Medicaid Quality Strategy
Requirements as outlined under Code of Federal Regulation 42 CFR 438.200 - 204 delineate State responsibilities for adoption of a Quality Strategy. 42 CFR 438.202(a) states that States will have a written strategy for assessing and improving the quality of managed care services offered by all Managed Care Organizations (MCOs) and Prepaid Inpatient Health Plans (PIHPs).
- 2021 Evaluation and Effectiveness Review
- 2020 State of Colorado Quality Strategy
- 2019 State of Colorado Quality Strategy
- State of Colorado Quality Strategy
Reports
- HEDIS: Standardized performance measures designed to ensure that purchasers and consumers have the information they need to reliably compare the performance of managed health care plans.
- Performance Improvement Projects (PIPs): Improvement projects completed by the Department's contracted health plans
- Client Satisfaction Surveys (CAHPS): Standardized surveys that ask consumers and patients to report on and evaluate their experiences with health care.
- Studies: Focused Studies identify opportunities and meaningful interventions that will promote quality care. Interventions developed based on recommendations from the Focused Studies.
- Performance Measure and Encounter Data Validation: Behavioral Health Organization Performance Measure Validation are annual validation activities outlined in the CMS protocol. Encounter Data Validation evaluates the accuracy and completion of administrative encounters for behavioral health services.
- BHO Quality Plans and Annual Evaluations: Health Care Policy and Financing (the Department) requires Behavioral Health Organizations (BHOs) to complete and submit annually a Quality Improvement Plan and Annual Quality Report. These reports note findings and opportunities for improvement and list techniques used the BHOs to improve performance.
- Annual Technical Reports: Annual Technical Reports and Legislative Reports on Status of Pediatric Health Care Quality Performance Measures
- Site Reviews/Audits: Site Reviews are performed on-site at the MCO/PIHP health care delivery system sites to assess the physical resources and operational practices in place to deliver health care.
- Experience of Care and Health Outcomes (ECHO) Surveys: Satisfaction surveys for clients who have received behavioral Health care services.
412 Audit
2023 RAE 412 Audits: Encounter Data Validation
- 2023 Rocky Mountain Health Plans Medicaid Prime *Rocky Mountain Health Plans disagrees on a number of findings included in this report and has submitted their disagreement with the report to the Department*
- 2023 Denver Health Medical Plan
2022 RAE 412 Audits: Encounter Data Validation
- 2022 Rocky Mountain Health Plans 412 Audit: Encounter Data Validation *Rocky Mountain Health Plans disagrees on a number of findings included in this report and has submitted their disagreement with the report to the Department*
- 2022 Denver Health Medical Plan 412 Audit: Encounter Data Validation
2021 RAE 412 Audits: Encounter Data Validation
- 2021 Rocky Mountain Health Plans 412 Audit: Encounter Data Validation
- 2021 Denver Health Medical Plan 412 Audit: Encounter Data Validation
2020 RAE 412 Audits: Encounter Data Validation
- 2020 Rocky Mountain Health Plans 412 Audit: Encounter Data Validation
- 2020 Denver Health Medical Plan 412 Audit: Encounter Data Validation *Denver Health disagrees on a number of findings included in this report and has submitted their disagreement with the report to the Department*
411 Audit
2023 RAE 411 Audits: Encounter Data Validation
- Region 1: Rocky Mountain Health Plans *Rocky Mountain Health Plans disagrees on a number of findings included in this report and has submitted their disagreement with the report to the Department*
- Region 2: Northeast Health Partners
- Region 3: Colorado Access *Colorado Access disagrees on a number of findings included in this report and has submitted their disagreement with the report to the Department*
- Region 4: Health Colorado, Inc. "Health Colorado Inc disagrees on a number of findings included in this report and has submitted their disagreement with the report to the Department."
- Region 5: Colorado Access *Colorado Access disagrees on a number of findings included in this report and has submitted their disagreement with the report to the Department*
- Region 6: Colorado Community Health Alliance
- Region 7: Colorado Community Health Alliance
- Denver Health Medical Plan *DHMP disagrees on a number of findings included in this report and has submitted their disagreement with the report to the Department*
2022 RAE 411 Audits: Encounter Data Validation
- Region 1: Rocky Mountain Health Plans *Rocky Mountain Health Plans disagrees on a number of findings included in this report and has submitted their disagreement with the report to the Department*
- Region 2: Northeast Health Partners
- Region 3: Colorado Access *Colorado Access disagrees on a number of findings included in this report and has submitted their disagreement with the report to the Department*
- Region 4: Health Colorado, Inc.
- Region 5: Colorado Access *Colorado Access disagrees on a number of findings included in this report and has submitted their disagreement with the report to the Department*
- Region 6: Colorado Community Health Alliance
- Region 7: Colorado Community Health Alliance
2021 RAE 411 Audits: Encounter Data Validation
- Region 1: Rocky Mountain Health Plans
- Region 2: Northeast Health Partners
- Region 3: Colorado Access
- Region 4: Health Colorado, Inc.
- Region 5: Colorado Access
- Region 6: Colorado Community Health Alliance
- Region 7: Colorado Community Health Alliance
2020 RAE 411 Audits: Encounter Data Validation
- Region 1: Rocky Mountain Health Plans
- Region 2: Northeast Health Partners *Northeast Health Partners disagrees on a number of findings included in this report and has submitted their disagreement with the report to the Department*
- Region 3: Colorado Access
- Region 4: Health Colorado, Inc.
- Region 5: Colorado Access
- Region 6: Colorado Community Health Alliance
- Region 7: Colorado Community Health Alliance