Each year the Medicaid Provider Rate Review Advisory Committee (MPRRAC) focuses on a particular scope based on services under review for that year. Services are reviewed on a three-year basis but are subject to change. Please email HCPF_RateReview@state.co.us if you have any questions regarding the review schedule.
YEAR ONE SERVICES (2023 Review Cycle):
1. Anesthesia
2. Ambulatory Surgical Centers (ASCs)
3. Behavioral Health Services (FFS only)
4. Maternity Services (Surgeries & other maternity services)
5. Pediatric Behavioral Therapy (PBT)
6. Abortion Services
7. Dental Services
8. DDID Dental Services
9. Surgeries:
- Cardiovascular System
- Digestive System
- Eye & Auditory System
- Integumentary System
- Musculoskeletal System
- Respiratory System
YEAR TWO SERVICES (2024 Review Cycle):
1. Home and Community-Based Services (HCBS):
- ADL Assistance and Delivery Models
- Behavioral Services
- Community Access and Integration
- Community Directed Attendant Support Services (CDASS)
- Day Program
- Professional Services
- Residential Services
- Respite Services
- Technology, Adaptations, and Equipment
- Transition Services
2. Emergency Medical Transportation (EMT)
3. Non-emergent Medical Transportation (NEMT)
4. Qualified Residential Treatment Programs (QRTP)
5. Psychiatric Residential Treatment Facilities (PRTF)
6. Home Health Services
7. Pediatric Personal Care (PPC)
8. Private Duty Nursing (PDN)
9. Physician Services
- Sleep Studies
- EEG Ambulatory Monitoring Codes
10. Fee-for-service Behavioral Health Substance Use Disorder (SUD) Codes
YEAR THREE SERVICES (2025 Review Cycle):
1. Dialysis and Dialysis-related Services
- Facility
- Non-Facility
2. Durable Medical Equipment
3. Eyeglasses and Vision
4. Laboratory and Pathology Services
5. Physician Services
- Cardiology
- EEG Ambulatory Monitoring
- ENT
- Family Planning
- Gastroenterology
- Health Education
- injections and Other Miscellaneous J-Codes
- Nero/Psychological Testing Services
- Ophthalmology
- Other
- Primary Care E&M
- Radiology
- Respiratory
- Sleep Study
- Vaccines Immunizations
- Vascular
- Women's Health
6. Outpatient PT, OT & ST
7. Prosthetics, Orthotics and Disposable Supplies
8. Targeted Case Management (TCM)
- Case Management
- Transition Coordination
9. Early Intervention TCM
10. Specialty Care Services
11. DIDD