Research, Data and Grants
- Budget Documents
- Premiums, Expenditures and Caseload Reports
- Medicaid Management Information System (MMIS) Reprocurement
- Quality and Health Improvement Reports
- Colorado Choice Transitions (CCT) and Money Follows the Person (MFP)
- No Wrong Door (NWD) System Implementation
- Testing Experience and Functional Assessment Tools (TEFT)
- Division of Intellectual and Developmental Disabilities (DIDD)
Section 1202 Primary Care "Bump" Payments
Section 1202 of the ACA required Health First Colorado (Colorado's Medicaid Program) to reimburse primary care providers at or above Medicare Part B rates, also referred to as “bump” payments. The purpose of the policy is to increase the number of primary care providers accepting Health First Colorado, improve members' access to quality primary care, and build more advanced models of primary care. Colorado implemented bump payments in calendar years 2013 and 2014 and elected to extend bump payments through fiscal year 2015. The Department contracted with University of Colorado, School of Medicine to conduct an analysis of the effect of the increased rates on access to care for Health First Colorado members. Two preliminary reports were delivered in November 2015 and March 2016. This final report presents the results of the increased payments for bump-eligible services from January 2013 to June 2014. The report examines four client-based access to care measures and three provider-based measures using Health First Colorado claims data from January 2010 through July 2015. The report also contains a new appendix that examines the immunization and prevention services that will have a continuation of the enhanced payments.
In a follow-up study, the University of Colorado, School of Medicine examined the expansion population, with a special focus on substance use disorder, pregnancy and childbirth, primary care, and Emergency Department services.
Accountable Care Collaborative Evaluation
With support from The Colorado Health Foundation and Rose Community Foundation, the Department contracted with the Colorado School of Public Health to conduct a two-year evaluation of the Accountable Care Collaborative (ACC) program. This report includes findings from the quantitative and qualitative analyses on the impact of the ACC on health care utilization, costs and quality. The quantitative study analyzes administrative claims data between July 2009 and June 2015, a period that spans the introduction and establishment of the ACC. The qualitative portion of the evaluation, which includes interviews conducted with representatives of designated primary care medical providers, is focused on practice experiences and perspectives with the program to date. The report examines where cost savings occurred, key performance indicator performance, quality measures utilized in an Oregon companion project, what support is most helpful for practices, and a deep dive into care coordination and the team-based approach. The findings are being used to inform current and future implementations of the ACC program.
In response to stakeholder feedback, the Department also developed a strategy and contracted with TriWest to incorporate the member perspective into the evaluation. With funding from the Department, TriWest conducted 10 "dyad" interviews with pairs of ACC members and their care managers to identify the core components of good care coordination. With support from The Colorado Health Foundation and Rose Community Foundation, TriWest also conducted 88 individual interviews with members to learn about their experiences accessing care and the ACC program in general. Pending a federal match request, TriWest will utilize findings from the member interviews to inform the development of a member experience survey that can be used within and beyond the ACC. TriWest findings and themes on the member perspective are also incorporated into the final School of Public Health ACC evaluation report.
- ACC Care Coordination Dyad Interviews - full report
- ACC Care Coordination Dyad Interviews - one pager
- ACC Individual Member Interviews - full report
- ACC Individual Member Interviews - one pager
Certified Community Behavioral Health Clinics Grant (CCBHC)
The Quality and Health Improvement Unit (QHI) of HCPF has been awarded one of the Planning Grants for Certified Community Behavioral Health Clinics (CCBHCs) by the Substance Abuse and Mental Health Services Administration (SAMHSA). The purpose of this program is to support states to certify clinics as CCBHCs, establish prospective payment systems for Health First Colorado-reimbursable services, and prepare to participate in a two year demonstration program. Populations to be served are adults with serious mental illness, children with serious emotional disturbance, and those with long term and serious substance use disorders, as well as others with mental illness and substance use disorders. Learn more about the CCBHC Grant.
Colorado Advanced Interoperability Initiative Grant
The Office of the National Coordinator for Health Information Technology (ONC) awarded Colorado Dept. of Health Policy & Financing the Colorado Advanced Interoperability Initiative grant in 2015. CORHIO and Quality Health Network, Colorado’s two health information exchange (HIE) organizations, have been selected to provide HIE services for the program.
Colorado All Payer Claims Database (CO APCD)
The Colorado All Payer Claims Database (CO APCD) is the most comprehensive source of health claims data in the state with claims from Health First Colorado (Colorado's Medicaid Program), Medicare, and commercial payers in the state. The public website allows consumers to shop for health care services and also provides statewide cost and utilization information. Scholarships are available for custom data requests to support projects to improve care, improve quality and lower costs in the state. Visit the data showcase to see how organizations are using custom data from the CO APCD. The Center for Improving Value in Health Care (CIVHC) is the administrator of the CO APCD and is responsible for ensuring the database operates in accordance with the legislation and securing the necessary funds to support the ongoing operation of the database. Learn more about the CO APCD.
Colorado Dental Health Care Program for Low-Income Seniors
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).
Colorado State Innovation Model
Between February, 2015 and January 2019, the State of Colorado will receive up to $65 million from the Centers for Medicare and Medicaid Services with oversight from the Center for Medicare and Medicaid Innovation (CMMI) to implement and test its State Health Care Innovation Plan.
Colorado’s plan, entitled “The Colorado Framework,” creates a system of clinic-based and public health supports to spur innovation. The state will improve the health of Coloradans by:
- providing access to integrated primary care and behavioral health services in coordinated community systems;
- applying value-based payment structures;
- expanding information technology efforts, including telehealth; and
- finalizing a statewide plan to improve population health.
Funding will assist Colorado in integrating physical and behavioral health care in more than 400 primary care practices and community mental health centers comprised of approximately 1,600 primary care providers. In addition, the state will work to establish a partnership between their public health, behavioral health and primary care sectors.
The grant proposal was led by the governor’s office, the Departments of Health Care Policy & Financing, Human Services and Public Health and Environment, Regulatory Affairs, Personnel Administration and included input from more than one hundred stakeholders from the public, private and nonprofit sectors representing governments, physical and behavioral health care providers, public and private payers, and advocates.
Colorado Long-Term Services and Supports No Wrong Door System Grant
The No Wrong Door (NWD) initiative is part the state’s effort to streamline access to long-term services and supports for all consumers, regardless of age, disability or pay source. Through a three-year grant from the federal Administration for Community Living, Colorado will pilot three NWD regional entities to develop a model for implementing NWD statewide. Learn more about the No Wrong Door Implementation Grant project.
Colorado Long-Term Services and Supports Testing Experience and Functional Assessment Tools Grant
Colorado's "Demonstration Grant for Testing Experience and Functional Assessment Tools in Community-Based Long Term Services and Supports" (TEFT) grant program, spans four years through March 2018. This grant program is working through the field testing of an experience of communications survey, demonstration of the personal health record, refinement of the functional and assessment items and creation of a standard electronic LTSS record. Learn more about Colorado's Testing Experience and Functional Tools Grant project.
With grant funding from the Colorado Health Foundation (CHF), the Institute for Patient and Family Centered Care (IPFCC) conducted a three day site visit in 2012 to interview Department staff and stakeholders about person and family-centered care and stakeholder engagement. In December 2012, IPFCC delivered a report with recommendations, entitled Advancing the Practice of Client- and Family-Centered Care for the Colorado Department of Health Care Policy and Financing. The Department used this report to secure funding from CHF to implement several key recommendations. The Department has begun to implement person-and family-centered practices by involving clients and families as a feedback mechanism to the Department through in-person and virtual advisory councils made up of solely Health First Colorado (Colorado's Medicaid Program) and Child Health Plan Plus members and family members/caretakers. Internally, we have established a group of staff Champions to work to implement person-centered approaches to each section’s work; we are incorporating person-centered values into our hiring, on-boarding and performance planning process; providing relevant trainings; and continuing to seek support to extend such trainings to the contractors and providers with whom we work, so that we approach all of our work in a way that is person-centered. For more information, please see our Quarterly Report and Strategic Plan.
County Member Experience Project
County Departments of Human/Social Services are the first interaction many Coloradans have with the Health First Colorado (Colorado’s Medicaid Program) or Child Health Plan Plus (CHP+) programs through the eligibility determination process.
We invite our county partners to join us in improving the Health First Colorado and CHP+ member and county staff experiences within the eligibility process through this project launching in September, 2017. For more information, contact HCPF_peoplefirst@state.co.us.
School-Based Health Center Improvement Project (SHCIP)
The goal of this funding opportunity is to establish and evaluate a national quality system for children’s health care provided through Health First Colorado (Colorado's Medicaid Program) and Child Health Plan Plus (CHP+). Learn more about SHCIP.
Accountable Care Collaborative Request for Proposals
The Department has released the formal request for proposals (RFP) for seven Regional Accountable Entities for the next iteration of the Accountable Care Collaborative. The RFP documents are available below for stakeholder viewing and are current as of the initial posting on May 11, 2017.
Potential bidders must access the RFP using the State’s procurement website for the most current information. The deadline for proposal submission is July 28, 2017.
For more information regarding State procurement rules, please see the State of Colorado Procurement Manual.
A pre-bid conference was held for potential bidders on May 18, 2017. A recording of the meeting is available online.
Member Portal Updates
Explanation of Benefits
The Department is required to make available an explanation of benefits (EOB) to all Health First Colorado (Colorado’s Medicaid program) members. The EOBs will allow Health First Colorado members to see claims made on their behalf so they can discover and report administrative and provider errors or fraudulent claims. The EOBs must comply with federal requirements (42 CFR 433.116 and Section 11210 of the State Medicaid Manual) and those outlined in Senate Bill (SB) 16-120.
The Department has developed a summary of recent activities related to stakeholder and member engagement that was mandated by SB 16-120.
Due to the extension of the interChange system go-live, the EOBs that comply with SB 16-120 will not be available beginning July 1, 2017. Once launched, the EOBs will be available in the interChange Member Portal. The Department is working to identify a launch date for the Member Portal and the SB 16-120 mandated EOBs.
As information becomes known, updates on the EOBs and information on the launch timing of the new Member Portal will be posted here.
The Department of Health Care Policy and Financing is not responsible for the content of external websites.