Quality and Health Improvement Reports | Department of Health Care Policy and Financing

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).

Opportunity for Public Comment

During the public comment period, when submitting comments for the 2024 State of Colorado Quality Strategy and/or the 2024 Evaluation and Effectiveness Review, please indicate which document and reference the page number for your comments.

Comments may be submitted via one of the following methods:

Email to hcpf_quality_improvement@state.co.us
Fax to 303-866-4411, Attn: Public Comment – CMS Quality Strategy
Mail your comments to:
Colorado Department of Health Care Policy and Financing
Attn: Public Comment – CMS Quality Strategy
303 East 17th Avenue, Suite 1100
Denver, CO 80203

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.
Experience of Care and Health Outcomes (ECHO) Surveys: Satisfaction surveys for clients who have received behavioral Health care services.
- 2020

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

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

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*

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*

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

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

Financial Template Review

Quality of Care Grievance Reports

Network Adequacy Validation Reports

Network Adequacy Validation FY 23-24