Controlling Medicaid Costs Initiatives

The Cost Control and Quality Improvement Office was created following unanimous approval of SB 18-266 "Controlling Medicaid Costs" in May of 2018. This law focuses on controlling Medicaid costs, which consume a significant portion of the State's budget. The Office leads collaborative efforts across multiple stakeholders to drive insights and solutions that address the rising cost of health care across the state and within the Medicaid program, with an emphasis on increasing quality and addressing system inefficiencies to better meet the needs of Coloradans. The Office crafts strategy and oversees cost management programs, ensures timely access to necessary care and support resources, assists with policy and payment mechanisms to promote value and leads efforts to significantly reduce cost across the health system.

The guiding principles behind development of SB 18-266 "Controlling Medicaid Costs" include:

  • propelling Medicaid claim cost-control solutions towards industry standards and payer best practices,
  • preparing for volatility (growing seniors populations, changes in federal funding, rising prescription drug prices and rises in unemployment)
  • building a sustainable approach to controlling claims costs and
  • containing costs and improving member health outcomes.

The bill dedicates permanent staff to pursue cost-control, value-based payments and other approaches, makes available expenditure, quality of medical services, and pharmaceuticals information to providers, and utilizes technology to further review claims prior to payment to prevent improper payments. The bill also creates an evidence-based hospital review program to ensure appropriate utilization of hospital services.

Resources, implementation updates and stakeholder meeting information will be posted on this page.

Provider Tools Training and Educational Materials

The Department is developing powerful analytical tools for Regional Accountable Entities (RAEs) and providers to use to better coordinate care, manage costs, and improve member health.

  • Tools and trainings will be available in the coming months.

Upcoming Stakeholder Engagement Opportunities

  • To be announced

Legislative Reports