CurrentUnitedHealthcarePolicy N/A

Behavioral health value-based reimbursement enhancement

Defines enhanced reimbursement criteria and rate enhancements for behavioral health value-based payments for Medicaid members served by Rocky Mountain Health Plans (RMHP) and Northeast Health Partners (NHP) for the July 1, 2027–June 30, 2028 rate-enhancement period, and describes how practices earn points across geographic, provider capability, and prioritized-population criteria.

Policy Summary

PayerUnitedHealthcare

PolicyBehavioral health value-based reimbursement enhancement

Policy CodePolicy N/A

Change TypeMaterial additions to criteria and rate mapping

Effective DateJul 1, 2027

Next Review DateN/A

Key ActionContact RMHP via rmhprae_bh_pr@uhc.com for questions about SFY 2028 criteria.

SourceLink

POLICY UPDATE CHANGES

Increased reimbursement rates for behavioral health value-based payments for the July 1, 2027 - June 30, 2028 period tied to a points-based criteria framework.

Specific point-based criteria and county lists for geographic weighting (including CEAC and rural counties) were provided to determine point awards.

Provider capability and enrollment requirements (e.g., Violet enrollment and Violet Verified Organization benchmarks) and specialty visit thresholds were specified as point-earning criteria.

Prioritized-population percentage bands and associated points were defined for awarding points based on the share of members served from specified demographics.

Jul 1, 2027 - Jun 30, 2028rate-enhancement period

70max geographic points

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20min visits required

150%max rate (% of base)

111-190top-tier points range

Eligibility and Point Criteria for Rate Enhancements

Geographic criteria

Practices may earn geographic points based on the share of members they served during the lookback period who live in designated CEAC or rural counties, or who received care at a local brick-and-mortar Colorado practice. Practices may only earn points from one geographic section (maximum 70 points).

Practices may only earn points in one geographic section; maximum 70 points from geographic criteria.

CEAC

At least 50% of members served during the lookback period live in a county designated as a County with Extreme Access Considerations (CEAC).>= 50%
Points = 70; Eligible CEAC counties: Archuleta, Baca, Bent, Cheyenne, Conejos, Costilla, Crowley, Custer, Dolores, Grand, Gunnison, Hinsdale, Huerfano, Jackson, Kiowa, Kit Carson, Las Animas, Lincoln, Mineral, Moffat, Phillips, Prowers, Rio Blanco, Routt, Saguache, San Juan, San Miguel, Sedgwick, Washington, Yuma.
At least 30% of members served during the lookback period live in a county designated as a County with Extreme Access Considerations (CEAC).>= 30%
Points = 30; Eligible CEAC counties: Archuleta, Baca, Bent, Cheyenne, Conejos, Costilla, Crowley, Custer, Dolores, Grand, Gunnison, Hinsdale, Huerfano, Jackson, Kiowa, Kit Carson, Las Animas, Lincoln, Mineral, Moffat, Phillips, Prowers, Rio Blanco, Routt, Saguache, San Juan, San Miguel, Sedgwick, Washington, Yuma.

Rural counties

At least 50% of members served during the lookback period live in a designated rural county.>= 50%
Points = 30; Eligible rural counties: Alamosa, Chaffee, Delta, Elbert, Fremont, Lake, Logan, Montezuma, Montrose, Morgan, Otero, Ouray, Pitkin, Rio Grande, Summit.

Local practice

At least 50% of members served during the lookback period received care from a brick-and-mortar location within a local Colorado county (local practice).>= 50%
Points = 10; Eligible local counties: Alamosa, Archuleta, Bent, Chaffee, Cheyenne, Conejos, Costilla, Crowley, Custer, Delta, Dolores, Eagle, Elbert, Fremont, Garfield, Grand, Gunnison, Hinsdale, Huerfano, Jackson, Kiowa, Kit Carson, La Plata, Lake, Larimer, Las Animas, Lincoln, Logan, Mesa, Mineral, Moffat, Montezuma, Montrose, Morgan, Otero, Ouray, Phillips, Pitkin, Prowers, Pueblo, Rio Blanco, Rio Grande, Routt, Saguache, San Juan, San Miguel, Sedgwick, Summit, Baca, Washington, Weld, Yuma.

Provider capability criteria

Applies to practices that provided at least 20 visits for members during the lookback period. Practices may receive points from all provider-capability sections.

Practice provided at least 20 visits for members during the lookback period (practice eligible to earn provider capability points).

Prioritized specialty

Practice contains at least one health care provider from a prioritized specialty who provided at least 10 visits to members during the lookback period.>= 10 visits
Points = 20; Prioritized specialties include providers with type child psychiatrist, autism service provider, or eating disorder (as established during credentialing), or providers completing >=20 hours training specific to serving members with intellectual and developmental disabilities.

Violet enrollment and verification

Violet enrollment (base): At least 30% of health care providers in the practice are enrolled with Violet by Dec. 31, 2026.

Prioritized-population criteria

Includes practices that provided at least 20 visits for members during the lookback period. Practices may receive points from one prioritized-population percentage band.

Practice provided at least 20 visits for members during the lookback period (practice eligible to earn prioritized-population points).

ONE of

15%–24% of members served during the lookback period belong to prioritized populations (members who speak a non-English primary language, are Hispanic, identify as non-white race, have a social determinant of health need, are current or former foster care involved, or have intellectual or developmental disabilities).15%-24%
Points = 10.
25%–34% of members served during the lookback period belong to prioritized populations (see list above).25%-34%
Points = 20.

Rate-enhancement ranges

Total points achieved across geographic, provider capability, and prioritized-population criteria determine the reimbursement multiplier applied for the rate-enhancement period (July 1, 2027 – June 30, 2028).

ANY of the following

0 total points achieved
Rate = 0% enhancement (0% of base).
1–20 total points achieved
Rate = 110% of base fee schedule.
21–50 total points achieved
Rate = 120% of base fee schedule.
51–80 total points achieved
Rate = 130% of base fee schedule.

Coding and Threshold Details

Violet enrollment thresholds — percentage thresholds and associated points across baseline and enhanced tiers and lookback changes.

Violet enrollment (base) - thresholdAt least 30% of health care providers in the practice enrolled with Violet by Dec. 31, 2026. Note: thresholds increase to 40% for the CY27 lookback period and 50% for the CY28 lookback period (impacting SFY29 and SFY30 rates respectively).

Violet enrollment (base) - points20 points

Violet enrollment (base) - noteTo enroll, click here. (Operational enrollment link reference)

Violet enrollment (enhanced) - thresholdAt least 50% of health care providers in the practice enrolled with Violet by Dec. 31, 2026.

Violet enrollment (enhanced) - points10 points

Violet Verified Organization designation - profile & benchmark (base) - thresholdsBy Dec. 31, 2026: • 30% of providers must complete their Violet profile; AND • 40% of providers must achieve a Violet benchmark (Badge).

Actions, Contacts, and Program Participation

Note

Questions and contact

For questions about the SFY 2028 criteria or guidance on the Medicaid behavioral health value‑based program, contact RMHP at rmhprae_bh_pr@uhc.com.

Terms and County Lists

Members (definition)

Definition'Members' = Medicaid members enrolled with Rocky Mountain Health Plans (RMHP) or Northeast Health Partners (NHP).

ScopeApplies to Medicaid members in Region 2 served during the lookback and rate-enhancement period (see effective dates).

UsageTerm 'members' is used throughout the document to determine eligibility and percentage-based criteria (geographic and prioritized-population measures).

Counties with extreme access considerations (CEAC)

DefinitionCounties with extreme access considerations (CEAC) are a specific list of Colorado counties eligible for CEAC geographic points.

Eligible CEAC counties (selected examples)Archuleta, Baca, Bent, Cheyenne, Conejos, Costilla, Crowley, Custer, Dolores, Grand, Gunnison, Hinsdale, Huerfano, Jackson, Kiowa, Kit Carson, Las Animas, Lincoln, Mineral, Moffat, Phillips, Prowers, Rio Blanco, Routt, Saguache, San Juan, San Miguel, Sedgwick, Washington, Yuma.

Policy Summary

PayerUnitedHealthcare

PolicyBehavioral health value-based reimbursement enhancement

Policy CodePolicy N/A

Change TypeMaterial additions to criteria and rate mapping

Effective DateJul 1, 2027

Next Review DateN/A

Key ActionContact RMHP via rmhprae_bh_pr@uhc.com for questions about SFY 2028 criteria.

SourceLink

On This Page

Points = 20; thresholds will increase to 40% for the CY27 lookback and 50% for the CY28 lookback.

Violet enrollment (enhanced): At least 50% of health care providers in the practice are enrolled with Violet by Dec. 31, 2026.

Points = 10.

Violet Verified Organization designation (base): By Dec. 31, 2026, at least 30% of providers in the practice complete their Violet profile and 40% achieve a Violet benchmark (Badge).

Points = 20.

Violet Verified Organization designation (enhanced): Practice must have 60% of health care providers achieve a Violet benchmark.

Points = 20.

Providers meeting the above capability criteria may have points aggregated; practices may receive points from multiple capability sources as specified.

35%–44% of members served during the lookback period belong to prioritized populations (see list above).35%-44%

45%–100% of members served during the lookback period belong to prioritized populations (see list above).45%-100%

Points = 40.

Prioritized specialties note: prioritized specialty providers must have provided at least 10 visits during the lookback period to count under provider capability criteria.

81–110 total points achieved

Rate = 140% of base fee schedule.

111–190 total points achieved

Rate = 150% of base fee schedule (maximum).

Rate-enhancement period: July 1, 2027 - June 30, 2028.

Violet Verified Organization designation - points (base)20 points

Violet Verified Organization designation (enhanced) - thresholdsPractice must complete profiles and 60% of providers must achieve a Violet benchmark.

Violet Verified Organization designation (enhanced) - points20 points

Provider visit threshold — minimum visits (>=20) during the lookback period required for eligibility for capability/prioritized-population criteria and related notes on specialty visit thresholds.

Practice visit thresholdPractice must have provided at least 20 visits for members during the lookback period to be eligible for provider capability criteria.

Specialty provider visit thresholdA prioritized specialty provider must have provided at least 10 visits to members during the lookback period to count toward the practice specialty criterion.

Specialties counted & pointsPrioritized specialties receive 20 points. Prioritized specialties include providers with type child psychiatrist, autism service provider, or eating disorder (as established during credentialing), or providers completing >=20 hours training specific to serving members with intellectual and developmental disabilities.

CEAC criteria for pointsTo earn CEAC geographic points, at least 50% of members served during the lookback period must live in a CEAC (70 points) or at least 30% for the 30-point option.