Interim Payments for providers adversely impacted by the COVID Pandemic, which provides Primary Care with either Behavioral Health or Dental Services.
In an innovative program to help support safety-net health providers, the Department of Health Care Policy & Financing (the Department) has partnered with five private Colorado foundations and Regional Accountable Entities (RAEs) to create a new funding opportunity for providers managing through the COVID-19 pandemic. Caring for Colorado, The Colorado Health Foundation, Delta Dental Foundation, Rocky Mountain Health Foundation and Rose Community Foundation have come together in a public-private partnership to support primary care clinics through Health First Colorado (Colorado's Medicaid program).
The COVID-19 public health emergency has led to state budget limitations and significantly reduced revenue for health care providers. This new flexible funding opportunity protects practices that did the right thing by closing their doors and rapidly shifting to telemedicine, which protected our members but caused them to suffer financial losses.
For eligible providers, this interim payment ensures a net benefit. The Providers will have more cash on hand as they have received close to double payment when actual claims are processed in October 2021. At the end of the loan period in August 2022, they have a Total Net Benefit equal to 50% of the July 2021 Interim Payment no matter their federal match rate for claims.
Eligibility & Application
Your clinic is eligible to receive an interim payment if:
- billed less than $100,000.00 in calendar year (CY) 2020,
- provided integrated behavioral health and/or dental care during CY 2020,
- and has experienced more financial loss than has been received in federal relief payments.
Please see the Resource Section for additional information on payments and how your practice can take advantage of this funding opportunity.
Payment and reconciliation examples:
Provider Interim Payment Example
|July 2021 Interim Payment is distributed to provider||$50,000 Lump Sum Interim Payment||The paid amount is equal to an average of quarterly claims paid for Calendar Year 2020 by Medicaid for Fee-for-Services (Q1+Q2+Q3+Q4/4). Managed care payments are not included..
Half of this amount is a grant, and half is a no-interest loan that must be paid back starting in October 2021. See below.
|Provider bills normally for Q3 (July-Sept. 30, 2021) but payment for those claims will be held.||$0 Claims Payment||Medicaid for Fee-for-Services payments are held by the Department during this time, but payments from managed care payments will continue.|
|Q4 claims payment made in October 2021||$40,000
FFS Claims Payment
|Provider receives the payment held by the Department after the quarter closes. These are the Medicaid for Fee-for-Services payments that were not paid during Q3. The payment is made through the normal claims payment process.|
|Total Paid to Provider for Q3 2021||$90,000
|Provider received July 2021 Interim Payment plus actual claims billed during Q3. No reconciliation starts for 10 months- allowing for providers to have more cash immediately on hand.|
|Reconciliation Process starts December 2021|
|Amount provider received for claims||$40,000 FFS
Claims Amount Paid
|The payment is made through the normal claims payment process in October 2021.|
|Amount provider receives as a grant||$25,000
Grant Foundation Funding
|Half of the July 2021 Interim Payment|
|Amount provider owes to HCPF||($25,000)
|Starting December 2021, the provider can write a check for this amount, pay back in quarterly payments, or have their weekly Medicaid for Fee-for-Services payments reduced to complete the repayment by August 2022.|
|Net Benefit for Q3 2021||$65,000||Provider's Net is $25,000 more than would have been paid that quarter without this program.|
*In this example, the provider received a $25,000 grant AND a $25,000 no-interest loan, plus their actual claims payments for the quarter.
($25,000 grant + $25,000 loan + actual claims) = cash on hand for the provider through October 2021 to ensure patient access to care through practice financial stability
All providers who participate will have a Net Benefit of receiving half of the July 2021 Interim Payment that does not need to be repaid in addition to their payment for FFS claims during Q3 2021. Providers also get an up-front, no interest loan to help when it’s needed.
Frequently Asked Questions
- Will larger sites be able to apply?
A: If the foundation funding is not exhausted for providers meeting these initial eligibility criteria, the Department may make it available to medium and finally large practices.
- What can these funds be used for? Are there any restrictions?
A: These funds can be used for general operations of the PCP so the practice can continue to see Health First Colorado members and prevent staff layoffs during the public health emergency. Once the federal funds have been returned any surplus can be used at the providers' discretion.
- Will there be technical assistance for this application and reconciliation process? How can I tell if my practice will be eligible? A:
A. The RAEs will be providing direct outreach to potentially eligible sites and can provide technical assistance for completing applications and later to understand the reconciliation process. Providers should reach out to their Provider Relations contact below for more information. To find the RAE for your region please visit the Accountable Care Collaborative web page.
- Rocky Mountain Health Plans (Dale Renzi): 970-248-5132
- Northeast Health Partners (Alma Mejorado): 719-529-1468
- Colorado Access (Aaron Brotherson): 303-810-8784
- Health Colorado (Brian Hill or Julia Duffer): 1-888-502-4187
- Colorado Community Health Alliance (Josie Dostie or Andrea Skubal):303-256-1717
Timeline for Round 2 Provider Interim Payments
Below is the estimated timeline for key decisions and actions.
|Disaster State Plan Amendment (SPA) submitted||May 17, 2021|
|Release application to potentially eligible providers||May 17, 2021 - June 3, 2021|
|Awards designated*||June 18, 2021|
|Funds Distributed*||July 2, 2021|
|Providers continue to submit claims as usual but payment will be held||July 1 - Sept. 30, 2021|
|End of claims hold||October 1, 2021|
|FFS for the period of July 2-Sept. 30, 2021 released||By October 8, 2021|
|Department completes the reconciliation process of what occurred compared to interim loan payment||October 2022|
|Providers will receive notice of owed amount and will have 30 days to appeal||November 2022|
|Collection of loan of federal portion will begin||December 2022|
|All federal funds will be recouped and returned to CMS||Aug. 31, 2022|
*Contingent upon the CMS-approved Disaster State Plan Amendment (SPA) and executed foundation contracts.