP to implement the Medical Home initiative, which provides primary care practices with a supplemental fee, in addition to customary reimbursements, to reward completion of preventive care services for the Medicaid patients they serve. This higher reimbursement for preventive care visits (around 120-130% RBRVS) is available to all practices willing to fill out a medical Home Index questionnaire and to provide a medical home for Medicaid children. CCHAP also works closely with Colorado Access (the non-profit managed care company that administers CHP+), which plans to provide enhanced reimbursement similar to the Medicaid reimbursement described above for primary care practices for the CHP+ children they serve.
Enrollment and eligibility assistance – CCHAP and HCPF are partnering to assist CCHAP-affiliated practices with enrollment-related issues for Medicaid and CHP+ children. CCHAP also trains practices to work around problems with eligibility and enrollment. CCHAP now has the capability to assist families with document verification and will be a certified Presumptive Eligibility Site soon.
Business Systems Review – CCHAP is able to provide assistance to your practice regarding the processing of Medicaid claims, coding, denials and issues around reimbursement. Other business systems might include web portal access, provider enrollment into Medicaid, etc.
Practice administrators network – CCHAP has developed a Practice Manager’s Network that meets quarterly. This network allows practice managers to provide new information, lessons learned and support one another in the care of low-income children. Practice Managers are very involved in providing feedback to CCHAP in planning for further enhancements to the CCHAP support services.
Family Supports and Clinical Services
Social Services Support – CCHAP provides a Social Worker and Resource Coordinator for its practices. The Social Worker and Resource Coordinator assist families with Medicaid, CHP+ and who are uninsured cope with the many socio-economic and psychosocial issues that influence families’ abilities to access and appropriately utilize health care services. Types of referrals they process are: financial assistance, housing, food/nutrition, day care, substance abuse, family violence, parenting skills, smoking cessation, legal problems, transportation, etc. CCHAP will assist your practice in connecting with community-based organizations in your county to assure long term success for these referrals.
Mental Health Services – CCHAP continues to develop new service delivery models to improve a child’s access to mental health services. CCHAP has formalized its current arrangement with front range behavioral health organizations and mental health centers to: 1) improve access for children, 2) improve communication regarding patients between mental health providers and the practices, and 3) relax the diagnosis-driven eligibility criteria for Medicaid children so that all CCHAP provider referrals for child behavioral health assessments will be accepted and all referred children will be quickly evaluated and treated. CCHAP has negotiated for a Child Psychiatrist to be available for telephone consultation on CCHAP patients in a majority of CCHAP practices. CCHAP has arranged for mental health providers to provide care for Medicaid and CHP+ children within the CCHAP practice offices in five locations, with plans for several more.
Case Management/Care Coordination – CCHAP continues a multi-pronged approach to case management that includes practice-based strategies, staff training, and collaboration with community organizations and state agencies. CCHAP utilizes the CCHAP resource coordinator and HCPF care coordinators to evaluate, educate and assist families that overutilize emergency departments or frequently miss office appointments (no-shows). The Pediatric Pulmonary Division at The Children’s Hospital offers an asthma case management program for children whose asthma is poorly controlled, as well as education and support for families, and follow up care with the appropriately health care provider.
Immunizations – CCHAP-affiliated practices receive assistance with building the Colorado Immunization Registry into their practice in order to improve their documentation of immunization status, to communicate between practices, and to implement client and provider reminders to improve immunization rates. CCHAP and CIIS assist the practice in doing reminder recall to get all children in for needed immunizations and preventive care.
Transportation - CCHAP helps practices obtain transportation for those Medicaid, CHP+ and uninsured families who need assistance. CCHAP links practices and patients with their local EPSDT care coordinator to provide non-urgent transportation. Additionally, CCHAP provides cab vouchers to assist CHP+ or uninsured patients for whom transportation is not a covered benefit, or to Medicaid patients in emergency situations.
Cross-Cultural Communication Training – Primary care practices are finding that the families they serve are becoming increasingly diverse. Staff and providers have asked for assistance with learning how to adapt to the growing number of families from various ethnic, cultural and racial groups. CCHAP has a well-trained, highly experienced Director of Cross-Cultural Health Care who can bring cross-cultural communication training to CCHAP practices.
Provider Resource Hotline For Children with Special Health Care Needs – CCHAP has worked closely with Family Voices to create a hotline for primary care practices that helps providers determine the most appropriate resources for their specific children with chronic illness or special needs and helps link families with all of those resources.
Developmental Screening – CCHAP recommends developmental screening using a well-standardized screening tool on all low-income children. CCHAP helps practices link with free services for selecting and obtaining screening tools, obtaining staff training and received a high level of reimbursement for developmental screening. CCHAP recommends practices work closely with the Colorado ABCD program.
Becoming an Effective Medical Home – CCHAP promotes the medical home concept as described by the American Academy of Pediatrics for all children. CCHAP works with HCPF (Medicaid and CHP+) to assist practices in assessing how well the practice is providing the components of a medical home, using the Medical Home Index, a practice self-assessment survey. HCPF and CCHAP also provide coaching for practices in making the changes that they practice wants to make. CCHAP provides a variety of materials, services and technical assistance to assist practices with all components of a medical home.
Continuous Quality Improvement (CQI) / Best Practices – CCHAP works closely with HCPF, Family voices and the Colorado Clinical Guidelines Collaborative (CCGC) to provide practices with technical assistance to enable practices to develop continuous quality programming. Practices will be assisted in making any changes they feel they want to make to improve efficiency or to improve their “medical home-ness.”
