CHP+ Managed Care Network

CHP+ Managed Care Network

The Child Health Plan Plus (CHP+) relies on dedicated providers like you to serve the health care needs of Colorado's low-income children and pregnant women enrolled in the program. By participating in CHP+, you are joining a network of providers throughout the State whose efforts and commitment have resulted in a significant increase in the number of Colorado families who have access to appropriate health care. Without the participation of providers like you, this program would not be possible!

Why participate as a provider in CHP+?

Participating in the program allows you to:

• Provide preventive and early appropriate care for children and pregnant women with no regular access to health care
• Receive payment for the care of children and pregnant women for whom you now provide free care
• Reduce inappropriate use of emergency departments
• Provide a medical home for more of Colorado's children and pregnant women.
• Renewal Letter

How does the CHP+ Managed Care Network work?

The State of Colorado, Department of Health Care Policy and Financing (the Department) administers the CHP+ program. Health Maintenance Organizations (HMOs) contract with The Department to provide medical services to CHP+ members. The Division of Insurance approves services areas for the HMOs based on the HMOs provider network adequacy in the areas. The CHP+ Managed Care Network functions much like a traditional HMO operated by The Department.   Colorado Access performs the contract administration duties with providers on behalf of The Department.

The ability of a CHP+ member to select a particular HMO is dependent on where the CHP+ member resides. A pre-HMO enrollment period is the span of time from a member's original enrollment until the member is enrolled in a CHP+ participating HMO. The CHP+ Managed Care Network delivers care during this span or pre-HMO enrollment period.

The following table lists the counties and respective HMO affiliations:

CHP+ Managed Care Network Only Counties. In counties where the CHP+ Managed Care Network is the only available health plan, providers enter into a contract with The Department.

Mixed Counties. In counties where the CHP+ Managed Care Network and other HMOs are available (Mixed), providers may choose to enter into a contract with The Department, the HMO, or both. However, for continuity of care issues, providers are strongly recommended to enter into a contract with The Department for the purposes of providing medical care to CHP+ members during the pre-HMO enrollment period when the CHP+ Managed Care Network serves CHP+ members.

Rocky Mountain HMO Only and Colorado Access Only Counties. In counties where only one HMO is available (for example, Rocky Mountain HMO only or Colorado Access only), providers must enter into a contract with that designated HMO. However, for continuity of care issues, providers are also strongly recommended to enter into a contract with The Department for the purposes of providing medical care to CHP+ members during the pre-HMO enrollment period when the CHP+ Managed Care Network serves CHP+ members.

Choice Counties. In counties where there is a choice of HMOs in the CHP+ member's county of residence, providers must enter into a contract with at least one of the designated HMOs. However, for continuity of care issues, providers are also strongly recommended to enter into a contract with The Department for the purposes of providing medical care to CHP+ members during the pre-HMO enrollment period when the CHP+ Managed Care Network serves CHP+ members.

Choice Colorado Access or Kaiser	Choice Colorado Access, Denver Health, Kaiser	Choice Colorado Access or Colorado Choice Health Plan		HMO Only Colorado Access Only	HMO Only Rocky Mountain Health Plan Only		HMO Only Colorado Choice Health Plan Only	SMCN Only CHP+ State Managed Care Network Only
Boulder	Adams	Alamosa	Huerfano	Clear Creek	Archuleta	Mesa	Chaffee	Sedgwick
Broomfield	Arapahoe	Bent	Mineral	Elbert	Delta	Moffat	Las Animas
Douglas	Denver	Conejos	Otero	El Paso	Dolores	Montrose	Baca
	Jefferson	Costilla	Prowers	Gilpin	Eagle	Montezuma	Cheyenne
		Crowley	Rio Grande	Larimer	Garfield	Ouray	Kit Carson
		Custer	Saguache	Lincoln	Grand	Pitkin
		Fremont	Yuma	Logan	Gunnison	Rio Blanco
		Washington	Kiowa	Phillips	Hinsdale	Routt
				Morgan	Jackson	San Juan
				Park	Lake	San Miguel
				Pueblo	La Plata	Summit
				Teller
				Weld

The ability of a CHP+ member to select a particular HMO is dependent on where the CHP+ member resides. A pre-HMO enrollment period is the span of time from a member's application date until the member is enrolled in a CHP+ participating HMO. The State Managed Care Network delivers care during this span or presumptive eligibility period.

State Managed Care Network is available in all counties during the presumptive eligibility and pre-HMO enrollment periods, as well as enrollments for prenatal clients.

*Effective 6/01/10

• Colorado Choice Health Plan starts as an HMO to provide service to CHP+ children in Alamosa, Bent, Chaffee, Conejos, Costilla , Crowley, Custer, Freemont, Huerfano, Las Animas, Mineral, Otero, Prowers, Rio Grande, Saguache, and Yuma counties.
  
• Colorado Access will be the only HMO to provide service to CHP+ children in Clear Creek, Elbert, Larimer, Lincoln, Morgan, Park, Pueblo, and Washington counties

*Effective 02/01/10

• Rocky Mountain Health Plan expands service to CHP+ children in Archuleta, Dolores, Eagle, Grand, Gunnison, Hinsdale, Jackson, Lake, Moffat, Ouray, Pitkin, Rio Blanco, Routt, San Juan, San Miguel, and Summit counties.

*Effective 3/1/2011

• Colorado Choice Health Plan expanded into five additional counties; Baca, Cheyenne and Kit Carson will become a Colorado Choice HMO only county. Also expansion into Kiowa and Washington counties which they will share with Colorado Access CHP HMO.

**Please note the CHP+ State Managed Care Network is no longer available as an HMO to children in these counties.

How can you determine which HMO a CHP+ member belongs to?

For those CHP+ members enrolled in a HMO other than the CHP+ Managed Care Network, CHP+ members will receive a temporary medical insurance card valid until a permanent card is received from the CHP+ member's HMO. Those CHP+ members enrolled in the CHP+ Managed Care Network will receive a medical insurance card and a CHP+ Benefits Booklet. CHP+ Customer Service is available to answer any questions regarding a CHP+ member's eligibility at 800.359.1991 between the hours of 8 am - 6 pm.

What are the requirements and responsibilities of CHP+ providers?

CHP+ providers are responsible and required to:

• Accept members, without regard to health status or health care needs
• Not differentiate or discriminate in the treatment of members or in the quantity or quality of services delivered to members on the basis of race, sex, age, religion, or source of payment
• Observe, protect and promote the rights of members as patients
• Abide by all applicable Federal and State of Colorado laws and regulations, in the performance of their work evidenced by current licenses to provide care to members
• Obtain and maintain such policies of general liability, professional liability and other insurance as necessary
• Maintain a current contract with CHP+
• Agree to provide all medically necessary covered services to members
• Make necessary and appropriate arrangements to ensure the availability of covered services to members 24 hours a day, seven days a week (applicable only to Primary Care Providers)