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
- 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.
- Client Satisfaction Surveys (CAHPS): Standardized surveys that ask consumers and patients to report on and evaluate their experiences with health care.
- Studies: Focused 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 Evaluations: Health 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/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.
- 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
- 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
2022 RAE 412 Audits: Encounter Data Validation
- 2022 Rocky Mountain Health Plans 412 Audit: Encounter Data Validation *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*
- 2022 Denver Health Medical Plan 412 Audit: Encounter Data Validation
2021 RAE 412 Audits: Encounter Data Validation
- 2021 Rocky Mountain Health Plans 412 Audit: Encounter Data Validation
- 2021 Denver Health Medical Plan 412 Audit: Encounter Data Validation
2020 RAE 412 Audits: Encounter Data Validation
- 2020 Rocky Mountain Health Plans 412 Audit: Encounter Data Validation
- 2020 Denver Health Medical Plan 412 Audit: Encounter Data Validation *Denver Health disagrees on a number of findings included in this report and has submitted their disagreement with the report to the Department*
2019 RAE 412 Audits: Encounter Data Validation
- 2019 Rocky Mountain Health Plans 412 Audit: Encounter Data Validation *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*
- 2019 Denver Health 412 Audit: Encounter Data Validation *Denver Health disagrees on a number of findings included in this report and has submitted their disagreement with the report to the Department*
2018 RAE 412 Audits: Encounter Data Validation
- 2018 Denver Health 412 Audit: Encounter Data Validation *Denver Health disagrees on a number of findings included in this report and has submitted their disagreement with the report to the Department*
411 Audit
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*
2022 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.
- 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
2021 RAE 411 Audits: Encounter Data Validation
- Region 1: Rocky Mountain Health Plans
- Region 2: Northeast Health Partners
- Region 3: Colorado Access
- Region 4: Health Colorado, Inc.
- Region 5: Colorado Access
- Region 6: Colorado Community Health Alliance
- Region 7: Colorado Community Health Alliance
2020 RAE 411 Audits: Encounter Data Validation
- Region 1: Rocky Mountain Health Plans
- Region 2: Northeast Health Partners *Northeast Health Partners disagrees on a number of findings included in this report and has submitted their disagreement with the report to the Department*
- Region 3: Colorado Access
- Region 4: Health Colorado, Inc.
- Region 5: Colorado Access
- Region 6: Colorado Community Health Alliance
- Region 7: Colorado Community Health Alliance
2018 BHO 411 Audits: Encounter Data Validation
- Access Behavioral Care Denver
- Access Behavioral Care Northeast
- Behavioral Healthcare, Inc.
- Colorado Health Partnerships, LLC
- Foothills Behavioral Health Partners, LLC
Quality and Performance Reporting
- Quality Health Improvement Project - Improving Access to Key Services for At-Risk Children and Families
- Quality and Health Improvement 2016 Data Report
- Performance Improvement Projects (PIPs): Improvement projects completed by the Department's contracted health plans
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).