I-Coverage Coverage Unwind
imvelaphi
NgoJanuwari ka-2020, iSebe lezeMpilo laseMelika kunye neeNkonzo zoLuntu (HHS) liphendule kubhubhani we-COVID-19 ngokubhengeza imeko kaxakeka yezempilo yoluntu (PHE). ICongress yadlulisela umthetho wokuqinisekisa ukuba nabani na obhalise kwi-Medicaid (i-Health First Colorado (iprogram ye-Colorado Medicaid) e-Colorado), kunye nabantwana kunye nabantu abakhulelweyo ababhalise kwiNkqubo ye-Inshurensi yezeMpilo yaBantwana (iSicwangciso seMpilo yaBantwana kunye (CHP +) eColorado), yaqinisekiswa ukuba igcina impilo yabo ngexesha lePHE. Le yile imfuneko yokhuseleko eqhubekayo. ICongress yapasisa umthetho oyilwayo ophelise imfuneko eqhubekayo yokugubungela ngentwasahlobo ka-2023.
UCwangciso lokuphela koFundo oluqhubekayo
AmaLungu
I-Health First Colorado kunye namalungu e-CHP + abuyele kwiinkqubo eziqhelekileyo zokuvuselela ukufaneleka. Amalungu afunekayo ngoMeyi 2023 aye aziswa ngo-Matshi 2023. I-Colorado Department of Health Care Policy & Financing (HCPF) iya kuthatha iinyanga ze-14, kubandakanywa nokuqaphela, ukuqhubela phambili kunye nokuhlaziywa kokuhlaziywa komntu ngamnye malunga ne-1.7 yezigidi zabantu ababhalisiweyo.
Yintoni ekufuneka uyazi malunga nenkqubo yokuhlaziya?
Ukuqonda inkqubo yohlaziyo kuya kukunceda ukuba uxhase kakhulu i-Health First Colorado abaguli abafanelekileyo ngolu tshintsho. Cofa Apha ukufunda ngakumbi malunga nento ekufuneka beyenzele ukuhlaziywa kwabo, kubandakanywa ukumisela ukufaneleka kunye nendlela yokubhalisa kwakhona.
Senza ntoni ukuxhasa ababoneleli bethu?
- Sazisa amalungu ethu malunga nokuphela koshicilelo oluqhubekayo. Iqela lethu lolawulo lokhathalelo linxibelelana nabo egameni lababoneleli bezonyango ezisisiseko (PCMPs), kwaye babeka phambili amalungu asemngciphekweni omkhulu.
- Sidale khulula iiflaya zolwazi, iincwadana kunye nezinye izinto onokuthi uzinike izigulane zakho. Ungazicela ezi khulula imathiriyeli isiwe kwiofisi yakho ngeyethu entsha inkqubo yokuodola kwi-intanethi. Okwangoku izixhobo ziyafumaneka kwi IsiNgesi kwaye Spanish.
- Senze iividiyo ezifundisayo ukuze wabelane nabasebenzi bakho kunye namalungu. Ezi zifumaneka ngesiNgesi nangeSpanish.
- Songeze imihla yohlaziyo lwamalungu kwingxelo yenyanga ye-attribution (PEPR) ukuze ukwazi ukuhluza ingxelo yakho kumalungu abandakanyekayo kunye nalawo angabandakanyekanga, amalungu asemngciphekweni omkhulu, kunye namalungu anemihla ezayo yokuhlaziya. Cela imiyalelo kumququzeleli wakho wokuziqhelanisa.
- Senze imiyalelo yesinyathelo-nge-nyathelo malunga nendlela onokujonga ngayo ukufaneleka kwelungu kwi State Web Portal.
- Ukuba unemibuzo malunga nokujonga ukufaneleka nceda uqhagamshelane nomphathi wenethiwekhi yomnikezeli wakho ngenkxaso eyongezelelweyo.
- Ukufumanisa ukuba ngubani umphathi wenethiwekhi yomnikezeli wakho nceda u-imeyilele providernetworkservices@coaccess.com
- Senze i-FAQ ukuze uhlolisise imibuzo ephakanyiswe ngoontanga bakho. Nceda uskrolele ezantsi kweli phepha ukujonga i-FAQ.
Isilumkiso kwi-Scam
- Bagrogrisa amalungu kunye nabafaki-zicelo ngokuphulukana nokhuseleko lwezempilo
- Bafuna imali
- Bacela inkcazelo yobuqu entununtunu yaye banokude bamgrogrise ngokuthatha amanyathelo asemthethweni
I-HCPF ayiceli amalungu okanye abafaki zicelo ngemali okanye ulwazi lomntu olunovakalelo olufana neenombolo ezipheleleyo zokhuseleko loluntu ngefowuni okanye umbhalo; I-HCPF ayisongeli isenzo somthetho ngefowuni okanye isicatshulwa.
I-HCPF kunye namasebe eengingqi zeenkonzo zoluntu zinokuqhagamshelana namalungu ngefowuni ukucela ulwazi loqhagamshelwano lwangoku kuquka inombolo yefowuni, idilesi ye-imeyile, kunye nedilesi yeposi. Ungaluhlaziya olu lwazi kwi-PEAK nangaliphi na ixesha.
Amalungu, abafaki-zicelo kunye namahlakani kufuneka bandwendwele iwebhusayithi kaRhulumente ukuze bafumane ulwazi oluthe kratya kwaye banike ingxelo ngemiyalezo yobuqhophololo enokubakho kwiGqwetha Jikelele loKhuseleko lwabaThengi.
Ababoneleli banokunceda njani?
- Ungasinceda ukuba silumkise amalungu anobuqhophololo ngokwabelana ngemiyalezo (umbhalo, intlalontle, incwadana yeendaba) efumaneka kwiwebhusayithi yeHCPF: hcpf.colorado.gov/alert
- Ungaxela ubuqhophololo kwaye ufunde ngakumbi hfcgo.com/alert
Unokulithabatha njani inyathelo?
- Qinisekisa ukuba abasebenzi bakho baqhelene ne-Health First Colorado ukufaneleka kunye neenkqubo zokubhalisa kwakhona ukuze bakwazi ukuphendula nayiphi na imibuzo enokuba nayo izigulane zakho.
- Ukuqinisekisa ukuba ubuyiselwe ngokufanelekileyo, kufuneka ujonge ukufaneleka kweMpilo yokuqala yeColorado kwisigulana sakho ngasinye:
- Ngexesha lokuqeshwa kwabo kucwangcisiwe
- Xa isigulane sifika kwidinga laso
- Buza umbhexeshi wakho wokuziqhelanisa nayo nayiphi na imibuzo onokuba nayo.
- Jonga uludwe lwethu lwenyanga lubalulwe. Olu luhlu luya kukunceda uqonde ukuba zeziphi izigulana ezimele zihlaziywe kwaye nini. Olu luhlu luya kubonisa:
- Imihla yohlaziyo yezigulane zakho
- Izigulana zakho ezizibandakanyayo nezingabandakanyekanga
- Naziphi na izigulana zakho ezifanelekile njengomngcipheko omkhulu
- Amaqabane onyango aphuculweyo (ECPs) ngamalungu abandakanyekayo.
Ungayinceda njani iMpilo yakho yokuqala yeColorado abaguli abafanelekileyo?
- Unganceda ukwazisa amalungu malunga nohlaziyo lwe-Medicaid ngokwabelana ngemiyalezo kwii-toolkits ze-HCPF kwaye ngo ukuthumela iflaya neencwadana kwiindawo zikawonke-wonke nakwiidesika zolwamkelo.
- Yazisa izigulane zakho kufuneka zithathe inyathelo lokugcina i-inshorensi yempilo yazo, kunye nendlela abanokukwenza ngayo oko. I-HCPF iye yaphuhlisa izixhobo zokusebenza zeqabane ukunceda ekubuyiseleni iinkqubo zokuhlaziya rhoqo. Hlaziya idilesi yakho kwaye Thatha inyathelo kuHlaziyo lwakho izixhobo zonke ziquka izixhobo zokunceda amalungu ukuba athathe amanyathelo ukugcina ukhuseleko lwabo. Ezi mathiriyeli zichonga amanyathelo angundoqo ukuze amalungu awathabathe kuquka; ukuhlaziya ulwazi lwabo loqhagamshelwano, ukuthatha inyathelo xa kufuneka uhlaziyo, kwaye bafune uncedo ngohlaziyo kwiindawo zoluntu okanye kwingingqi xa belufuna.
- Zifundise wena kunye nabasebenzi bakho kwi inkqubo yohlaziyo ngoko unokunceda ngokufanelekileyo izigulane zakho. Jonga iHCPF's Uhlaziyo lwezixhobo zeMfundo. Imibuzo ebuzwa rhoqo (FAQs) malunga nokuphela kwemfuno eqhubekayo yokugubungela kunye nokubuyela kwiinkqubo zokuhlaziya rhoqo ziyafumaneka kwi Iziko leZibonelelo zoCwangciso lwePHE.
- Thumela amalungu anemibuzo malunga nenkqubo yokuhlaziya iphepha lewebhu le-Health First Colorado elikhoyo IsiNgesi kwaye Spanish.
- Yalathisa nasiphi na isigulana sakho esingasafanelekiyo kwi-Health First Colorado ukuya izibonelelo zokhuselo lwezempilo ezifikelelekayo.
Siyixabisile intsebenziswano yakho kwaye siyakukhuthaza ukuba wabelane ngengxelo ngezona zenzo zilungileyo, izixhobo ezitsha, kunye neemetrics ezinentsingiselo nathi practice_support@coaccess.com.
Gcina i-Coloradans i-Inshurensi
I-HCPF iqikelela ukuba ngaphezu kwe-325,000 amalungu akhoyo ngoku akayi kuphinda afanelekele i-Health First Colorado emva kokuphononongwa kwabo ngonyaka. Olu hlaziyo luza kwenziwa kwinyanga yokukhumbula ilungu labhalisa, nto leyo ethetha ukuba ukuba ilungu libhalise ngoJulayi 2022, uphononongo lwabo lokufaneleka luya kwenziwa ngoJulayi ka-2023.
Ukuba iimeko zelungu langoku zitshintshile ukususela ekubeni babhalise kwi-Health First Colorado, njengokuqala umsebenzi omtsha onokuthi ubabeke ngaphezu komda wengeniso, kufuneka bafumane ezinye iindlela zokukhusela i-inshurensi yezempilo ukuze bagweme imiphumo enokuba yingozi yokungaxhaswanga.
Ukusukela ngo-Epreli ka-2023, imida yokufaneleka kwengeniso inyukile ukuze ichaze ukunyuka kwamaxabiso. Ngelixa ikhaya linokuba ngaphezulu komda womvuzo we-Health First Colorado, kunokwenzeka ukuba abantwana abakwelo khaya bafanelekele i-CHP+. I-CHP+ ikwabandakanya abantu abakhulelweyo ngokukhulelwa kwabo kunye nokubeleka, kunye neenyanga ezili-12 emva kokubeleka. Cofa Apha ukubona imida ehlaziyiweyo yokufaneleka.
Qhagamshela kwiMpilo yaseColorado
Abo bangasafanelekiyo kwi-Health First Colorado coverage banokufumana ezinye iindlela zokhuseleko lwezempilo Qhagamshela kwiMpilo yaseColorado, indawo yentengiso ye-inshurensi yezempilo esemthethweni yaseColorado.
Ndazi Njani Xa UHlaziyo Lwam Lufuneka?
Spring 2023
Ndiyigqibezela Njani iNkqubo yoHlaziyo?
Spring 2023
Iingcebiso eziKhawulezayo zokugqibezela uHlaziyo lwakho
Spring 2023
Ndingalufumana Njani Uncedo ngoHlaziyo lwam?
Spring 2023
Imibuzo ebuzwa qho
Kuza kwenzeka ntoni kukhuseleko lomnxeba?
- Ukutyelelwa kwefowuni kunye nevidiyo kuya kuqhubeka kugutyungelwa yonke i-Health First Colorado kunye namalungu e-CHP +. Oku akubandakanyi utyelelo lwabantwana.
- I-Telemedicine iya kuba yinzuzo, sisusa iikhowudi zokuHlola uMntwana kwi-telemedicine esebenzayo ngoMeyi 12, 2023. Iikhowudi zenkqubo ezichaphazelekayo ziquka i-99382, 99383, 99384, 99392, 99393 kunye ne-99394. Funda ngakumbi Apha. Ukuba unayo nayiphi na imibuzo, nceda uthumele i-imeyile kuMorgan Anderson morgan.anderson@state.co.us kunye noNaomi Mendoza ngo naomi.mendoza@state.co.us.
- I-Health First Colorado kunye namalungu e-CHP + angasebenzisa ukutyelelwa kwefowuni kunye nevidiyo kunyango lwesiqhelo, unyango kunye nolunye utyelelo. Ayingabo bonke ababoneleli ababonelela ngeenkonzo zomnxeba nangona kunjalo, amalungu kufuneka ajonge ukuba umboneleli wabo ubonelela nge-telehealth. Olu yayilutshintsho kumgaqo-nkqubo owenziwe ukuphendula kwi-COVID-19 ukuba i-Health First Colorado yenze isigxina.
Kuya kwenzeka ntoni ngababoneleli abavale iingcango zabo kwaye basebenza ngokupheleleyo ngokwenza i-telehealth?
Ababoneleli basenokuthi basebenze kwaye bahlawule ngendlela efanayo emva kwePHE. I-specialty provider, i-e-health entity, kwiiklinikhi kunye namaqela ababoneleli abangekho oogqirha abanikezela ngeenkonzo ngokukodwa nge-telemedicine iya kufumaneka kungekudala. Xa ifumaneka, aba baboneleli baya kuhlaziya ubhaliso lwabo lwangoku ukubonisa ukuba babonelela ngeenkonzo kuphela nge-telemedicine.
Ngaba kuya kubakho utshintsho kwizinga lokuziphatha kwi-telehealth yezempilo?
Ukutyelela i-telemedicine yezempilo ye-fee-for-service, akukho tshintsho lwezinga elilindelekileyo ngenxa ye-PHE. Ukulingana kwentlawulo phakathi komntu kunye notyelelo lwe-telemedicine kusekho. Akusayi kubakho tshintsho kwindlela ii-RAEs ezihlawula ngayo izibonelelo ze-telemedicine yezempilo yokuziphatha.
Ngaba ababoneleli baya kukwazi ukubona umhla omiselweyo wohlaziyo kwi-portal yoMboneleli?
Iphothali yomnikezeli ayiboneleli ngemihla yokuhlaziywa kokufaneleka. I-portal iya kubonisa i-coverage yokuqala nemihla yokuphela. Sikhuthaza amalungu ukuba angene kwii-akhawunti zawo ze-PEAK ukuze abone imihla yawo yokuhlaziya.
Ngaba kukho indawo ethile yedatha ebonisa ubume bohlaziyo?
Iifayile zedatha zeveki ezivela kwi-HCPF azinayo indawo ethile yokubonisa imeko yokuhlaziywa kwelungu. Akunakwenzeka ukugqiba ukuba ngaba uhlaziyo lufakwe lilungu okanye lukwinkqubo yokuhlaziywa ngumsebenzi ofanelekileyo. Nangona kunjalo, usebenzisa umhla wohlaziyo abasebenzisi bendawo banokumisela ukuba uhlaziyo alukavunywa.
Ngaba kukho indawo yedatha ebonisa amalungu aza kuhlaziywa ngokuzenzekela?
Okwangoku, iifayile ze-HCPF azibandakanyi indawo ebonisa ukuhlaziywa kwe-auto. Nangona kunjalo, nje ukuba iinkqubo ezazisakuba ngamaqela ziqhubeka qho ngenyanga, imihla yokuhlaziya amalungu iya kuhlaziywa ukuya kunyaka olandelayo.
Imibuzo ebuzwa qho
Kutheni sibona imihla yokumisela kwakhona njenge-2018, i-2011 kumalungu athile?
Asikwazanga ukufumana ingcaciso kwi-HCPF malunga nokuba kutheni sibona le mihla. Nangona kunjalo, nawuphi na umhla wohlaziyo ukusuka kwiminyaka emithathu yokugqibela ye-PHE ephambi kwe-5/31/23 iya kuba phantsi kokhuseleko oluqhubekayo. Amalungu afumana ipakethe yokuhlaziya enomhla wohlaziyo kaMeyi 2023 okanye kamva kufuneka agcwalise loo pakethi ukuze agcine izibonelelo.
Ukuba ilungu alinayo idilesi ye-imeyile okanye inombolo yefowuni, bangayenza njani i-akhawunti kwiwebhusayithi ye-PEAK?
I-akhawunti ye-PEAK emiselweyo ayinikezeli enye inketho ngaphandle kwenombolo yefowuni okanye idilesi ye-imeyile. Ekuphela kwendlela ejikeleze oku ngoku kukunceda ilungu ukuseka idilesi ye-imeyile ukuze wenze i-akhawunti.
Ngaba abantwana abakhuliswe ngabanye abazali okanye abo babekade bekhuliswa ngabanye abantu baza kuhlaziywa ngokuzenzekelayo?
Abantwana abakukhathalelo lomntwana ongengowakho baya kufumana ipakethe yohlaziyo yokuhlaziya ulwazi lwabemi. Nangona kunjalo, ukuba ilungu alithathi nyathelo ngoko ke liya kuhlaziywa ngokuzenzakalelayo. Abantwana abakulo ngoku nabangaphantsi kweminyaka eli-18 baya kuhlaziywa kwaye abayi kufumana ipakethe. Abo bebefudula bekwinkathalelo baya kuqhubeka behlaziywa ngokuzenzekelayo de babe neminyaka engama-26 ubudala.
Ngaba imimandla iya kuba nenkxaso eyaneleyo yabasebenzi ukugcina umthamo wokuhlaziywa kwamalungu eMedicaid?
I-HCPF kungoku nje iphanda ukuba ingabaxhasa njani na abasebenzi abaselungelweni lokujongana nokusilela emsebenzini. I-HCPF iya kutyala i-15 yezigidi zeedola kwizibonelelo ezongezelelweyo zezibheno.
Iya kuba yintoni inkqubo xa uhlaziyo lungeniswa ngexesha elifanelekileyo, kodwa i-county ayiyiqhubeki ngaphambi kokuphela komhla wokubhaliswa kwelungu?
Xa uhlaziyo lwelungu lungeniswa ngePEAK, uhlaziyo luyaqwalaselwa lungeniswe ngaloo mhla. Kuya kubakho ixesha loxolelo phakathi komhla wesi-5 kunye nowe-15 kwinyanga nganye ukuze kuhlaziywe amalungu kuloo nyanga. Logama nje i-PEAK “ivuma” uhlaziyo lwelungu ngomhla we-15 kwinyanga ekuthethwa ngayo, iya kuthathwa njengepheleleyo ngeenjongo zohlaziyo.
Ababoneleli banokunceda njani kwinkqubo yohlaziyo?
Ababoneleli banokuzisa ulwazi malunga nenkqubo yohlaziyo ngokuthumela iiflaya zethu kwiindawo zabo zoluntu. Iiflaya, amajelo eendaba ezentlalo, umxholo wewebhusayithi, kunye nezinye izixhobo zokufikelela ebantwini zinokufumaneka kweyethu Iphepha lewebhu le-PHE lokucwangcisa. Izixhobo ezikwii-toolkits ziphakamisa ulwazi malunga namanyathelo aphambili ekufuneka amalungu awathathe: ukuhlaziya ulwazi loqhagamshelwano, ukuthatha inyathelo xa kufuneka uhlaziyo, kunye nokufuna uncedo ngohlaziyo kwiindawo zoluntu okanye zengingqi xa bezifuna.
Ababoneleli banokuzifundisa bona kunye nabasebenzi babo kwiziseko zenkqubo yokuhlaziya ukuncedisa izigulane ezinokuba nemibuzo. Bona wethu Uhlaziyo lwezixhobo zeMfundo.
Imibuzo eyongezelelweyo ebuzwa rhoqo malunga nokuphela kwemfuno eqhubekayo yokugubungela inokufumaneka Apha.