Review of Medicaid Provider Rates — advisory committee, schedule, reporting, and public meetings
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Establishes procedures, timelines, and an advisory committee for periodic review of provider rates under the Colorado Medical Assistance Act; affects the Colorado Department of Health Care Policy & Financing, the created advisory committee, the Joint Budget Committee, providers, recipients, and other stakeholders in Colorado Medicaid rate-setting.
The required frequency for reviewing provider rates was changed so each provider rate is reviewed at least every three years (previous text referenced five years).
Creates a Medicaid provider rate review advisory committee with specified membership, duties, and reporting responsibilities.
Requires quarterly public meetings conducted by the state department to inform provider rate reviews and describes content and invitation requirements for those meetings.
Specifies new reporting timelines: annual analysis reports due May 1 (analysis) and written recommendations due November 1 (report), with certain provisions effective on later dates.
Provides a process for out-of-cycle reviews including notification deadlines and requirement that the department provide written reasons if a requested out-of-cycle review cannot be conducted.
Sunset/repeal dates for the advisory committee were extended to 2034 with related statutory repeal mechanics.
Provider Rate Review Criteria and Process
Provider rate review criteria and process
Process and analytic criteria the state department must follow when conducting provider rate reviews.
From first-phase analysis requirements.
Annual analysis reporting cadence.
Post-analysis collaboration and goal-setting.
Annual recommendations and reporting to legislature and advisory committee.
Public input and meeting requirements.
Exclusions and exceptions
- State department may propose exclusions from the review schedule for rates adjusted periodically by other statute or federal law.
Potential exclusions subject to department proposal.
- The advisory committee or the Joint Budget Committee may direct the state department to include rates proposed for exclusion in the review schedule (i.e., override exclusions).
Committee or JBC can require inclusion of excluded rates.
Advisory committee roles and responsibilities.
Out-of-Cycle Review Requests and Petition Forwarding
Out‑of‑cycle review requests — notification, forwarding, and department response
The advisory committee or the Joint Budget Committee may, by majority vote, request an out‑of‑cycle review of a provider rate; they must notify the state department of the request by December 1 of the year prior to the requested review. If the state department determines it cannot conduct the requested out‑of‑cycle review, it must provide written notification to the advisory committee and the Joint Budget Committee within 30 days that includes a description of the reasons the review cannot be conducted. The state department must also forward petitions/proposals to the advisory committee and the Joint Budget Committee (per statutory direction to include proposed exclusions and allow the committees to direct inclusion).
- Notification deadline: request for out‑of‑cycle review must be submitted to the state department by December 1 of the year prior to the review.
- State department response: if it cannot conduct the review, it must provide written reasons within 30 days of the request.
- Committee authority: advisory committee or Joint Budget Committee may direct the department to review rates not scheduled that year; the department must include proposed exclusions with the schedule and the committees may direct inclusion by majority vote.
Medicaid Provider Rate Review Advisory Committee
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