ACC 2.0 Attribution Tips and Reminders
As we enter the new ACC 2.0 contract, we’ve received a lot of feedback from our providers. We know that there have been some challenges with initial member attribution. As the RAE for regions 3 and 5, we are working closely with the Colorado Department of Health Care Policy and Financing (HCPF) and the enrollment broker, Health First Colorado Enrollment, to address these challenges. We are sharing issues as soon as we’re alerted and working to find solutions. We have a few tips and reminders to help you navigate these early challenges.
You can find additional information from HCPF here.
Even if a member is not attributed to your practice, you can bill HCPF for fee-for-service (FFS) payments if the member is enrolled in Health First Colorado FFS Medicaid. If you have a patient that needs care, you can see the patient and bill FFS while encouraging the member to call Health First Colorado Enrollment to change their primary care provider (PCP). The member’s attribution determines your per-member per-month (PMPM) payment from the RAE and your key performance indicator (KPI) calculations. It is not tied to your FFS payments.
When verifying Health First Colorado (Colorado’s Medicaid Program) member eligibility in HCPF’s Provider Web Portal, a practice/provider may see that a member has a managed care assignment with Denver Health and Hospital Authority. This does not always mean that a member is enrolled in Denver Health’s Medicaid Choice Managed Care Organization.
Denver Health and Hospital Authority currently participates with Health First Colorado in two benefit plans:
- 1. Denver Health Medicaid Choice (PIHP)--a closed-network managed care organization; and
- 2. Primary Care Medical Provider--A fee-for-service provider within the open network of Health First Colorado
To determine whether the member is enrolled with Denver Health and Hospital Authority’s Managed Care Organization, a provider/practice needs to look specifically at the benefit plan column on the managed care assignment table of the HCPF Provider Web Portal. For step-by-step instructions see the Verifying Member Eligibility and Co-Pay Quick Guide which can be found here.
Assignment to a Denver Health and Hospital Authority Primary Care Medical Provider Benefit Plan does not impact your fee-for-service payments. Health First Colorado members can continue to see any Health First Colorado provider, including specialists.
The screenshots below show the two types of member benefit plan enrollments in Denver Health and Hospital Authority.
As part of the RAE contracting process, we asked each provider how many additional Health First Colorado members they were willing to accept as part of the new process for attributing unattributed members. Due to some attribution challenges, providers are currently experiencing with enrollment caps/panel limits, HCPF would like regional organizations to distribute the following messaging:
Primary care medical providers (PCMPs) are not required to have a limit on the number of Health First Colorado (Colorado’s Medicaid Program) members that can be attributed to them and have the ability to set their own panel limit/cap. RAEs are responsible for working with PCMPs to identify and set in the interChange a PCMPs panel limit/cap.
Key information for PCMPs:
Primary care medical providers (PCMPs) are not required to have a limit on the number of Health First Colorado (Colorado’s Medicaid Program) members that can be attributed to them
- PCMPs have the ability to set their own panel limit/cap
- PCMPs can maintain an open panel with no limit
- PCMPs should contact their Regional Accountable Entity to establish their panel limit/cap
- If a PCMP chooses to have a panel limit/cap and reaches this limit, the PCMP will not receive any additional attributions, including claims history, geographic attributions or member choice
- PCMPs must contact their RAE for their panel limit/cap, if one has been established; PCMPs cannot view their panel limit/cap through the Provider Web Portal
If you would like to change your panel limit for Health First Colorado members attributed to your practice, you can do so by contacting your provider relations representative by phone or email at ProviderRelations@coaccess.com
HCPF has contracted with IBM Watson Health (formerly Truven) to host the new Data Analytics Portal (DAP), which replaces the former SDAC. The Data Analytics Portal is a tool for primary care medical providers and RAE that includes population and performance information for the Accountable Care Collaborative. HCPF has updated the DAP website to include background information, job aids, trainings and contact information. To visit the website, click here.
If you are a primary care provider contracted with us, you can gain access to the portal by contacting Sandy Rangel at email@example.com.
January 1, 2018 kicked off the baseline year for the Track One Primary Care Provider (PCP) Alternative Payment Methodology (APM). All PCPs are required to participate or face declining Medicaid reimbursement rates over the coming years. The model reduces the reimbursement rate for select codes by 4%, and a practice’s achievement on a combination of self-selected structural and performance measures will allow them to earn back that 4%.
Practices were able to select their measures in January, and the Department of Health Care Policy and Financing (HCPF) will reopen the measure selection process again in November. All practice sites will be able to add or change their measures at that time.
HCPF indicates that 100 practice sites in Colorado have not yet completed the measure selection process. It is imperative that you select measures in November.
Prior to November, HCPF aims to provide PCPs with their claims baseline data via the provider portal so they have a gauge as to how they are doing and what measures they may want to select when the process reopens.
In the first year, HCPF is paying for simply reporting on those measures that do not yet have performance goals attached to them.
As a reminder, the timeline for the APM is as follows:
Calendar Year 2018 = Baseline year for selected measures
- July 1, 2018 = Reimbursement rate reduced by 4% (HCPF will continue to reimburse at 100% until July 2020; possible 4% reduction will occur retroactively at that time, for the following fiscal year).
Calendar Year 2019 = Performance year for selected measures
- Early 2020 = RAEs to assess PCP site achievement on structural measures; HCPF to
calculate achievement on performance measures
- July 1, 2020 = Reimbursement rate on identified codes adjusted for following year based on measure achievement in 2019 over 2018
HCPF will be doing more webinars in the coming months, as well as reaching out to those practice sites that have not yet selected measures in order to help them do so. You can also contact Dan Obarski at firstname.lastname@example.org for more information. Your assigned provider representative can help you contact him.
The most current and critical information related to the APM and measure selection can be found here.
Additionally we have prepared this document to help you select measures that most align with other programming, so that you might maximize your focus and resource allocation. However, the measures you select are entirely your choice.