Public Comment: Medicaid Statewide Managed Care System

The Department of Health Care Policy & Financing has opened a 30-day public comment period to collect feedback on the revised Medicaid Statewide Managed Care System rule. The comment period will run from October 25, 2021 through November 24, 2021. Existing rules regarding Medicaid managed care programs are being revised to reflect the changes for Phase II of the Accountable Care Collaborative (ACC). 

Overview of Changes to the Existing Rule

The purpose of the rule changes are to align the language and policies with the following:

  • C.R.S. 25.5-5 Part 4 describing the Statewide Managed Care System

  • The Department’s 1915(b) waiver with the Centers for Medicare and Medicaid Services authorizing the ACC

  • Federally approved contracts with the Regional Accountable Entities (RAEs) and Managed Care Organizations (MCOs).

A brief overview of primary changes to the existing rule include the following:

  • Language and terminology have been aligned with that in C.R.S. 25.5-5 Part 4 on the Statewide Managed Care System,

  • Current Section 8.212 on the Community Behavioral Health System has been integrated into Section 8.205

  • New sections were added:

    • The 8.205.1 Definitions section has been added for clarity and consistency.

    • The 8.205.10 Utilization Management section has been added to added to reflect federal requirements and comply with C.R.S. 25.5-5-402 (15)

  • Changes were made to reflect current policy:

    • Enrollment is mandatory into the Statewide Managed Care System.

    • Client eligibility

    • Clients/members cannot opt out of the Statewide Managed Care System.

    • There are new Covered Services for the inpatient and residential substance use disorder benefit

  • Other modifications

Medicaid Statewide Managed Care System Rule Draft Revision

Public Comment Period

The Department will be accepting public comments from October 25, 2021 through November 24, 2021. To submit comments, please complete the Medicaid Statewide Managed Care System Public Comment form. Please email questions to hcpf_acc@state.co.us.