Inpatient Hospital Review Program (IHRP) 2.0 | Colorado Department of Health Care Policy & Financing

The Department of Health Care Policy and Financing (HCPF) suspended the Inpatient Hospital Review Program (IHRP) in April 2020 as a result of the impact of the Covid-19 pandemic and Public Health Emergency (PHE) on hospitals. The Department is currently in the planning stages of relaunching IHRP, now referenced as IHRP 2.0.

IHRP 2.0 is a redesigned, focused program whose primary goal is to help hospitals coordinate with the appropriate Regional Accountable Entity (RAE) for efficient and effective discharge planning and care coordination.

Inpatient Hospital Review Program 2.0 Post implementation Surveys

The Department of Health Care Policy and Financing (HCPF) would like your feedback on the implementation of the Inpatient Hospital Review Program (IHRP 2.0). The survey opened October 11, 2023, and will run through October 29, 2023. Your responses will be used to consider changes to the program.

Please select the appropriate link below to take the survey:
Hospital Provider IHRP 2.0 Post Implementation Survey
RAE representatives use this link: RAE Provider IHRP 2.0 Post Implementation Survey

Thank you for taking the time to complete this survey.

IHRP 2.0 Implementation

The implementation of Step 1 (inpatient pre-admission review) of the Inpatient Hospital Review Program (IHRP) 2.0 has been deferred until further notice in response to provider feedback. Providers may stop testing inpatient pre-admission review workflows and processes for Step 1 of IHRP.

Steps 2 and 3
IHRP 2.0 post-admission reviews performed on hospital inpatient day 6 (Step 2) and days 30, 60 and 90 and every 30 days thereafter (Step 3) have been required since May 1, 2023. Post-admission reviews do not impact claims payment and allow providers to ask the member’s Regional Accountable Entity (RAE) for assistance in care coordination. A request for assistance can be escalated by emailing HCPF_IHRP_ACC@state.co.us if a provider asks for, but does not receive, a response from the RAE. Protected Health Information (PHI) should not be included in emails.

Claims analysis will be performed to confirm providers are submitting post-admission reviews as required.

The IHRP Joint Operating Committee (JOC) will continue to meet monthly to discuss questions, issues, results and best practices. JOC meeting dates, training materials and additional information about IHRP 2.0 can be found on this page.

Contact either the ColoradoPAR Program Utilization Management (UM) Team at hcpf_um@state.co.us or Acentra® (formerly Kepro) Provider Relations at COproviderissue@kepro.com with questions or for assistance.

Background

Senate Bill 18-266 requires Health First Colorado (Colorado’s Medicaid program) to implement an evidence-based hospital review program to ensure appropriate utilization of hospital services. The hospital review program created by SB 18-266 is the Inpatient Hospital Review Program (IHRP). The initial version of IHRP (IHRP 1.0) was paused at the beginning of the COVID-19 Pandemic and Public Health Emergency.

IHRP 1.0 required admission review Prior Authorization Requests (PARs) for all inpatient admissions excluding maternity related admissions and Long-Term Acute Rehab (LTAC) and required that any admissions determined to be an emergency were entered within 24 hours of the members stabilization, as determined by the hospital. It also required that all members in the hospital at day 4 have a concurrent review. Complex Case reviews were required at the 4-day concurrent review for a subset that included NICU admissions, Sepsis, Respiratory Failure and Pneumonia.

About IHRP 2.0

Newer: New Vendor, New System, New Program

New UM Vendor - Acentra (formerly Keystone Peer Review Organization/Kepro)
New PAR Portal
- Feedback from IHRP 1.0 has been incorporated into Acentra's (formerly Kepro's) system, resulting in ease of access to determinations and streamlined requests.

Better: Smaller more focused, refined program and requirements

Admission Reviews - required on small subset of admission of bariatric and back surgeries.
Concurrent Reviews - also known as a Post-Admission Clinical review, focus on care coordination, discharge and transition planning rather then approval or denial of stay.
- Required on small subset at Day 6: neonatal stays, sepsis, cellulitis, pulmonary edema and respiratory failure, thoracis and abdominal vascular procedures.
- Also required on all stays at Day 30 and every 30 days thereafter.

Smarter: Focused on enhanced data shared between the hospitals and the Regional Accountable Entities (RAEs)

Data submitted to Kepro by hospitals will be shared with members assigned RAE to assist with care coordination and discharge and transition planning.
- Exact data points and process to be shared prior to Go-live.

Timeline

December 2022/January 2023 - IHRP Provider Survey sent out.
- Ensure that you are signed up to receive Provider communications sent out via Gainwell.
January 2023 - Regular Joint Operating Committee (JOC) Meetings Begin
February 2023 - Training Sessions Begin (see below)
April 3, 2023 - IHRP 2.0 “Soft Launch”
- Providers begin submitting Pre and Post Admission reviews on April 3, 2023.
- Provide feedback on IHRP 2.0 to hcpf_um@state.co.us.
May 1, 2023 - Providers must comply with the requirements of IHRP 2.0 Steps 2 and 3 including submitting Post Admission Reviews for care coordination.

Recorded Webinars From Completed Trainings

Please view a recorded session in order to ensure that you have all necessary information prior to moving on to the next subject. These trainings are 1 hour each. The order these trainings should be viewed is:

Introduction to IHRP And Atrezzo - The Intro to IHRP 2.0 and Portal Registration training will give a brief introduction to Kepro, discuss the background of IHRP and introduce the new version and its requirements. It will also introduce Atrezzo and demonstrate how to create an account, add users, and register NPI numbers.
System Overview - The System Overview training will demonstrate how to login to the portal, create a case and submit a PAR request.
- Providers can skip the System Overview if they are already submitting PARS in Atrezzo.
IHRP Benefit Specific Training - The IHRP 2.0 Benefit Specific training will describe provider responsibilities, admission review requirements and post admission review requirements. This will also discuss the review types, turnaround times, medical necessity, and PAR outcomes.
IHRP 2.0 Q&A Sessions - The IHRP 2.0 Q&A sessions have been scheduled to answer any systems or benefit questions that may arise.

Please note that Pre Admission Review requirements included in the Provider Benefit Specific Training and Colorado Ordering Provider Training have been updated. The new, reduced requirements may be found in the IHRP Infographic (Draft) listed under “Resources” on this web page.

Resources

Joint Operating Committee

The Joint Operating Committee (JOC) is a recurring meeting, or forum, with Hospital Providers, Colorado Hospital Association, Acentra (formerly Kepro) and the Department that allows for program updates and allows IHRP Providers to raise questions, concerns and issues and receive real time responses, and work collectively to identify solutions, resolutions and next steps. The goal of JOC is to create a productive, respectful, and collaborative, open dialogue with a focus on solutions between all those working on IHRP 2.0.