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).


  • 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.
  • Client Satisfaction Surveys (CAHPS)Standardized surveys that ask consumers and patients to report on and evaluate their experiences with health care.
  • StudiesFocused Studies identify opportunities and meaningful interventions that will promote quality care. Interventions developed based on recommendations from the Focused Studies.
  • 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.
  • BHO Quality Plans and Annual EvaluationsHealth Care Policy and Financing (the Department) requires Behavioral Health Organizations (BHOs) to complete and submit annually a Quality Improvement Plan and Annual Quality Report. These reports note findings and opportunities for improvement and list techniques used the BHOs to improve performance.
  • Annual Technical Reports: Annual Technical Reports and Legislative Reports on Status of Pediatric Health Care Quality Performance Measures
  • Site Reviews/AuditsSite 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.
  • Experience of Care and Health Outcomes (ECHO) Surveys: Satisfaction surveys for clients who have received behavioral Health care services.

412 Audit

2023 RAE 412 Audits: Encounter Data Validation

2022 RAE 412 Audits: Encounter Data Validation

2021 RAE 412 Audits: Encounter Data Validation

2020 RAE 412 Audits: Encounter Data Validation

411 Audit

2023 RAE 411 Audits: Encounter Data Validation

2022 RAE 411 Audits: Encounter Data Validation

2021 RAE 411 Audits: Encounter Data Validation

2020 RAE 411 Audits: Encounter Data Validation

Quality and Performance Reporting

Starting in 2015 some online reports include an Accessible format that lists just the Executive Summary. Non-Accessible reports including all content can be requested by contacting the Department's Quality and Health Improvement Unit. Colorado does not currently exempt Managed Care Entities (MCEs) from External Quality Review (EQR).

Financial Template Review