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In an effort to continually ensure comparable access to medical services which is provided to non-Health First Colorado members, and in accordance with 42 CFR 447.203, Health First Colorado (Colorado's Medicaid Program) has developed an Access Monitoring Review Plan (the AMRP, or Plan) which outlines the processes used to monitor and act of access issues.
Learn more about the Access Monitoring Review Plan
The Department of Health Care Policy and Financing (Department) is committed to creating a high-performing, cost-effective system that delivers quality services and improves the health of Coloradans. The next iteration (Phase II) of the Accountable Care Collaborative (ACC) seeks to leverage the proven successes of Health First Colorado (Colorado's Medicaid Program) to enhance the member and provider experience.
Learn more about Accountable Care Collaborative Phase II
Stakeholders and participants involved with this committee provide guidance and make recommendations to help improve health, access to care, cost and satisfaction of members and providers in the Accountable Care Collaborative (ACC). These committee meetings are open to the public.
Learn more about the Accountable Care Collaborative Program Improvement Advisory Committee
The Adult Intellectual and Developmental Disabilities Waiver Redesign Stakeholder Group provides advice and consultation for the Office of Community Living's efforts to redesign its home and community based services waivers serving adults with intellectual and developmental disabilities.
Learn more about the Adult Intellectual and Developmental Disabilities Waiver Redesign Stakeholder Group
The purpose of the Advocates Communication Meeting is to ensure ongoing, transparent, and collaborative communication between the Division for Intellectual and Developmental Disabilities and the advocacy stakeholders.
Learn more about the Advocates' Communication Meeting
Behavioral Health Quality Improvement Committee (BQuIC) works on issues involving quality of behavioral health care. The BQuIC meetings are normally held on the fourth Tuesday of every month from 10:00 a.m. to 12:00 p.m. Attendees for this meeting include staff from the Department of Health Care Policy and Financing (Department), Health Services Advisory Group (HSAG), Office of Behavioral Health (OBH), and staff from each of the five Behavioral Health Organizations (BHOs) in Colorado.
Learn more about the Behavioral Health Quality Improvement Committee
Health First Colorado (Colorado's Medicaid Program) established the Benefits Collaborative in 2008, in an effort to define its covered services. The Benefits Collaborative serves as the Department's formal coverage standard development process. Since the Benefits Collaborative aims to produce evidence-based policies guided by best practices, we seek to invite a diverse group of stakeholders - providers, administrators, members, advocates, policy makers, etc. into the process.
Learn more about the Benefits Collaborative
The Children's Disability Advisory Committee serves in an advisory capacity to the Department and makes recommendations regarding issues related to benefits for disabled children and youth age 20 and under, provider education interventions, and application of standards.
The Committee consists of parents of children with disabilities, representatives from other state agencies, children's advocate and policy organizations, and Early and Periodic Screening, Diagnostic and Treatment (EPSDT) staff.
Learn more about the Children's Disability Advisory Committee
The Department is currently engaging stakeholders to provide information and gather feedback on the Children’s Home and Community Based Services Waiver (CHCBS) Parental Fees.
Learn more about the Children's Home and Community Based Services Parental Fees
The Children's Services Steering Committee serves in an advisory capacity to the Department and makes recommendations regarding issues related to benefits for children and youth age 20 and under, provider education interventions and application of standards.
Learn more about the Children's Services Steering Committee
The primary function of this council is to provide guidance and recommendations regarding operational policy and procedural changes to the CCT program and to create solutions to streamline community transitions. The council will analyze barriers for transitions and provide recommendations for improved practices. Additionally, The CCT Advisory Council will provide recommendations for the use of rebalancing funds to the Department of Health Care Policy and Financing. The work of this council will directly inform the implementation of the Colorado’s Olmstead Plan.
Learn more about the Colorado Choice Transitions Advisory Council
The commission's three-year mission is to analyze health care costs and make policy recommendations to the Legislature and the governor for lowering health care costs in the state.
Learn more about the Colorado Commission on Affordable Health Care
The Colorado Healthcare Affordability and Sustainability Enterprise Board is responsible for working with the Department of Health Care Policy and Financing and the Medical Services Board to develop the hospital provider fee model, monitor the implementation of the bill, help with preparation of annual reports on this program, and ensure that the Health First Colorado (Colorado's Medicaid Program) and Child Health Plan Plus (CHP+) eligibility expansions are implemented as intended.
Learn more about the Colorado Healthcare Affordability and Sustainability Enterprise Board
The Colorado Hospital Transformation Program is an initiative under development by the Colorado Department of Health Care Policy and Financing (Department) in collaboration with the hospital community and other stakeholders in health care delivery.
Learn more about the Colorado Hospital Transformation Program
This Colorado Indigent Care Program Stakeholder Advisory Council makes recommendations to the Medical Services Board regarding rules for the program.
Learn more about the Colorado Indigent Care Program Stakeholder Advisory Council
The Department of Health Care Policy and Financing, in collaboration with stakeholders, has developed new processes for eligibility determination, needs assessments, and support planning for all individuals seeking or receinvg long-term services and supports. The new processes will be peson-centered, enhance self-direction, and facilitate greater coordination of services, as well as be equally applicable to adults with disabilities and children.
Learn more about Colorado's Long-Term Services and Supports Assessment and Support Plan
The Colorado Opportunity Framework coordinates and aligns the interventions of government, private, non-profit and community partners through a life stage/indicator-based framework. The Colorado Opportunity Framework creates a thoughtful, broadly integrated health care delivery system that incorporates key social determinants of health.
Learn more about the Colorado Opportunity Framework
The Community First Choice Development and Implementation Council is an advisory group consisting primarily of consumer, family and advocate members. The Council is responsible for working together to provide a set of recommendations to the State on how to proceed with this option.
Learn more about the Community First Choice Development and Implementation Council
The Office of Community Living was created by Governor Hickenlooper through an Executive Order in July 2012. The Office helps meet the growing need for long-term services and supports by people with disabilities and aging adults and is housed in the Department of Health Care Policy and Financing (Department).
The Community Living Advisory Group worked from August 2012 to September 2014 to consider and recommend changes to the Long-term Services and Supports (LTSS) delivery system. The Advisory Group worked closely with the Colorado Commission on Aging and other planning groups to carry out this work and build on previous discussions and recommendations. The Advisory group finalized its work and issued its Final Report in September 2014.
Learn more about the Community Living Advisory Group
The Colorado Department of Health Care Policy & Financing (HCPF) houses an advisory committee focused on quality improvement for HCPF’s Office of Community Living (OCL). The Community Living Quality Improvement Committee (CLQIC) provides input to the OCL on the development of a robust quality strategy from a person-centered perspective.
Learn more about the Community Living Quality Improvement Committee
Conflict Free Case Management prohibits an agency or entity to deliver both Case Management Support and Home and Community Based Direct Services to qualified individuals.
Learn more about Conflict Free Case Management
SB 18-266 “Controlling Medicaid Costs” directs the Department to pursue cost-control strategies in Medicaid. The bill dedicates permanent staff to pursue cost-control, value-based payments and other approaches; makes available expenditure, quality of medical services, and pharmaceuticals information to providers; and utilizes technology to further review claims prior to payment to prevent improper payments. The bill also creates an evidence-based hospital review program to ensure appropriate utilization of hospital services.
Learn more about the Controlling Medicaid Costs Initiatives
The Drug Utilization Review (DUR) Board serves in an advisory capacity to the Department and makes recommendations regarding issues of drug utilization, provider education interventions, and application of standards. The Board meets once quarterly. The Board consists of nine members appointed by the Executive Director; four physicians, four pharmacists licensed and actively practicing in Colorado, and one non-voting pharmaceutical industry representative.
The DUR Board also determines the prior authorization criteria for drugs with special prescribing guidelines and the prior authorization criteria for non-preferred drugs, those that don't make the Preferred Drug List (PDL).
Learn more about The Drug Utilization Review Board
The eHealth Commission was created to provide advice and guidance to the Office of eHealth Innovation on advancing Health IT in Colorado.
The Department of Health Care Policy and Financing (HCPF) serves as the fiscal agent leveraging the state’s procurement, contracting, and accounting established processes to manage solicitations, contracts, and payments to vendors and organizations on behalf of the new eHealth Innovation Office.
Learn more about the eHealth Commission
The purpose of this stakeholder meeting is to engage providers, members, and other stakeholders as the Department works to implement EVV for community based services offered through both the State Plan and Waivers.
Learn more about the Electronic Visit Verification Stakeholder Workgroup
As part of the Department’s efforts to shift providers from volume to value, the Department, along with stakeholders, has developed a payment model to make differential payments based on the provider’s performance. This payment model aims to give providers greater flexibility in care provided, reward performance, and maintain transparency and accountability in payments made. Under the proposed model, a portion of the Federally Qualified Health Center's Alternative Payment Methodology (APM) cost-based rates will be tied to quality activities and performance metrics. Progress within this framework not only encourages higher organizational performance but also helps the Accountable Care Collaborative (ACC) achieve its respective programmatic goals.
Learn more about Federally Qualified Health Center Payment Reform
Through the passage of the Medicare Access and CHIP Reauthorization Act of 2015, federal financing for the Children’s Health Insurance Program (CHIP) was extended through September 30, 2017. It is unclear whether or not Congress will consider extending federal financing beyond 2017.
Learn more about the Future of Child Health Plan Plus (CHP+)
The federal Centers for Medicare and Medicaid Services (CMS) issued a final rule effective March 2014 to ensure that the provision of Home and Community Based Services (HCBS) occurs in settings that meet certain criteria. States have until March 2019 to ensure that their HCBS settings are compliant with the final rule which ensures that HCBS participants have access to the benefits of community living, and that services are true alternatives to those provided in an institutional setting and are delivered in the most integrated setting possible.
Ways to be involved in the Final Settings Rule Implmentation Process
The Health First Colorado (Colorado's Medicaid Program) Provider Rate Review Advisory Committee was created to establish a process for the periodic review of provider rates under the Colorado Medical Assistance Act.
Learn more about Health First Colorado Provider Rate Review Advisory Committee
An opportunity for the public to provide comments and input on Home and Community Based Services (HCBS) waiver amendments and/or renewals.
Learn more about HCBS Public Comment Opportunities
We host quarterly meetings in partnership with the Department Public Health and Environment to discuss regulatory compliance issues with providers.
Learn more about Home Care Information Exchange Meeting
Hospital Back-Up (HBU) is a program within Health First Colorado (Colorado's Medicaid Program) that supports qualified skilled nursing facilities in providing hospital level care to members who are ventilator dependent, have complex wounds, or have medically complex needs, as defined in rule 10 CCR 2505-10 8.470.1. The Hospital Back-Up Operational Process Improvement Workgroup has been developed to build on improvement recommendations identified by the University of Colorado's research of the HBU program.
Learn more about Hospital Back Up Operational Process Improvement Workgroup
The Individuals with Intellectual and Developmental Disabilities (IDD) Waiver Renewal Stakeholder workgroup will provide input toward the 2019 renewal of the Children’s Extensive Supports (CES), Developmental Disabilities (DD), and Supported Living Services (SLS) waivers.
Learn more about the IDD Renewal Stakeholder Workgroup
The In-Home Support Services (IHSS) Subcommittee is a subcommittee of the Participant Directed Programs Policy Collaborative (PDPPC). The Workgroup includes IHSS stakeholders and is tasked with planning, implementation, and policy review for IHSS.
Learn more about In-Home Support Services Subcommittee
The Integrated Quality Improvement Committee Meeting (IQuIC) will work on issues involving quality of physical and behavioral health managed care services and potential opportunities for improvement.
Learn more about Integrated Quality Improvement Committee Meeting
The Medical Quality Improvement Committee (MQuIC) is a partnership with the physical health organizations, the external quality review organization (EQRO), the Department and community to examine quality within existing and new systems of service and identify potential opportunities for improvement. MQuIC is scheduled to meet on the first Thursday of every other month from 1:30-3:30 pm and is held on the 4th floor at 1570 Grant Street, Denver, Colorado 80203.
Learn more about The Medical Quality Improvement Committee (MQUIC)
The Medicaid Provider Rate Review Advisory Committee (MPRRAC) was enacted in June of 2015 (Senate Bill 15-228) and operates in accordance with the Colorado Medical Assistance Act, Section 25.5-4-401, C.R.S. (Colorado Revised Statutes).
Learn more about Medicaid Provider Rate Review Advisory Committee
The Medical Services Board sets forth the rules that govern the Department's programs. The Board was established by law effective July 1, 1994 and consists of eleven members appointed by the Governor and confirmed by the Senate. Medical Services Board meetings are open to the public.
Learn more about the Medical Services Board
The Department has created a Member Experience (formerly Person- and Family-Centeredness) Advisory Council to help us integrate a person-and family-centered approach into Department business practices, policies and partnerships by engaging with Health First Colorado (Colorado's Medicaid Program) and Child Health Plan Plus (CHP+) members and family members/caretakers. There is an In-Person and a Virtual Advisory Council. Both serve as a way for members and their families/caretakers to work collaboratively with the Department to identify and implement person-centered practices, and create sustainable culture change in the Department.
Learn more about the Member Experience Advisory Councils
The purpose of Nursing Facility Advisory Committee is to identify challenges in providing Health First Colorado (Colorado's Medicaid Program) services in nursing facilities. This committee provides an opportunity for Department staff, recipients, and providers to discuss issues unique to nursing facilities and their residents.
Learn more about the Nursing Facility Advisory Council
The Nursing Facility Provider Fee Advisory Board (PFAB) serves as a forum where the Department and stakeholder community can discuss the Nursing Facility Provider Fee program. The PFAB will explore alternative modeling options and approaches to improving and maintaining the program. The Board consists of community volunteer members who are familiar with the Nursing Facility Provider Fee program and reflect the diverse interests of the stakeholder community.
Learn more about the Nursing Facility Provider Fee Advisory Board
The function of the Board is to promote improved quality of life at nursing facilities through grants that support progressive culture change.
Learn more about the Nursing Home Innovations Grant Board
The Office of Community Living is working on a variety of policy and rule changes related to its Home and Community Based Services waivers and programs. The engagement of clients and stakeholders throughout these changes is a critical part of this process. This page provides information about a variety of projects.
Learn more about Office of Community Living Stakeholder Engagement
The Participant-Directed Programs Policy Collaborative (PDPPC) is a stakeholder/Department meeting that replaced the Consumer-Directed Attendant Support Services (CDASS) Advisory Committee in January 2012. The PDPPC is a place where CDASS stakeholders and the Department work together, with transparency, on CDASS issues going forward.
Learn more about the Participant Directed Programs Policy Collaborative
The Pharmacy and Therapeutics (P&T) Committee performs clinical reviews of drug classes and makes recommendations which help the Department develop and manage the Medicaid Preferred Drug List (PDL). The P&T Committee is required to consider clinical criteria such as drug safety and efficacy when making its recommendations and considers public comments and testimony related to the drug classes being reviewed or other PDL-related agenda items.
Learn more about the Pharmacy and Therapeutics Committee
As part of the Department of Health Care Policy & Financing’s (Department) efforts to shift providers from volume to value, the Department is developing a structure to make differential fee-for-service payments to give providers greater flexibility, reward performance while maintaining transparency and accountability, and create alignment across the delivery system. Under the proposed model, providers can earn higher reimbursement (when designated as meeting specific criteria) as they implement and achieve more advanced criteria. Movement along this framework not only encourages higher organizational performance but also helps the Accountable Care Collaborative (ACC) achieve its respective programmatic goals.
Learn more about Primary Care Payment Reform
The purpose of the School Health Services (SHS) Stakeholder Forum is to provide an informal environment for the SHS Program participating providers and other stakeholders to exchange ideas, review policies and other pertinent information that relates to the SHS Program. The group can make recommendations to the Department for improvement and changes to the SHS Program that address processes and services.
Learn more about the School Health Services Stakeholder Forum
The purpose of the Senate Bill (SB) 18-231 Transition Planning Task Force is to examine the problems that occur when children with intellectual and developmental disabilities and their parents experience difficulties in transitioning from receiving services in the educational setting to receiving services through the Department of Health Care Policy and Financing. The Task Force is charged with submitting a report by January 2, 2019, of its findings and recommendations to the Health and Human Services Committee of the Colorado Senate, the Public Health and Human Services Committee of the Colorado House of Representatives, and the Colorado Joint Budget Committee, or any successor committees. The Departments of Education and Health Care Policy and Financing are collaborating in the work of the Task Force.
Learn more about the SB 18-231 Transition PlanningTask Force
The purpose of this program is to promote the health and welfare of Colorado’s low-income seniors by providing access to dental care to individuals age 60 and over who are not eligible for dental services under any other dental health care program, such as Health First Colorado (Colorado's Medicaid Program).
Learn more about the Senior Dental Advisory Committee
The purpose of the Spinal Cord Injury Advisory Committee is to advise the Department as it reviews elements of the Spinal Cord Injury waiver.
Learn more about the Spinal Cord Injury Advisory Committee
The Colorado State Medical Assistance and Services Advisory Council exists to improve and maintain the quality of Health First Colorado (Colorado's Medicaid Program) by contributing specialized knowledge and experience and providing a two-way channel of communication with the individuals, organizations, and institutions in the community that provide medical care and services. State Medical Assistance and Services Advisory Council meetings are open to the public.
Learn more about the State Medical Assistance and Services Advisory Council
In accordance with House Bill 18-1136, the Department of Health Care Policy and Financing (Department) will be working to provide the full continuum of substance use disorder (SUD) benefits to Health First Colorado (Colorado’s Medicaid program) enrollees. The Department will be adding the inpatient and residential components, including withdrawal management, to the continuum of outpatient SUD services currently available. The Department’s objective is to make these services available for individuals who meet nationally-recognized evidence-based level of care criteria without shifting care from outpatient settings when they are more appropriate.
Learn more about Ensuring a Full Continuum of SUD Benefits
This page exists to provide and exchange information with members, stakeholders, providers, legislators, and policymakers about the Department's efforts to ensure qualified individuals recieve the services they need at the time they're needed, within the constraints of the state's limited financial resources.
Learn more about Waiting Lists and Enrollments