CurrentUnitedHealthcarePolicy N/A

Enhanced behavioral health value-based reimbursement criteria

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Defines criteria and point-based geographic, provider-capability, and prioritized-population measures that determine rate enhancements for behavioral health value-based payments for Medicaid members served by Rocky Mountain Health Plans and Northeast Health Partners for the July 1, 2027–June 30, 2028 enhancement period.

Policy Summary

PayerUnitedHealthcare

PolicyEnhanced behavioral health value-based reimbursement criteria

Policy CodePolicy N/A

Change TypeRate enhancement effective period added

Effective DateJul 1, 2027

Next Review DateN/A

Key ActionFor questions about the SFY 2028 criteria contact rmhprae_bh_pr@uhc.com.

SourceLink

POLICY UPDATE CHANGES

Increased reimbursement for behavioral health value-based payments applies July 1, 2027 to June 30, 2028 and also applies to Medicaid members enrolled in Region 2 operated by Northeast Health Partners.

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

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CurrentUnitedHealthcarePolicy N/A

Enhanced behavioral health value-based reimbursement criteria

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Policy Summary

PayerUnitedHealthcare

PolicyEnhanced behavioral health value-based reimbursement criteria

Policy CodePolicy N/A

Change TypeRate enhancement effective period added

Effective DateJul 1, 2027

Next Review DateN/A

Key ActionFor questions about the SFY 2028 criteria contact rmhprae_bh_pr@uhc.com.

SourceLink

POLICY UPDATE CHANGES

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

Behavioral Health Reimbursement Criteria

Behavioral health reimbursement criteria

Point-based criteria determine the percentage rate enhancement of the base fee schedule for behavioral health services during the enhancement period. Practices must follow section-specific eligibility thresholds (for geographic, provider capability, and prioritized-population measures) and scoring rules described below.

ALL of the following

ONE geographic section only (max 70 points)
- ALL of the following
  - Criteria: At least 50% of members served during the lookback period live in a CEAC (counties with extreme access considerations).
  - Points: 70.
  - Notes: 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 and Yuma.
- ALL of the following
  - Criteria: At least 30% of members served during the lookback period live in a CEAC (same eligible counties as above).
  - Points: 30.
- ALL of the following
  - Criteria: At least 50% of members served during the lookback period live in a rural county.
  - Points: 30.
  - Notes: Eligible rural counties: Alamosa, Chaffee, Delta, Elbert, Fremont, Lake, Logan, Montezuma, Montrose, Morgan, Otero, Ouray, Pitkin, Rio Grande and Summit.
- ALL of the following
  - Criteria: 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).
  - Points: 10.
  - Notes: Eligible local counties listed in policy (includes 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 and Yuma).

ALL of the following

Applicability: This section applies only to practices that provided at least 20 visits for members during the lookback period.
ANY of the following
- ALL of the following
  - Criteria: Practice contains at least one prioritized-specialty provider who provided at least 10 visits during the lookback period.
  - Points: 20.
  - Notes: Prioritized specialties include providers with provider type child psychiatrist, autism service provider, or eating disorder (per credentialing), or providers who completed ≥20 hours training specific to serving members with intellectual and developmental disabilities.
- ALL of the following

ALL of the following

Applicability: Includes practices that provided at least 20 visits for members during the lookback period.
ONE percentage group
- ALL of the following
  - 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 or were previously involved in foster care, or have intellectual or developmental disabilities.
- ALL of the following
  - Prioritized populations: same definitions as above.
- ALL of the following
  - Prioritized populations: same definitions as above.

ALL of the following

Total points achieved map to reimbursement percent of base fee schedule for the rate-enhancement period:
0 points → No enhancement (Rate = 100% of base fee schedule).
1–20 points → Rate = 110% of base fee schedule.
21–50 points → Rate = 120% of base fee schedule.
51–80 points → Rate = 130% of base fee schedule.
81–110 points → Rate = 140% of base fee schedule.
111–190 points → Rate = 150% of base fee schedule.

ALL of the following

Lookback and cohort timing: Lookback period and notification schedule described in policy (e.g., lookback for Oct 1, 2025 entry: Jan 1, 2026–Dec 31, 2026; enhancement notifications noted in policy).
Applicability: Increased reimbursement applies July 1, 2027–June 30, 2028 and also applies to Medicaid members enrolled in Region 2 operated by Northeast Health Partners.

Rate Enhancement Bands & Thresholds

Rate enhancement bandsmixed

0	Points achieved = 100%. Rate as a percentage of base fee schedule = 0.
1-20	Points achieved = 110%. Rate as a percentage of base fee schedule = 1.
21-50	Points achieved = 120%. Rate as a percentage of base fee schedule = 2.
51-80	Points achieved = 130%. Rate as a percentage of base fee schedule = 3.
81-110	Points achieved = 140%. Rate as a percentage of base fee schedule = 4.
111-190	Points achieved = 150%. Rate as a percentage of base fee schedule = 5.

Total points rangemixed

0-190

Total possible points range across criteria; maps to enhancement percent of base fee schedule for July 1, 2027 - June 30, 2028.

Violet enrollment thresholds

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

Violet enrollment (base) - CY27/CY28 increasesThreshold rises to 40% for the CY27 lookback period and 50% for the CY28 lookback period (impacting SFY29 and SFY30 rates)

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

Violet Verified Organization designation - baselineBy Dec. 31, 2026: 30% of providers must complete their Violet profile and 40% must achieve a Violet benchmark (Badge)

Violet Verified Organization designation - enhancedEnhanced designation requires completion plus 60% of providers achieving a Violet benchmark by Dec. 31, 2026

Key Definitions

Members (definition)

Definition of 'Members'Medicaid members enrolled with RMHP or NHP

ScopeApplies to behavioral health value‑based payment enhancements described in this document (July 1, 2027 - June 30, 2028)

Reference useTerm 'members' is used throughout the document to indicate Medicaid members enrolled with RMHP or NHP

CEAC (Counties with extreme access considerations)

CEAC purposeCounties with extreme access considerations (CEAC) are a specified list of Colorado counties used for geographic scoring

CEAC - 70-point thresholdIf at least 50% of members served during the lookback period live in a CEAC, the practice earns 70 points

Provider Contacts & Actions

Note

Questions — SFY 2028 criteria contact

For questions about the SFY 2028 criteria, contact the address below for provider inquiries.

Email: rmhprae_bh_pr@uhc.com