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.

How to submit a CORA request for documents that have been archived from our website. 

First Three-Year Cycle Review (2023 - 2026)

2024

• Year Two Services:
  • Emergency Medical Transportation (EMT)
  • Non-Emergent Medical Transportation (NEMT)
  • Qualified Residential Treatment Programs (QRTP)
  • Psychiatric Residential Treatment Program (PRTF)
  • Home Health Services
  • Pediatric Personal Care (PPC)
  • Private Duty Nursing (PDN)
  • Physician Services
    • EEG Ambulatory Monitoring Codes
    • Sleep Studies
  • FFS Substance Use Disorder (SUD) Codes
  • Home and Community Based Services (HCBS):
    • ADL Assistance and Delivery Models
    • Behavioral Services
    • Community Access and Integration
    • Community Directed Attendant Support Services (CDASS)
    • Day Program
    • Professional Services
    • Residential Services
    • Respite Services
    • Technology, Adaptations, and Equipment
    • Transition Services 

2024 Medicaid Provider Rate Review Analysis and Recommendation Report

• Appendix A - Research Methodology
• Appendix A1 - Excluded Codes
• Appendix A2 - Base Data Summary
• Appendix A3 - Benchmark Ratios 
• Appendix B - Access to Care Metrics
• Appendix C - Rate Change Track Document
• Appendix D - PDN Cross-work of Benchmark Ratios
• Appendix E - Stakeholder Feedback 
• Appendix F - Glossary & County Reference Map 

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

• November 19, 2024 2:30pm - 3:00pm

 

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