Accountable Care Collaborative Phase II
The Department of Health Care Policy and Financing (Department) is committed to creating a high-performing, cost-effective system that delivers quality services and improves the health of Coloradans. Phase II of the Accountable Care Collaborative (ACC) leverages the proven successes of Health First Colorado (Colorado's Medicaid program) to enhance the member and provider experience.
Learn more about Accountable Care Collaborative Phase II
Accountable Care Collaborative Phase III
The mission of the Department of Health Care Policy & Financing is to improve health care equity, access, and outcomes for the people we serve while saving Coloradans money on health care and driving value for Colorado. The ACC Phase III features are designed in support of achieving this mission.
Learn more about Accountable Care Collaborative Phase III
Accountable Care Collaborative Program Improvement Advisory Committee
Stakeholders and participants involved with this committee provide guidance and make recommendations to help improve health, access to care, cost and satisfaction of members and providers in the Accountable Care Collaborative (ACC). These committee meetings are open to the public.
Learn more about the Accountable Care Collaborative Program Improvement Advisory Committee
Addressing the Health-Related Social Needs (HRSN) of Health First Colorado and CHP+ Members
The Department of Health Care Policy & Financing (HCPF) is actively working to better support the health-related social needs (HRSN) of Health First Colorado (Colorado's Medicaid program) and Child Health Plan Plus (CHP+) members, such as housing instability and food security, in an effort to recognize that a member’s health depends on more than health care alone. There is growing interest in supporting individuals' HRSN from other Colorado state agencies, community partners and our federal partners.
Learn more about Addressing the Health-Related Social Needs (HRSN) of Health First Colorado and CHP+ Members
Ambulatory Surgical Center Payment Methodology Stakeholder Meetings
The Department of Health Care Policy & Financing (HCPF) invites organizations and individuals to attend one of two public meetings that will present information about possible changes to the Ambulatory Surgical Center (ASC) payment methodology. HCPF staff will review the current methodology and present a small number of alternative payment methodologies. All attendees will be invited to ask questions. The meetings are informational only.
Learn more about the Ambulatory Surgical Center Payment Methodology Stakeholder Meetings
American Rescue Plan of 2021
The American Rescue Plan Act of 2021 (ARPA) is a federal law related to the Home and Community Based Services Enhanced Federal Match provision.
Learn more about the American Rescue Plan of 2021.
Bariatric Surgery Rule Change Consideration
The Department of Health Care Policy and Financing (HCPF) has held public virtual stakeholder meetings that presented information about possible changes to the bariatric surgery rule (citation: 300.3.c). At the meetings, HCPF staff reviewed the current rule and proposed possible changes to the rule. Attendees were invited to learn, ask questions, and provide initial feedback about the potential change. Feedback was gathered at the meetings and via a feedback form that was shared with attendees.
Learn more about the Bariatric Surgery Rule Change Consideration
Behavioral Health Hospital Engagement Forum
The purpose of these meetings is to provide a forum for hospitals and RAEs to discuss behavioral health issues in hospital settings.
Learn more about the Behavioral Health Hospital Engagement Forum
Child Health Plan Plus Prenatal Waiver
Medicaid and Children's Health Insurance Program (CHIP) Section 1115 waivers allow states to test new approaches to administering Medicaid and CHIP programs beyond what is required by federal statute. These waivers give states flexibility to design and improve their programs to better serve Medicaid and CHIP populations through experimental, pilot, or demonstration projects.
Learn more about the Child Health Plan Plus Prenatal Waiver
Children's Disability Advisory Committee
The Children's Disability Advisory Committee serves in an advisory capacity to the Department and makes recommendations regarding issues related to benefits for children and youth with disabilities age 20 and younger, provider education interventions, and application of standards.
The Committee consists of parents of children with disabilities, representatives from other state agencies, children's advocate and policy organizations, and Early and Periodic Screening, Diagnostic and Treatment (EPSDT) staff.
Learn more about the Children's Disability Advisory Committee
Colorado Healthcare Affordability and Sustainability Enterprise (CHASE) Board
The Colorado Healthcare Affordability and Sustainability Enterprise Board is responsible for working with the Department of Health Care Policy and Financing and the Medical Services Board to develop the hospital provider fee model, monitor the implementation of the bill, help with preparation of annual reports on this program, and ensure that the Health First Colorado (Colorado's Medicaid program) and Child Health Plan Plus (CHP+) eligibility expansions are implemented as intended.
Learn more about the Colorado Healthcare Affordability and Sustainability Enterprise Board
Colorado Indigent Care Program Stakeholder Advisory Council
This Colorado Indigent Care Program Stakeholder Advisory Council makes recommendations to the Medical Services Board regarding rules for the program.
Learn more about the Colorado Indigent Care Program Stakeholder Advisory Council
Community Health Workers
The Colorado Legislature passed Senate Bill 23-002 in May 2023 to add community health worker (CHW) services as a Health First Colorado (Colorado’s Medicaid program) benefit starting July 1, 2025. HCPF will conduct a series of stakeholder meetings to get input on how to meet federal requirements to add CHW services.
Learn more about the Community Health Workers
Complementary and Integrative Health Advisory Committee
The purpose of the Complementary and Integrative Health (formerly Spinal Cord Injury (SCI) Advisory Committee) is to advise the Department as it reviews elements of the Complementary and Integrative Health waiver (formerly the SCI waiver).
Learn more about the Complementary and Integrative Health Advisory Committee
Cover All Coloradans
HB22-1289, known as Health Benefits for Children and Pregnant Persons or the Cover All Coloradans bill, expands health coverage to children and pregnant persons regardless of immigration status.
Learn more about Cover All Coloradans
Direct Care Workforce Collaborative
Office of Community Living is working collaboratively with stakeholders to identify and move forward strategies to support the recruitment and retention of Colorado's direct care workforce.
Learn more about the Direct Care Workforce Collaborative
Drug Utilization Review
The Drug Utilization Review (DUR) Board serves in an advisory capacity to the Department and makes recommendations regarding issues of drug utilization, provider education interventions, and application of standards. The Board meets once quarterly. The Board consists of nine members appointed by the Executive Director, four physicians, four pharmacists licensed and actively practicing in Colorado, and one non-voting pharmaceutical industry representative.
The DUR Board also determines the prior authorization criteria for drugs with special prescribing guidelines and the prior authorization criteria for non-preferred drugs, those that don't make the Preferred Drug List (PDL).
Learn more about The Drug Utilization Review Board
eHealth Commission
The eHealth Commission was created to provide advice and guidance to the Office of eHealth Innovation on advancing Health IT in Colorado.
The Department of Health Care Policy and Financing (HCPF) serves as the fiscal agent leveraging the state's procurement, contracting, and accounting established processes to manage solicitations, contracts, and payments to vendors and organizations on behalf of the new eHealth Innovation Office.
Learn more about the eHealth Commission
Electronic Visit Verification Stakeholder Workgroup
The 21st Century CURES Act, passed in December 2016, requires Medicaid programs to implement an Electronic Visit Verification (EVV) system for Personal Care and Home Health services. Per section 12006, all states must implement an EVV system to avoid a reduction in federal Medicaid funding, which could have a negative impact on Personal Care and Home Health services received by Health First Colorado members.
The purpose of this stakeholder meeting is to engage providers, members, and other stakeholders as the Department works to implement EVV for home and community based services offered through both the State Plan and Waivers.
Learn more about the Electronic Visit Verification Stakeholder Workgroup
EPSDT Advisory Committee
The EPSDT Advisory Committee serves in an advisory capacity to the Department and makes recommendations regarding issues related to benefits for children and youth age 20 and under, provider education interventions and application of standards.
Learn more about the EPSDT Advisory Committee
Gender-Affirming Care Stakeholder Engagement
The Department is updating its gender affirming care policy and will be presenting proposed changes. Stakeholders are invited to ask questions and provide feedback to help inform and refine the final policy.
Learn more about Gender-Affirming Care Stakeholder Engagement
HCBS Final Settings Rule Implementation in Colorado
The federal Centers for Medicare and Medicaid Services (CMS) issued a final rule effective March 2014 to ensure that the provision of Home and Community Based Services (HCBS) occurs in settings that meet certain criteria. States have until March 2019 to ensure that their HCBS settings are compliant with the final rule which ensures that HCBS participants have access to the benefits of community living, and that services are true alternatives to those provided in an institutional setting and are delivered in the most integrated setting possible.
Learn more about Ways to be involved in the Final Settings Rule Implementation Process
HCBS Public Comment Opportunities
An opportunity for the public to provide comments and input on Home and Community Based Services (HCBS) waiver amendments and/or renewals.
Learn more about HCBS Public Comment Opportunities
Health First Colorado Member Access to Care
Through ongoing monitoring and evaluation, the Department ensures that Health First Colorado members receiving fee-for-service benefits have timely access to relevant and appropriate health care. The Department considers all levels of access issues, from single rate/procedure code access issues to geographic specific issues through to broader demographic access issues (such as access to care for LGBTQ+ members or for non-English speaking members). The Department also prepares access reports in line with federal access requirements.
Learn more about Health First Colorado Member Access to Care
Health First Colorado Provider Rate Review Advisory Committee
The Health First Colorado Provider Rate Review Advisory Committee was created to establish a process for the periodic review of provider rates under the Colorado Medical Assistance Act.
Learn more about the Health First Colorado Provider Rate Review Advisory Committee
Health Services Initiatives (HSI)
Through the Children’s Health Insurance Program (CHIP), states can develop Health Services Initiatives (HSIs) to improve the health of low-income children and youth. In Colorado, CHP+ is our Children’s Health Insurance Program.
Learn more about Colorado HSI.
Hospital Facility Fee Steering Committee
The adoption of House Bill (HB) 23-1215 creates a Steering Committee to develop a report detailing the impact of outpatient facility fees, which are fees hospitals charge for using their facilities in addition to treatment costs and fees charged, individually, by doctors. This report will be delivered to the state House of Representatives Health and Insurance Committee and the Senate Health and Human Services Committee, or their successor committees.
Learn more about the Hospital Facility Fee Steering Committee
Hospital Transformation Program Community Advisory Council
The Colorado Hospital Transformation Program Community Advisory Council meetings will provide valuable consumer input to all parts of the Hospital Transformation Program.
Learn more about the Hospital Transformation Program Community Advisory Council
HRCC (HCPF, RAEs, Child Welfare, Counties) Collaborative Forum
The purpose of the HRCC Collaborative forum is to improve coordination and alignment of policies and practices across the Department of Health Care Policy and Financing (HCPF), the Regional Accountable Entities (RAEs), the Colorado Department of Human Services (CDHS), and the Colorado Counties to ensure timely service delivery to child welfare involved children and their families.
Learn more about the HRCC Collaborative Forum
Human Rights Committee
The Human Rights Committee (HRC) is a third-party mechanism to safeguard the rights of persons receiving services. The Human Rights Committee is an advisory and review body to the administration of the community center board or regional center.
Learn more about the Human Rights Committee
Implementation of a Canadian Prescription Drug Importation Program
In accordance with Senate Bill 19-005, the Department of Health Care Policy & Financing (Department) will be developing an application to the U.S. Department of Health and Human Services (HHS) to establish a Canadian prescription drug importation program.
Learn more about Implementation of a Canadian Prescription Drug Importation Program
Institutes for Mental Disease (IMD)
This page provides information and resources related to Institutes of Mental Disease (IMD). Policies related to IMDs impact multiple provider types. The page serves as a library for communications from the Center of Medicare and Medicaid Services regarding IMD guidelines and opportunities, research and reports conducted on behalf of the Department, and source documents and summaries of Colorado IMD policy. The page includes a list of Department staff who can answer IMD-related questions for specific provider types.
Learn more about the Institute for Mental Disease (IMD)
Integrated Quality Improvement Committee Meeting
The Integrated Quality Improvement Committee Meeting (IQuIC) will work on issues involving quality of physical and behavioral health managed care services and potential opportunities for improvement.
Learn more about the Integrated Quality Improvement Committee Meeting
Long-Term Services and Supports New Assessment and Person-Centered Support Plan
The Department of Health Care Policy & Financing, in collaboration with stakeholders, has developed new processes for eligibility determinations, needs assessments, and support planning for all individuals seeking or receiving long-term services and supports (LTSS). The new processes will be person-centered, enhance self-direction, and facilitate greater coordination of services, as well as be equally applicable to adults with disabilities and children. The new process will be automated in a new case management IT solution.
Learn more about Long-Term Services and Supports New Assessment and Person-Centered Support Plan
Maternity Advisory Committee
The Maternity Advisory Committee will review program data, provide input on member quality and experience metrics, and give recommendations to help improve member experiences and maternity outcomes.
Learn more about the Maternity Advisory Committee
Medicaid Provider Rate Review Process
The Rate Review Process was enacted in June of 2015 (Senate Bill 15-228) and operates in accordance with the Colorado Medical Assistance Act, Section 25.5-4-401, C.R.S. (Colorado Revised Statutes).
Learn more about the Rate Review Process
Medical Services Board
The Medical Services Board sets forth the rules that govern the Department's programs. The Board was established by law effective July 1, 1994 and consists of eleven members appointed by the Governor and confirmed by the Senate. Medical Services Board meetings are open to the public.
Learn more about the Medical Services Board
Member Correspondence Improvements
The Member Correspondence Improvements Stakeholder Meetings focus on enhancing communication with Health First Colorado members. Stakeholders, providers, and community members are invited to collaborate and provide feedback on proposed changes to member letters and correspondence processes.
These meetings are open to the public, and input from diverse participants is encouraged to help shape future improvements.
Learn more about the Member Correspondence Improvements Stakeholder Meetings
Member Experience Advisory Council
The Department created a Member Experience Advisory Council (MEAC) to help us integrate a person-and family-centered approach into Department business practices, policies and partnerships by engaging with Health First Colorado (Colorado's Medicaid program) and Child Health Plan Plus (CHP+) members and family members/caretakers. The MEAC serves as a way for members and their families/caretakers to work collaboratively with the Department to identify and implement person-centered practices, and create sustainable culture change in the Department.
Learn more about the Member Experience Advisory Council
Nursing Facility Stakeholder Meeting
In recognition of the importance of stakeholder participation in our provider fee programs, the Department of Health Care Policy and Financing (the Department) has established the Nursing Facility Stakeholder Meeting (NFSM) (formerly known as the Nursing Facility Provider Fee Advisory Board). The NFSM serves as a forum where the Department and the stakeholder community can discuss the Nursing Facility Provider Fee program.
Learn more about the Nursing Facility Stakeholder Meeting
Nursing Home Innovations Grant Board
The function of the Board is to promote improved quality of life at nursing facilities through grants that support progressive culture change. This board is hosted by the Colorado Department of Public Health and Environment in cooperation with HCPF.
Learn more about the Nursing Home Innovations Grant Board
Office of Community Living (OCL) Stakeholder Engagement
The Office of Community Living is working on a variety of policy and rule changes related to its Home and Community Based Services waivers and programs. The engagement of clients and stakeholders throughout these changes is a critical part of this process. This page provides information about a variety of projects.
Learn more about Office of Community Living Stakeholder Engagement
Participant Directed Programs Policy Collaborative
The Participant-Directed Programs Policy Collaborative (PDPPC) is a stakeholder/Department meeting that replaced the Consumer-Directed Attendant Support Services (CDASS) Advisory Committee. The PDPPC is a place where CDASS stakeholders and the Department work together, with transparency, on CDASS issues going forward.
Learn more about the Participant Directed Programs Policy Collaborative
Pharmacy and Therapeutics Committee
The Pharmacy and Therapeutics (P&T) Committee performs clinical reviews of drug classes and makes recommendations which help the Department develop and manage the Medicaid Preferred Drug List (PDL). The P&T Committee is required to consider clinical criteria such as drug safety and efficacy when making its recommendations and considers public comments and testimony related to the drug classes being reviewed or other PDL-related agenda items.
Learn more about the Pharmacy and Therapeutics Committee
Public Emergency Medical Services Supplemental Payment Stakeholder Forum
The purpose of the Colorado Public Emergency Medical Service (EMS) Supplemental Payment Stakeholder Forum is to provide an informal environment for the EMS Program participating providers and other stakeholders to exchange ideas, review policies and other pertinent information that relates to the EMS Program. The group can make recommendations to the Department for improvement and changes to the EMS Program that address processes and services.
Learn more about the Public Emergency Medical Services Supplemental Payment Stakeholder Forum
Reproductive, Perinatal, and Sexual Health
Updates and information related to new legislation for Maternal, Child and Reproductive Health (SB 21-194, SB 21-009, SB 21-025 and SB 19-195), the Maternal Opioid Misuse (MOM) Grant, and the Maternal Advisory Committee (MAC).
Learn more about Reproductive, Perinatal, and Sexual Health
Rural Provider Access and Affordability Stimulus Advisory Committee
The Rural Provider Access and Affordability Stimulus Advisory Committee makes recommendations to the Department of Health Care Policy and Financing on the rural grants awarded through SB 22-200. These recommendations will assist the Department in selecting qualified rural hospitals that will receive grant payments aimed at improving health care affordability and access to care in rural Colorado.
The advisory committee will advise and make formal recommendations to the Department on the rural grants including: procedures and timelines for a qualified rural provider to apply for a grant, criteria to determine grant eligibility and amounts, grantees' reporting requirements, and permissible uses of the grant funds.
Learn more about the Rural Provider Access and Affordability Stimulus Advisory Committee.
School Health Services Stakeholder Forum
The purpose of the School Health Services (SHS) Stakeholder Forum is to provide an informal environment for the SHS Program participating providers and other stakeholders to exchange ideas, review policies and other pertinent information that relates to the SHS Program. The group can make recommendations to the Department for improvement and changes to the SHS Program that address processes and services.
Learn more about the School Health Services Stakeholder Forum
Senate Bill 23-174: Coverage Policy
Colorado currently requires behavioral health providers to identify the clinical diagnosis of a member receiving care, and include that diagnosis on a claim for reimbursement. The Colorado Legislature passed Senate Bill 23-174 requiring HCPF to provide access to a limited set of behavioral health services to members under the age of 21 without a covered diagnosis. The policy goes into effect July 1, 2024.
Learn more about the Senate Bill 23-174: Coverage Policy
Senior Dental Advisory Committee
The purpose of this program is to promote the health and welfare of Colorado's low-income seniors by providing access to dental care to individuals age 60 and over who are not eligible for dental services under any other dental health care program, such as Health First Colorado (Colorado's Medicaid program).
Learn more about the Senior Dental Advisory Committee
State Agency Telehealth Funding Dashboard
Through a collaborative partnership between OeHI and Health Care Policy and Financing (HCPF), a state-funded telehealth project dashboard was developed to provide information on state-funded telehealth activities and interventions occurring throughout Colorado.
Learn more about the State Agency Telehealth Funding Dashboard
State Medical Assistance and Services Advisory Council
The Colorado State Medical Assistance and Services Advisory Council exists to improve and maintain the quality of Health First Colorado (Colorado's Medicaid program) by contributing specialized knowledge and experience and providing a two-way channel of communication with the individuals, organizations, and institutions in the community that provide medical care and services. State Medical Assistance and Services Advisory Council meetings are open to the public.
Learn more about the State Medical Assistance and Services Advisory Council
Substance Use Disorder (SUD) Benefits House Bill 18-1136
In accordance with House Bill 18-1136, the Department of Health Care Policy and Financing (Department) will be working to provide the full continuum of substance use disorder (SUD) benefits to Health First Colorado (Colorado's Medicaid program) enrollees. The Department will be adding the inpatient and residential components, including withdrawal management, to the continuum of outpatient SUD services currently available. The Department's objective is to make these services available for individuals who meet nationally-recognized evidence-based level of care criteria without shifting care from outpatient settings when they are more appropriate.
Learn more about Ensuring a Full Continuum of SUD Benefits
Transitions Stakeholder Advisory Council
The primary function of this council is to provide guidance and recommendations regarding operational policy and procedural changes to the transition program and to create solutions to streamline community transitions. The council will analyze barriers for transitions and provide recommendations for improved practices.
Learn more about the Transitions Stakeholder Advisory Council
University of Colorado School of Medicine (CUSOM) Interagency Agreement
The University of Colorado School of Medicine (CUSOM) works in partnership with the Department to increase access to health care for Health First Colorado members through this Supplemental Funding Program.
Learn more about the CUSOM Interagency Agreement
Waiting Lists and Enrollment - Services for People with Intellectual and/or Developmental Disabilities
This page exists to provide and exchange information with members, stakeholders, providers, legislators, and policymakers about the Department's efforts to ensure qualified individuals receive the services they need at the time they're needed, within the constraints of the state's limited financial resources.
Learn more about Waiting Lists and Enrollments