CGM Upgrade Requests
For requests to upgrade a CGM where the new device has the same manufacturer and procedure code as the current device, the upgrade request may be approved regardless of the devices condition, functionality, and length of use. Cases will continue to be reviewed for medical necessity and may include ensuring compatibility of the new device with the member’s insulin pump.
Pediatric Long Term Home Health
In February 2022, the Department of Health Care Policy & Financing (HCPF) announced a temporary suspension of PAR requirements for Pediatric Long-Term Home Health (PLTHH). At that time, HCPF communicated that the suspension would expire in March 2024. Currently, HCPF is extending this pause through at least January 2025. This means that PARs will not resume before Jan. 31, 2025, for all PLTHH services. This continued pause does not impact outpatient PT, OT, or SLP services. Please see the Information Memo (IM) 23-044 for additional information about the pause extension and provider responsibilities during this time. Please reach out to homehealth@state.co.us with questions.
Attention Inpatient Providers: IHRP 2.0
Attention Hospital Staff: Senate Bill 18-266 requires Health First Colorado (Colorado’s Medicaid program) to implement an evidence-based hospital review program to ensure appropriate utilization of hospital services. The hospital review program created by SB 18-266, known as the Inpatient Hospital Review Program (IHRP) was paused at the beginning of the COVID-19 Pandemic and Public Health Emergency. Help is needed in identifying the staff who need to learn about the next generation Inpatient Hospital Review Program - IHRP 2.0.
Enter information in the Inpatient Hospital Review Program (IHRP) 2.0 Stakeholder Engagement Contact Form if wanting to be involved in the Stakeholder Engagement Opportunities for IHRP 2.0, which will begin in early December 2022. Those who have identified interest in participating in further stakeholder engagement opportunities for IHRP 2.0 will receive additional email communication and calendar invitations for stakeholder events. Forward this email to those that you believe should be involved from your hospital. Contact the ColoradoPAR Program Utilization Management Team at hcpf_um@state.co.us with any questions.