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!
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.
The State of Colorado, Department of Health Care Policy and Financing (HCPF) administers the
CHP+ program. Health Maintenance Organizations (HMOs) contract with HCPF 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 HCPF.
Colorado Access performs the contract administration duties with providers on behalf of HCPF.
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 HCPF.
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 HCPF, the HMO, or both. However, for continuity of care issues,
providers are strongly recommended to enter into a contract with HCPF 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 HCPF 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 HCPF 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.
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