Are you....

• An independent provider contracted with a RAE and feel frustrated and alone working within Colorado's Medicaid system? 

• Interested in becoming part of the independent provider network (IPN), but feel overwhelmed by the process and the challenges your IPN colleagues face in working with Medicaid?
• A Medicaid member frustrated by the system? 

If so, you're in the right place. You are not alone.

Welcome to COMBINE

COMBINE brings together Coloradans concerned about the delivery of behavioral healthcare for the Medicaid population. COMBINE is a 501c4 trade association and a member driven nonpartisan registered Small Donor Political Committee advocating for a diverse, competent, and sustainable Medicaid behavioral healthcare workforce in Colorado.  

Members are both professionals that provide Medicaid behavioral healthcare and the public. COMBINE offers mutual aid to members of the IPN and empowers members to advocate for a behavioral healthcare system that includes the IPN. Join us!

What We're Doing

MHPAEA PARITY

The Division of Insurance regulates commercial payers.  Read their policy letter regarding Parity here.

Is Colorado Medicaid subject to federal and state Parity laws?

Yes, Medicaid in Colorado is subject to federal and state Parity laws (MPHAEA) 

See the Executive Summary here from CMS 2017. And see Colorado's state law HB19-1269. 

So Medicaid members are not protected from MHPAEA Parity violations but members of commercial insurance are... ???

Outpatient clinics are a part of the essential safety net. 

Attend online BHA workshops (10 AM, once a month)
to learn safety net standards.

Jan 26, 2024, Feb 23, March 29, April 26, May 31, and Jun 28

Click here to register for HCPF Safety Net Provider Forum

What are the Mental Health "Parity" laws all about?

"MHPAEA prohibits covered plans from imposing financial requirements and treatment limitations that are more restrictive for MH/SUD services when compared to medical/surgical." 

Colorado Department of Insurance booklet. Know your rights!

Commissions: Medical (HCPF), Health (DHE), DOI bulletin drafts

DOI Bulletin Drafts for public comment

DOI Notice of Rulemaking Hearings

DOI Page for Providers with Commercial Contracts
(with directions for filing a complaint)

The (new Nov 2023) provider complaint form for COMMERCIAL plans

Click for HCPF Complaint form for COUNTY LEVEL complaints (enrollment, etc)

Do you have a complaint for HCPF (Medicaid) about RAEs?

If so, you can submit your complaint via the 
Health First Colorado Managed Care Provider Complaint Form.

Do you have a complaint for Colorado Division of Insurance (commercial payers)?

Here is the Complaint Form for Providers

(https://docs.google.com/forms/d/e/1FAIpQLScIfaitNLAw3fQSH9E9MzcHtqCGWV-5tatp5az8So4trz8w8g/viewform)

September 2023 DOI advisory: 

"The Division of Insurance strongly encourages providers to respond to its most recent bulletin and the associated website for Behavioral Health Providers. They need your complaint data. Pay close attention to the following directions to make your response as efficient and productive as possible.

1. All responses/complaints must be organized and individualized by insurance company, not issue. This helps DOI best process these as they process directly with each company, instead of having to cull through issue-focused emails to identify which payer is in violation on which issue(s).

Do not send a complaint about "supervisory billing" or "rates" or "credentialing" or "denied claims." Instead, organize your issues by insurance company and send an individual response or complaint for each insurance company. For example, you would have one complaint containing all of your Anthem issues, another one containing all of your United issues, etc.

2. All issues MUST be addressed in one of the following two contexts:

• Evidence of a parity violation between behavioral health and physical health OR
• Evidence of a contradiction between what an insurance company self-attested to the DOI and what a provider or member actually experienced. This second reason is why the DOI made the self-attestations public, so that providers and members can report things that directly violate that which the insurance companies self-attested.

Note: The Division of Insurance does not have the authority to interfere with carrier-provider disputes. It would take a legislative directive to make changes to the DOI's authority. At this time, the DOI's authority exists in two places: (1) Enforcing parity between behavioral health and physical health policies and procedures, and (2) Protecting consumers by pursuing resolutions to complaints made that validate an insurance company is committing a parity or self-attestation violation. This means that they cannot directly address rates, credentialing, auditing, contracting, claims issues, or any other single issue or topic with an insurance company unless it relates to a parity violation or self-attestation violation.

If so, you can submit your complaint via  https://doi.colorado.gov/for-consumers/file-a-complaint

Oct 4, 2022:  HCPF promotes free education for health services workers.  CLICK HERE.

Revitalizing Colorado’s healthcare workforce with zero-cost, short-term training programs at community and technical colleges.

Care Forward Colorado is revitalizing Colorado’s healthcare workforce through zero-cost, short-term training programs at community and technical colleges. In a year or less, trainees can learn skills to become a certified nursing assistant, emergency services professional, and many more professions that are desperately needed in Colorado’s healthcare facilities.

Have you seen HCPF's Independent Provider Network Forum webpage yet? 

September 30, 2022: UPDATE: For non-BHE Medicaid clinics training university interns and pre-licensure externs, HCPF/RAEs have agreed to use DORA's standard for supervision (3 years post-graduation experience plus supervision classes) and also will review providers with DORA stipulations "case by case".  This is a win for COMBINE's advocacy. 

August 19, 2022   HCPF released their narrative regarding huge disparity in rates received by the independent provider network compared to CMHC rates. The report is neither "independent" as required by law, nor complete.   Read their report.  Read COMBINE's response.