Rate Review Reports

Medicaid Provider Rate Review Annual Reports

Use the drop-down menus below to view services reviewed each year and the Department's accompanying Analysis and Recommendation Reports.

First Three-Year Cycle Review (2023 - 2026)

2023

Year One Services:

• Anesthesia
• Ambulatory Surgical Centers
• Fee-for-service Behavioral Health
• Pediatric Behavioral Therapy
• Maternity Services
• Abortion Services
• Dental Services
• Surgeries
  • Digestive System
  • Musculoskeletal System
  • Cardiovascular System
  • Respiratory System
  • Integumentary System
  • Eye and Auditory System
  • Other Surgeries
  • Co-Surgeries

2023 Medicaid Provider Rate Review Analysis and Recommendation Report

• Appendix A - Cycle 1 Year 1 Methodology and Data
• Appendix A - Table 2(a)  
• Appendix B1 - Base Data Summary
• Appendix B2 - Rate Ratios
• Appendix B2 (2) 
• Appendix C - Fiscal Impact
• Appendix D - Stakeholder Feedback
• Appendix E - Glossary and County Reference Map

Health Care Policy & Financing MPRRAC Report Presentation to the Joint Budget Committee

• November 28, 2023 9:00am - 9:30am

Rate Change Tracking Spreadsheet

• 2023 Rate Change Tracking Spreadsheet

Second Five-Year Review Cycle (2021-2025) Update - Review Cycle changed from 5 years to 3 years in 2023

2022

Year Two Services:

• Physician Services
• Dialysis & Nephrology
• Eyeglasses & Vision
• Laboratory & Pathology
• Injections & Miscellaneous J-Codes

2022 Medicaid Provider Rate Review Analysis Report

• Appendix A - Glossary & Colorado State County Classification Map
• Appendix B - Physician Services Data & Methodologies
• Appendix C - Dialysis, Vision, Laboratory, & Injections Data & Methodologies
• Appendix D - Service Groupings Data Book
• Appendix E - COVID-19 Impact on Services
• Appendix F - Respiratory Services Additional Data
• Appendix G - Out-of-Cycle Review Data Analysis Methodology

 

2022 Medicaid Provider Rate Review Recommendation Report 

2021

Year One Services:

• Emergency Medical Transportation (EMT)
• Non-Emergent Medical Transportation (NEMT)
• Home and Community-Based Services (HCBS) Waivers
• Targeted Case Management (TCM)

Report Documents

2021 Medicaid Provider Rate Review Analysis Report (Main Report)* 

• Appendix A - Glossary
• Appendix B - Transportation Data and Methodologies
• Appendix C - HCBS and TCM Data and Methodologies
• Appendix D - CDASS Rate Analysis
• Appendix E - Service Groupings Data Book
• Appendix F - HCBS Service Groupings by Waiver
• Appendix G - Rate Comparison with PACE and HCBS Services
• Appendix H - OCL Stance on Direct Care Workforce
• Appendix I - COVID-19 Impact on Services
• Appendix J - Transportation Services Visual Data

*Please note that the Medicaid Provider Rate Review Advisory Committee (MPRRAC) does not agree with the findings of this report, specifically regarding Transportation Services.

 

2021 Medicaid Provider Rate Review Recommendation Report 

 

First Five-Year Review Cycle (2016-2020)

2020

Year Five Services: 

Pediatric Personal Care Pediatric Behavioral Therapy Prosthetics, Orthotics, and Supplies Vision Services

Home Health Services Private Duty Nursing Speech Therapy Physical and Occupational Therapy

2020 Medicaid Provider Rate Review Analysis Report

2020 Medicaid Provider Rate Review Recommendation Report

 

2019

Year Four Services:

Ambulatory Surgical Centers Fee-for-Service Behavioral Health Services Residential Child Care Facilities Psychiatric Residential Treatment Facilities

Special Connections Program Services Dialysis Durable Medical Equipment

2019 Medicaid Provider Rate Review Analysis Report

• Appendix A - Glossary
• Appendix B - Rate Comparison and Access to Care Analysis Methodologies
• Appendix C - Service Grouping Data Book

2019 Medicaid Provider Rate Review Recommendation Report

 

2018

Year Three Services:

Evaluation and Management Primary Care Services Radiology Physical and Occupational Therapy

Maternity Services Surgeries Physician Services Dental Services

2018 Medicaid Provider Rate Review Analysis Report

• Appendix A - Glossary
• Appendix B - Rate Comparison Analysis Methodology
• Appendix C - Access to Care Analysis Methodology
• Appendix D - Service Grouping Data Books
• Appendix E - Dental Services Rate Comparison Analysis Methodology
• Appendix F - Rate Ratio Scatterplots

2018 Medicaid Provider Rate Review Recommendation Report

 

2017

Year Two Services:

Home- and Community-Based Waivers Physician Services

Surgeries Anesthesia

2017 Medicaid Provider Rate Review Analysis Report - Physician Services, Surgery, and Anesthesia

• Appendix A - Payment Comparison Methodology
• Appendix B - Rate Data Book
• Appendix C - Access Analysis Methodology
• Appendix D - Access Data Book

2017 Medicaid Provider Rate Review Analysis Report - Home- and Community-Based Services (HCBS) Waivers

• Appendix A - Payment Comparison Methodology
• Appendix B - Aggregate Utilization Data for Common Adult LTSS Waivers by Waiver
• Appendix C - Rate Review Process and Consumer Directed Attendant Support Services

2017 Medicaid Provider Rate Review Recommendation Report

 

2016

Year One Services:

Laboratory and Pathology Private Duty Nursing Home Health

Non-Emergent Medical Transportation Emergency Medical Transportation Physician-Administered Drugs

2016 Medicaid Provider Rate Review Analysis Report

2016 Medicaid Provider Rate Review Recommendation Report