Kutulutsa Kopitirirabe Kumasuka
Background
Mu Januware 2020, US department of Health and Human Services (HHS) idayankha mliri wa COVID-19 polengeza za ngozi yapagulu (PHE). Congress inapereka malamulo kuti atsimikizire kuti aliyense amene adalembetsa ku Medicaid (Health First Colorado (pulogalamu ya Medicaid ya Colorado) ku Colorado), komanso ana ndi amayi apakati omwe adalembetsa nawo Pulogalamu ya Inshuwalansi ya Ana (Child Health Plan). Plus (CHP +) ku Colorado), adatsimikiziridwa kuti aziteteza thanzi lawo panthawi ya PHE. Izi ndi kufunikira kopitiliza kufalitsa. Congress idapereka chigamulo chomwe chinathetsa kufunikira kopitiliza kufalitsa kumapeto kwa 2023.
Kukonzekera Kumapeto kwa Kufalitsa Kosalekeza
Kwa Mamembala
Mamembala a Health First Colorado ndi CHP + abwereranso kumayendedwe oyenereranso. Mamembala omwe akuyenera kuchitika mu May 2023 adadziwitsidwa mu March 2023. Dipatimenti ya Colorado ya Health Care Policy & Financing (HCPF) idzatenga miyezi ya 14, kuphatikizapo kuzindikira, kudutsa ndikumaliza kukonzanso kwa aliyense wa anthu pafupifupi 1.7 miliyoni omwe analembetsa.
Kodi muyenera kudziwa chiyani za kukonzanso?
Kumvetsetsa ndondomeko yokonzanso kudzakuthandizani kuthandizira bwino odwala anu oyenerera a Health First Colorado kupyolera mu kusinthaku. Dinani Pano kuti aphunzire zambiri za zomwe akuyenera kuchita pakukonzanso kwawo, kuphatikiza kudziwa kuti ali oyenerera komanso momwe angalembetsenso.
Kodi tikuchita chiyani kuti tithandizire othandizira athu?
- Tikudziwitsa mamembala athu za kutha kwa kufalitsa kosalekeza. Gulu lathu loyang'anira chisamaliro likulumikizana nawo m'malo mwa opereka chithandizo chamankhwala choyambirira (PCMPs), ndipo akuyika patsogolo mamembala omwe ali pachiwopsezo chachikulu.
- Tidapanga kwaulere zowulutsira zambiri, timabuku ndi zinthu zina kuti mupatse odwala anu. Mutha kupempha izi kwaulere zida kuperekedwa ku ofesi yanu kudzera yathu yatsopano online kuyitanitsa dongosolo. Panopa zipangizo zilipo mu English ndi Chisipanishi.
- Tapanga mavidiyo ophunzitsa kuti mugawane ndi ogwira nawo ntchito komanso mamembala anu. Izi zikupezeka mu Chingerezi ndi Chisipanishi.
- Tidawonjezanso madeti a membala ku lipoti la mwezi uliwonse la attribution (PEPR) kuti mutha kusefa lipoti lanu la omwe ali pachibwenzi komanso omwe sali pachibwenzi, omwe ali pachiwopsezo chachikulu, ndi mamembala omwe ali ndi masiku omwe akubwera. Funsani mphunzitsi wanu kuti akupatseni malangizo.
- Tinapanga malangizo atsatanetsatane amomwe mungayang'anire kuyenerera kwa membala pa State Web Portal.
- Ngati muli ndi mafunso okhudza kuyenerera, chonde funsani woyang'anira netiweki kuti akuthandizeni.
- Kuti mudziwe yemwe akuwongolera netiweki yanu chonde imelo providernetworkservices@coaccess.com
- Tinapanga FAQ kuti muwerengenso mafunso omwe abwera kuchokera kwa anzanu. Chonde pitani pansi pa tsamba ili kuti muwone FAQ.
Chizindikiro
- Amawopseza mamembala ndi ofunsira kuti ataya chithandizo chaumoyo
- Amafuna ndalama
- Amafunsa kuti awafotokozere zachinsinsi chawo ndipo mwina angawpsyeze kuti achitepo kanthu
HCPF simafunsa mamembala kapena ofunsira ndalama kapena zidziwitso zaumwini monga manambala athunthu achitetezo pafoni kapena pameseji; HCPF sikuwopseza milandu pafoni kapena pameseji.
HCPF ndi madipatimenti am'maboma azantchito za anthu amatha kulumikizana ndi mamembala pafoni kuti afunse zambiri zolumikizana nazo kuphatikiza nambala yafoni, imelo adilesi, ndi adilesi yamakalata. Mutha kusintha izi mu PEAK nthawi iliyonse.
Mamembala, ofunsira ntchito ndi ogwira nawo ntchito akuyenera kupita ku webusayiti ya Boma kuti adziwe zambiri ndikufotokozera mauthenga achinyengo omwe angachitike ku Attorney General Consumer Protection Unit.
Kodi opereka chithandizo angathandize bwanji?
- Mutha kutithandiza kuchenjeza mamembala omwe angakhale azachinyengo pogawana nawo mauthenga (mawu, ochezera, nkhani) zopezeka patsamba la HCPF: hcpf.colorado.gov/alert
- Mutha kunena zachinyengo ndikuphunzira zambiri pa hfcgo.com/alert
Kodi mungatani?
- Onetsetsani kuti antchito anu akudziwa bwino za kuyenerera kwa Health First Colorado ndi njira zolemberanso kuti athe kuyankha mafunso aliwonse omwe odwala anu angakhale nawo.
- Kuti muwonetsetse kuti mukubwezeredwa bwino, muyenera kuyang'ana kuyenerera kwa Health First Colorado kwa aliyense wa odwala anu:
- Pa nthawi yomwe kusankhidwa kwawo kumakonzedwa
- Wodwala akafika pa nthawi yoti akambirane
- Funsani mphunzitsi wanu mafunso aliwonse omwe mungakhale nawo.
- Onani mindandanda yathu ya pamwezi. Mindandanda iyi ikuthandizani kuti mumvetsetse odwala omwe akuyenera kukonzedwanso komanso liti. Mindandanda iyi iwonetsa:
- Madeti okonzanso odwala anu
- Odwala anu omwe ali pachibwenzi komanso osakwatiwa
- Aliyense mwa odwala anu omwe ali oyenerera kukhala pachiwopsezo chachikulu
- Enhanced Clinic Partners (ECPs) ndi mamembala omwe ali pachibwenzi.
Kodi mungathandize bwanji odwala anu oyenerera a Health First Colorado?
- Mutha kuthandiza kudziwitsa mamembala za kukonzanso kwa Medicaid pogawana mauthenga mu zida za HCPF ndi kuyika timapepala ndi timabuku m’malo opezeka anthu ambiri komanso pa desiki lolandirira alendo.
- Uzani odwala anu kuti achitepo kanthu kuti asunge chitetezo chawo, ndi momwe angachitire. HCPF yapanga zida zothandizirana kuti zithandizire kubwereranso kumayendedwe okhazikika. Sinthani Adilesi Yanu ndi Chitanipo kanthu pa Kukonzanso Kwanu Zida zonse zili ndi zinthu zothandizira mamembala kuchitapo kanthu kuti asunge nkhani zawo. Zolembazi zikuwonetsa zofunikira zomwe mamembala angachite kuphatikiza; kukonzanso mauthenga awo okhudzana nawo, kuchitapo kanthu pamene kukonzanso kuli koyenera, ndi kufunafuna chithandizo ndi kukonzanso zinthu zamtundu kapena zachigawo pamene akuzifuna.
- Dziphunzitseni nokha ndi antchito anu pa kukonzanso ndondomeko kotero mutha kuthandiza odwala anu moyenera. Onani zotsatira za HCPF Kukonzanso Maphunziro a zida. Mafunso Ofunsidwa Kawirikawiri (FAQs) za mapeto a mosalekeza Kuphunzira chofunika ndi kubwerera wokhazikika njira kukonzanso zilipo mu PHE Planning Resource Center.
- Tumizani mamembala omwe ali ndi mafunso okhudza kukonzanso patsamba la Health First Colorado lomwe likupezeka English ndi Spanish.
- Londolerani odwala anu aliwonse omwe sakuyenereranso ku Health First Colorado ndalama zogulira chithandizo chamankhwala.
Timayamikira mgwirizano wanu ndipo tikukulimbikitsani kuti mugawane nafe ndemanga pazantchito zabwino, zida zatsopano, ndi ma metric opindulitsa practice_support@coaccess.com.
Pitirizani Kuphimbidwa ndi Colorado
HCPF ikuyerekeza kuti oposa 325,000 omwe alipo tsopano sadzakhalanso oyenerera ku Health First Colorado pambuyo pa kuwunika kwawo kwapachaka. Ndemanga izi zidzachitika m'mwezi wokumbukira pomwe membala adalembetsa, kutanthauza kuti ngati membala adalembetsa mu Julayi 2022, kuwunika kwawo kudzachitika mu Julayi 2023.
Ngati zochitika za membala wamakono zasintha kuyambira pomwe adalembetsa ku Health First Colorado, monga kuyamba ntchito yatsopano yomwe ingawaike pamalipiro, ayenera kupeza njira zina zothandizira inshuwalansi ya umoyo kuti apewe zotsatira zowononga zomwe zingakhale zopanda inshuwalansi.
Pofika Epulo 2023, malire oyenerera kulandira ndalama adakwera kuti awerengere kukwera kwa inflation. Ngakhale kuti banja likhoza kupitirira malire a ndalama za Health First Colorado, ndizotheka kuti ana a m'banjamo akhoza kulandira CHP+. CHP+ imakhudzanso anthu oyembekezera kudzera m'mimba ndi pobereka, komanso kwa miyezi 12 pambuyo pobereka. Dinani Pano kuti muwone malire oyenerera omwe akusinthidwa.
Lumikizanani ndi Health Colorado
Iwo omwe salinso oyenera kulandira chithandizo cha Health First Colorado atha kupeza njira zina zothandizira zaumoyo Lumikizanani ndi Health Colorado, msika wa inshuwaransi yazaumoyo ku Colorado.
Kodi Ndidzadziwa Bwanji Pamene Kukonzanso Kwanga Kukutha?
Spring 2023
Kodi Ndimalizitsa Bwanji Ntchito Yokonzanso?
Spring 2023
Malangizo Ofulumira Pomaliza Kukonzanso Kwanu
Spring 2023
Kodi Ndingapeze Thandizo Lotani pakukonzanso Kwanga?
Spring 2023
Mafunso Ofunsidwa Kawirikawiri
Kodi chidzachitika ndi chiyani pakufalitsa kwa telehealth?
- Maulendo amafoni ndi makanema adzapitilirabe kuperekedwa kwa mamembala onse a Health First Colorado ndi CHP +. Izi zikupatula kuyendera ana kwabwino.
- Telemedicine idzakhalabe phindu, tikuchotsa zizindikiro za Well Child Check kuchokera ku telemedicine yomwe ikugwira ntchito pa May 12, 2023. Zizindikiro za ndondomeko zomwe zakhudzidwa zikuphatikizapo 99382, 99383, 99384, 99392, 99393 ndi 99394. Dziwani zambiri Pano. Ngati muli ndi mafunso, chonde tumizani imelo kwa Morgan Anderson morgan.anderson@state.co.us ndi Naomi Mendoza naomi.mendoza@state.co.us.
- Mamembala a Health First Colorado ndi CHP + angagwiritse ntchito maulendo a foni ndi mavidiyo pa chithandizo chamankhwala, chithandizo ndi maulendo ena. Si onse omwe amapereka chithandizo cha telehealth, kotero mamembala ayenera kuyang'ana ngati wowapereka amapereka telehealth. Uku kunali kusintha kwa mfundo zomwe zidapangidwa poyankha COVID-19 zomwe Health First Colorado yazipanga kukhala zamuyaya.
Kodi chingachitike ndi chiyani ndi othandizira omwe atseka zitseko zawo ndipo akugwira ntchito mokwanira pa telehealth?
Othandizira amatha kugwirabe ntchito ndikulipira chimodzimodzi pambuyo pa PHE. Katswiri wothandizira, e-health entity, kwa zipatala ndi magulu omwe si adokotala omwe amapereka chithandizo kokha ndi telemedicine adzapezeka posachedwa. Zikapezeka, opereka awa amasinthira kulembetsa kwawo komweko kuti awonetse kuti akupereka chithandizo ndi telemedicine.
Kodi padzakhala kusintha kwamitengo yaumoyo wamakhalidwe?
Pa maulendo a telemedicine omwe amalipidwa ndi ntchito, palibe kusintha kwachiyembekezo chifukwa cha PHE. Malipiro apakati pakati pa anthu ndi telemedicine maulendo akadalipo. Sipadzakhala kusintha momwe ma RAE amalipira phindu la telemedicine yamakhalidwe.
Kodi opereka chithandizo azitha kuwona masiku oti awonjezedwenso patsamba la Provider?
Khomo la opereka silipereka masiku oyenerera oti ayambitsenso. Tsambali likuwonetsa masiku oyambira ndi omaliza. Timalimbikitsa mamembala kuti alowe muakaunti yawo ya PEAK kuti awone masiku awo oti awonjezerenso.
Kodi pali gawo linalake la data lomwe likuwonetsa momwe kukonzanso?
Mafayilo a data a mlungu ndi mlungu ochokera ku HCPF alibe gawo linalake lowonetsa momwe membalayo asinthira. Sizingatheke kudziwa ngati kukonzanso kwaperekedwa ndi membala kapena kuli mkati mowunikiridwa ndi wogwira ntchito oyenerera. Komabe, kugwiritsa ntchito tsiku lokonzanso ogwiritsa ntchito amatha kudziwa ngati kukonzanso sikunavomerezedwe.
Kodi pali gawo la data lomwe likuwonetsa mamembala omwe azisinthidwa okha?
Pakadali pano, mafayilo a HCPF samaphatikiza gawo lomwe likuwonetsa kukonzanso kwamagalimoto. Komabe, machitidwe omwe anali m'magulu akale achitika mwezi uliwonse, masiku okonzanso a membala adzasinthidwa mpaka chaka chamawa.
Mafunso Ofunsidwa Kawirikawiri
Chifukwa chiyani tikuwona masiku otsimikizanso ngati 2018, 2011 kwa mamembala ena?
Sitinathe kumvetsetsa kuchokera ku HCPF chifukwa chake tikuwona masiku awa. Komabe, tsiku lililonse lokonzanso kuyambira zaka zitatu zomaliza za PHE zomwe zili patsogolo pa 5/31/23 zitha kugwa mosalekeza. Mamembala omwe alandila paketi yokonzanso yokhala ndi tsiku lokonzanso Meyi 2023 kapena pambuyo pake ayenera kumaliza paketiyo kuti asunge zopindula.
Ngati membala alibe adilesi ya imelo kapena nambala yafoni, angapange bwanji akaunti patsamba la PEAK?
Kukhazikitsidwa kwa akaunti ya PEAK sikupereka njira ina kupatula nambala yafoni kapena imelo. Njira yokhayo yochitira izi ndikuthandizira membalayo kukhazikitsa adilesi ya imelo kuti apange akaunti.
Kodi ana amene akusalidwa kapena amene poyamba anali m’gulu la ana oleredwa ndi makolo osakhala anawo angobadwanso mwatsopano?
Ana omwe ali m'gulu la olera adzalandira paketi yokonzanso kuti asinthe zambiri za chiwerengero cha anthu. Komabe, ngati membalayo sachitapo kanthu ndiye kuti adzakonzedwanso okha. Ana omwe pakali pano ali m'manja mwa olera komanso osakwanitsa zaka 18 adzasinthidwa okha ndipo sadzalandira paketi. Omwe anali m'gulu la ana oleredwa apitiliza kusinthidwa mpaka atakwanitsa zaka 26.
Kodi maboma adzakhala ndi thandizo lokwanira la ogwira ntchito kuti akwaniritse kuchuluka kwa mamembala a Medicaid?
HCPF pakadali pano ikufufuza momwe angathandizire ogwira ntchito oyenerera kuthana ndi mavuto obwera chifukwa cha ntchito. HCPF idzagulitsanso $ 15 miliyoni pazowonjezera zopempha.
Kodi ndondomeko idzakhala yotani ngati kukonzanso kwaperekedwa mkati mwa nthawi yoyenera, koma boma silikukonza tsiku lolembetsa membala lisanathe?
Pamene kukonzanso kwa membala kutumizidwa kudzera ku PEAK, kukonzanso kumaganiziridwa kuti kunaperekedwa pa tsikulo. Padzakhala nthawi yachisomo pakati pa 5 ndi 15 mwezi uliwonse pakuwonjeza mamembala a mweziwo. Malingana ngati PEAK "ivomereza" kukonzanso kwa membala pofika pa 15 mwezi womwe ukufunsidwa, idzaganiziridwa kuti ndi yokwanira kuti akonzenso.
Kodi opereka chithandizo angathandize bwanji pakukonzanso?
Othandizira atha kudziwitsa anthu za njira yokonzanso potumiza timapepala athu m'malo omwe ali ndi anthu ambiri. Zowulutsira, zoulutsira mawu, zomwe zili patsamba, ndi zida zina zofikira anthu zitha kupezeka patsamba lathu Tsamba lawebusayiti la PHE. Zomwe zili m'bukuli zimalimbikitsa anthu kudziwa zoyenera kuchita: kukonzanso mauthenga, kuchitapo kanthu nthawi yokonzanso, ndikupempha thandizo lachitukuko m'madera kapena m'madera pamene akuzifuna.
Othandizira angathenso kudziphunzitsa okha ndi antchito awo pazofunikira za ndondomeko yokonzanso kuti athandize odwala omwe angakhale ndi mafunso. Onani wathu Kukonzanso Maphunziro a zida.
Mafunso owonjezera omwe amafunsidwa pafupipafupi okhudza kutha kwa zomwe zimafunikira kufalitsa atha kupezeka Pano.