Colorado Medicaid Puts Hold on PARs March 2024
UPDATE 3/3/2022 – Effective Feb. 28, 2022, the pause on the PAR process will extend through March 2024.
HCPF (Colorado Department of Health Care Policy & Financing) states that these changes “allow the Department time to engage with stakeholders, train providers on operational changes, evaluate benefit policy, and notify Health First Colorado (Colorado’s Medicaid program) members before the pause is lifted”.
We recently reached out to families regarding recent changes in Colorado Medicaid’s PAR process that were resulting in an uptick in denials when cases were up for review by Kepro. We greatly appreciate the questions, support, and proactive approaches enacted by our caregivers in response.
We are thrilled to inform you that there has been a moratorium placed on PAR reviews until this process can be better implemented. This update is a result of tireless efforts from PASCO’s advocacy team. Our team worked with local policymakers and legal teams to help bring this burdensome process to light and increase awareness of how much these denials can inhibit individuals from receiving the care they deserve. After many calls, meetings, and petitions from our advocacy team and other local community partners, Colorado Medicaid decided to put a pause on the PAR process. They will use this time to work with families, home health agencies, and other stakeholders to identify individual and family needs, key issues, and opportunities to improve the PAR process.
This moratorium will put the entirety of the PAR process on hold for Pediatric long-term home health CNA services until June 1st, 2022. No reviews, approvals, or denials will take place during this time. For individuals whose PARs were denied during this time, their benefits will be reinstated back to November 1, 2021, so that there is no gap in services or payment for services.
PASCO plans on contacting families approximately two months before their PAR review dates once the process resumes, ensuring that each individual is prepared for whatever the new process may look like.
Currently, no direct action is required for families who have been affected. We do suggest that caregivers continue to obtain all necessary medical documentation and keep them in a safe place so they are prepared when PAR reviews resume. If you have any questions, please reach out to our support team at firstname.lastname@example.org.
Below is a reminder of some useful documents that you may need to gather for your PAR date:
- To support seizure precautions: any seizure logs, a Seizure Action Plan (from your Neurologist), or a Neurology report
- To support fall precautions: any documented ER visits or MD appointments that resulted from a fall, any therapy notes from PT or OT that mention unsteady gait or risk of falling.
- To support choking precautions: provide a copy of the most recent swallow study (if your child has had one), as well as ST or OT therapy notes that address impaired swallowing. Please mention any coughing during feeding, choking episodes, and any interventions required with medical specialists.
- To support the prevention of skin breakdown: provide any MD visit notes that address skin breakdown.
- If you have a Home Exercise Program/s that you follow: please request an updated plan (required to be updated every 12 months). Have it dated, your child’s name, detailed explanation of exercises, signed by the therapist, and on letterhead of the company they work for. Also, have the therapist add the statement “CNA has been shown the exercises and is competent to perform them”.
- Any additional tests, doctor’s statements, or notes from specialty clinics or physicians
Thank you to our amazing caregivers and families for their patience throughout this process. We are grateful for the support we have received on behalf of our advocacy team and look forward to seeing positive changes in the PAR process as a result. We could not have done it without you!
Thank you for this important information. I had no idea we needed this specific documentation and this allows us time to obtain it before we receive notice of cancellation of benefits. This is an important reminder of the documentation that is needed for what we just consider routine daily care needs.