Health Care Policy and Finance (HCPF) is the state department responsible for receiving and managing federal Medicaid funds.
Currently (October 2023) HCPF contracts with RAEs (Regional Accountability Entities) that are "managed care entities."
These RAEs are numbered 1 through 7, for different regions of Colorado, however there are not 7 entities.
Region 1 (Ft Collins and western counties) is managed by United Healthcare, which purchased the previously non-profit "Rocky Mountain Health Plans" in 2017 for $36 million.
Region 2 (Northeast Health Partners) is owned by a group of service providers who operate in the northeast counties of Colorado. The RAE contracts with these service providers, creating the appearance of self-dealing. Northeast Health Partners contracts with Beacon (now Carelon after acquisition by Anthem) for credentialing, utliization management and claims process.
Region 3 and Region 5 are managed by Colorado Access (which is a non-profit that contracts with for-profit Access Management). These regions cover Aurora and Denver.
Region 4, like Region 2, is owned by providers, who are paid by the RAE, who own the RAE, creating the appearance of self-dealing. Beacon/Carelon is actually a part owner of the RAE, with a 19% stake.
Regions 6 and 7 are managed by "CCHA", and the mental health care services are provided by contractors who contract with Anthem, now Carelon after the 2020 merger with Beacon (also now Carelon).
Arrow Performance Group project: In 2022 and 2023 HCPF contracted with Arrow Performance Group for more than $400,000 to interview several groups involved in the management and delivery of mental health care Medicaid services. Months of stakeholder meetings yielded these two reports and a quarterly meeting between HCPF and independent providers.
These meetings are scheduled for the second Friday of each month.
Currently (October 2023) there are no providers represented on the Coding Committee. COMBINE has advocated for inclusion.
"HCPF facilitates a quarterly Coding Committee meeting to discuss coding questions, policy considerations, and requested edits to the billing manual with sister agencies (BHA, CDHS, etc.), Managed Care Entities (MCEs), and providers. This meeting serves as an advisory opportunity for HCPF to engage state policy subject matter experts, MCE representatives, expert behavioral health coders, and providers to review and discuss issues that impact content in the billing manual. HCPF relies on this consultation to ensure proper billing codes and methodologies are reflected in the billing manual, as well as ensuring alignment with billing guidance, the State Plan, and federal and state changes to rule or statute. In addition to State staff, the only required attendees are representatives from the MCEs which are responsible for managing the Capitated Behavioral Health Benefit.
This meeting is not intended for general billing questions from providers. Providers are encouraged to reach out to their MCE or BHA program staff for specific billing questions. For any suggestions to add, delete or change coding guidance in this manual please send these to your MCE(s) or BHA program staff.
This meeting will occur quarterly, on the second Thursday of the month from 12:00 pm – 2:00 pm. I Meeting Link
Reasonable accommodations will be provided upon request for persons with disabilities. Please notify the 504/ADA Coordinator firstname.lastname@example.org at least one week prior to the meeting to make arrangements.
The Provider and Community Experience (PCE) subcommittee provides a forum for health care providers, community partners, and members to assess their experience and to make recommendations for subsequent improvements within the ACC. This subcommittee may consider and address issues relevant to:
2nd Thursday of every month 8:00 - 9:30 a.m.
"The Accountable Care Collaborative Program Improvement Advisory Committee (PIAC) is made up of stakeholders who provide guidance and make recommendations to help improve health, access, cost and satisfaction of members and providers in the Accountable Care Collaborative (ACC). PIAC meetings are held on the third Wednesday of each month and are open to the public. The Department provides call-in and webinar options because at this time no in-person meetings are being held."
Third Wednesday of Each Month 9:30 a.m. - 12:15 p.m.
"The Behavioral Health Independent Provider Network (IPN) Collaborative was created for behavioral health providers to engage with and partner collaboratively with the Department of Health Care Policy (the Department) and Financing and Regional Accountable Entities (RAEs). The Department recently published frequently asked questions and answers about key behavioral health initiatives and policies that may impact the IPN."
Meets four times a year. The next meeting will be on Friday, December 1, 2023; 1:00pm - 2:30pm.