CurrentColorado Rocky Mountain Health PlansPolicy N/A

Medicaid behavioral health value-based payment updates

Defines updates to Rocky Mountain Health Plans' value-based payment (VBP) program for Medicaid behavioral health providers in its Independent Provider Network, including annual review processes, rate enhancement tiers, and a partnership with Violet to assess and improve cultural competency.

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyMedicaid behavioral health value-based payment updates

Policy CodePolicy N/A

Change TypeProgram update with material changes

Effective DateJul 1, 2024

Next Review DateN/A

Key ActionEnroll your practice in the Violet platform by December 2024 to be eligible for increased reimbursement beginning July 1, 2025.

SourceLink

POLICY UPDATE CHANGES

Establishment of an annual review process using a 5-Star scale to determine practice-level reimbursement increases.

Partnership with Violet to assess provider cultural competence and offer training; practices that enroll by December 2024 will receive increased reimbursement starting July 1, 2025.

Rate enhancement structure defined as 100%, 110%, 120%, 130%, 140% or 150% of the published base fee schedule tied to Star ratings.

Reimbursement applies at the practice level (by TIN); all providers within a practice receive the same rate.

5-Starrating scale used to determine rate enhancements

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Value-Based Payment Criteria & Review

Annual review and criteria

Annual criteria (published each fall) define practice capabilities and associated points; points map to Star ratings which determine rate increases for the upcoming state fiscal year.

RMHP will complete an annual review of all practices within its IPN using a 5-Star scale to determine reimbursement increases for the upcoming state fiscal year.

Annual reviews, Star ratings and accompanying rate enhancements apply at the practice level (TIN); every provider within a practice receives the same reimbursement rate.

Each fall RMHP will publish VBP criteria that list specific practice capabilities and associated points, plus a crosswalk showing how points convert to Star ratings and corresponding rate increases.

The annual review process includes: criteria publication date; lookback period (dates of service included in assessment); practice enhancement notification date; and rate enhancement period (dates rate increases are effective).

Example timeline and lookback periods for early cycles: May 31, 2024 lookback = Jan 1, 2024–Dec 31, 2024 (enhancement notification Apr 1, 2025; rate period Jul 1, 2025–Jun 30, 2026). Subsequent annual cycles follow the published schedule (see full table).

Cultural competence (Violet) criteria

Enrollment in Violet and demonstration of cultural competence can yield enhanced reimbursement.

RMHP is partnering with Violet to assess and benchmark provider cultural competence for BIPOC, LGBQ and TGNC communities and to centralize training and provider surveys.

Practices that enroll with Violet by December 2024 will be eligible to receive increased reimbursement starting July 1, 2025.

Violet provides benchmarking, identifies inclusive care access gaps, and offers CE/CME-earning educational opportunities to improve culturally responsive care; RMHP funds subscription for providers.

Fee Schedule & Reimbursement Tiers

Fee schedule updatesmixed

Base fee schedule will be updated periodically to include new Medicaid procedure codes and annual fee changes.

Reimbursement tier — Star rating to percentage mapping

Star-to-rate mapping0 stars = 100%; 1 star = 110%; 2 stars = 120%; 3 stars = 130%; 4 stars = 140%; 5 stars = 150% of the published base fee schedule.

Publication cadenceRMHP will publish each April (starting 2025) the points achieved, Star rating and reimbursement rate for the upcoming state fiscal year.

Fee schedule updatesBase fee schedule will be updated periodically to include new Medicaid procedure codes and annual fee changes.

Initial rating distributionIn June 2024, practices will receive contract amendments with their initial Star rating and corresponding rate percentage (100%–150%).

What Providers Must Do

Note

Rate publication and opt-out

Each April (starting in 2025), RMHP will publish for each provider the number of points achieved, Star rating and their reimbursement rate for the upcoming state fiscal year. Practices may opt out of having their information posted by contacting rmhprae_bh_pr@uhc.com.

Published rates correspond to Star ratings: 1 star = 110%, 2 stars = 120%, 3 stars = 130%, 4 stars = 140%, 5 stars = 150% of the published base fee schedule.
RMHP updates the base fee schedule periodically to add new procedure codes and annual fee changes.

Prior Authorization

Contract amendment and opt-out period

RMHP will send each practice a unilateral contract amendment that implements the enhanced reimbursement structure and communicates each provider's initial Star rating and accompanying rate percentage (100%–150%) of the base fee schedule. After issuance, each practice will have 90 days to opt out of the new program; practices that do not opt out within that period will be bound by the amended contract terms.

Contract amendments issued in June 2024 will include each provider’s initial Star rating and rate percentage.

Key Definitions

Practice-level contracting (TIN) — all providers in a practice receive the same rate

Practice-level contracting (TIN)RMHP contracts at the practice level (by Tax Identification Number); all providers within a practice receive the same reimbursement rate determined by the practice's Star rating.

Uniform applicationAnnual reviews, Star ratings and accompanying rate enhancements apply to all practitioners within the practice (no provider-specific differentials within a TIN).

Base rate exceptionsThe base fee schedule may include different base rates by provider type (e.g., Ph.D. or Psy.D.), but the Star-based multiplier is applied at the practice level.

Opt-out and notificationsPractices will receive a unilateral contract amendment (June 2024) and have 90 days to opt out to remain on their current contract; practices may also opt out of public posting by contacting RMHP.

Violet — third-party platform for assessing cultural competence and providing training (payer-agnostic)