Quality and Health Improvement Reports

Medicaid Quality Strategy

Requirements as outlined under Code of Federal Regulation 42 CFR 438.200 - 204 delineate State responsibilities for adoption of a Quality Strategy. 42 CFR 438.202(a) states that States will have a written strategy for assessing and improving the quality of managed care services offered by all Managed Care Organizations (MCOs) and Prepaid Inpatient Health Plans (PIHPs).

• 2021 Evaluation and Effectiveness Review
• 2020 State of Colorado Quality Strategy
• 2019 State of Colorado Quality Strategy

Reports

• HEDIS: Standardized performance measures designed to ensure that purchasers and consumers have the information they need to reliably compare the performance of managed health care plans.
• Performance Improvement Projects (PIPs): Improvement projects completed by the Department's contracted health plans
• Client Satisfaction Surveys (CAHPS): Standardized surveys that ask consumers and patients to report on and evaluate their experiences with health care.
• Performance Measure and Encounter Data Validation: Behavioral Health Organization Performance Measure Validation are annual validation activities outlined in the CMS protocol. Encounter Data Validation evaluates the accuracy and completion of administrative encounters for behavioral health services.
• Annual Technical Reports: Annual Technical Reports and Legislative Reports on Status of Pediatric Health Care Quality Performance Measures
• Site Reviews/Audits: Site Reviews are performed on-site at the MCO/PIHP health care delivery system sites to assess the physical resources and operational practices in place to deliver health care.

412 Audit

2024 RAE 412 Audits: Encounter Data Validation

• 2024 Rocky Mountain Health Plans Medicaid Prime *Rocky Mountain Health Plans disagrees on a number of findings included in this report and has submitted their disagreement with the report to the Department*
• 2024 Denver Health Medical Plan

2023 RAE 412 Audits: Encounter Data Validation

• 2023 Rocky Mountain Health Plans Medicaid Prime *Rocky Mountain Health Plans disagrees on a number of findings included in this report and has submitted their disagreement with the report to the Department*
• 2023 Denver Health Medical Plan 

411 Audit

2024 RAE 411 Audits: Encounter Data Validation

• Region 1: Rocky Mountain Health Plans
• Region 2: Northeast Health Partners
• Region 3: Colorado Access *Colorado Access disagrees on a number of findings included in this report and has submitted their disagreement with the report to the Department*
• Region 4: Health Colorado, Inc.
• Region 5: Colorado Access *Colorado Access disagrees on a number of findings included in this report and has submitted their disagreement with the report to the Department*
• Region 6: Colorado Community Health Alliance
• Region 7: Colorado Community Health Alliance
• Denver Health Medical Plan *Colorado Access disagrees on a number of findings included in this report and has submitted their disagreement with the report to the Department*

2023 RAE 411 Audits: Encounter Data Validation

• Region 1: Rocky Mountain Health Plans *Rocky Mountain Health Plans disagrees on a number of findings included in this report and has submitted their disagreement with the report to the Department*
• Region 2: Northeast Health Partners
• Region 3: Colorado Access *Colorado Access disagrees on a number of findings included in this report and has submitted their disagreement with the report to the Department*
• Region 4: Health Colorado, Inc. "Health Colorado Inc disagrees on a number of findings included in this report and has submitted their disagreement with the report to the Department."
• Region 5: Colorado Access *Colorado Access disagrees on a number of findings included in this report and has submitted their disagreement with the report to the Department*
• Region 6: Colorado Community Health Alliance
• Region 7: Colorado Community Health Alliance
• Denver Health Medical Plan *DHMP disagrees on a number of findings included in this report and has submitted their disagreement with the report to the Department*

Financial Template Review

• RAE 1 Rocky Mountain Health Plan Final Report SFY23
• RAE 2 Northeast Health Partners Final Report SFY23
• RAE 3 Colorado Access Final Report SFY23
• RAE 4 Health Colorado Final Report SFY23
• RAE 5 Colorado Access Final Report SFY23
• RAE 6 Colorado Community Health Alliance Final Report SFY23
• RAE 7 Colorado Community Health Alliance Final Report SFY23
• Colorado Access Child Health Plan Plus Final Report SFY23
• Colorado Access Regional Accountable Entity 5 (Denver Health) Final Report SFY23
• Denver Health Medical Plan Health Maintenance Organization Final Report SFY23
• Denver Health Medical Plan Child Health Plan Plus Final Report SFY23
• Rocky Mountain Health Plan Health Maintenance Organization Final Report SFY23
• Rocky Mountain Health Plan Child Health Plan Plus Final Report SFY23
• Kaiser Permanente Child Health Plan Plus Final Report SFY23
• DentaQuest Child Health Plan Plus Final Report SFY23

Quality of Care Grievance Reports

• Medicaid FY 23-24
• CHP+ FY 23-24

Network Adequacy Validation Reports

• Network Adequacy Validation FY 23-24

**The Department does not exempt managed care health plans from external quality review (438.362.c).**