At a Glance is a Department of Health Care Policy & Financing (HCPF) publication that provides information on major initiatives, policy changes and program updates. Feel free to share At a Glance with your colleagues. Find previous editions of At a Glance on our website. Thank you for your interest!

Saving People Money on Health Care and Keeping CO Covered

New Colorado Hospital Transparency Reports and Tools

This month, HCPF released three reports: the Hospital Financial Transparency Report, the Colorado Hospital Community Benefit Annual Report, and the Colorado Healthcare Affordability and Sustainability Enterprise (CHASE) Annual Report. Hospitals represent over 40% of commercial health care dollars, which is why we are continually collaborating with hospitals, employers and other purchasers as well as stakeholders on hospital financial and pricing transparency, accountability, and tools. We appreciate hospitals’ partnership to address Colorado’s traditionally high prices, costs and profits to save Coloradans and our employers money on health care. Hospital efforts over the last several years have been meaningful and measurable in lowering the rate of price increases ultimately paid by Coloradans and our employers. 

Overall, the reports show that compared to 2021, in 2022, Colorado hospitals’ net operating income (profit not including investment income) dropped 50%, total net income (profit including investment losses) dropped by 90%, while Colorado’s urban and system-affiliated hospitals maintained a median of 183 days cash on hand (reserves) in 2022, which is higher than the 149 in 2019. Community benefit investments increased $125 million from the previous fiscal year to $1.09 billion. Consider the below.

• The 2024 Hospital Financial Transparency report reflects data from 2022 and illustrates that Colorado hospitals’ operating expenses grew 10.4% from 2021 while patient revenue grew 5.9% and operating income decreased by $981 million or 50%. This reflects a sharp pivot from 2014-2021 reporting periods when patient revenue growth was substantially higher than expense growth. Contributing to the changes seen in 2022 were hospitals’ increased labor costs, including an alarming chapter of contracted labor expenditure up 247.6% from 2019, in addition to inflationary pressure. Uncompensated care costs also rose 12.5% or $60.5 million between 2021 and 2022 to a total of $544 million, primarily driven by increases in charity care. Despite the shift seen in 2022, numerous indicators show much of Colorado’s hospital industry is healthy, with some exceptions, such as many of the state’s rural hospitals and the state’s largest safety net hospital, Denver Health. The report shows that net patient revenues are returning to trends seen before the pandemic and the median hospital reserve was 183 days cash on hand, meaning hospitals could operate without additional revenue for about six months. This compares to pre-pandemic 2019 reserve levels of about five months. While the investment market returns have turned around since the 2022 outlier losses and the alarming staffing agency impact is largely in the rearview mirror, the increase in frontline staff base wages over the last three years has created a new and higher operating expense baseline while the increase in migrants is having a pivotal impact on Denver Health and a measurable impact on hospitals largely in the greater Denver area.

• Colorado’s Hospital Community Benefit report enables communities to examine how much hospitals are investing in their communities, in lieu of paying taxes, while also illuminating those investment decisions. During hospitals’ fiscal year 2021, their community benefit investment rose 13% to $1.09 billion. Of that spending, 55% was directed into social determinants of health, such as housing, food, transportation, interpersonal violence, education, and job opportunities; 24% into charity care, including free or reduced-cost health care services; and 5% spent on programs addressing health behaviors/risks. HB23-1243 took effect in August 2023 and requires more specific, community benefit reporting categories that will help HCPF better report on specific investment while comparing community investment spending directly to identified needs, starting in 2025.

• The Colorado Healthcare Affordability and Sustainability Enterprise (CHASE) Annual report illustrates that CHASE enabled hospitals to reduce cost-shifting to Coloradans and employers covered by private or commercial payers. In 2022, Colorado hospitals received $0.81 on their dollar of cost of care for Medicaid patients, far and above the $0.70 on the dollar of cost of care they received for Medicare patients. Additionally, in 2022-23, the CHASE provided $464 million in increased reimbursement to hospital providers, and funded health insurance coverage through Health First Colorado (Colorado’s Medicaid program) and Child Health Plan Plus for more than 622,000 Coloradans - with no increase in Colorado General Fund expenditures. We invite all to celebrate this shared partnership and its tremendous result. 

More information is in our press releases and on our Hospital Reports Hub.

HCPF also released the Price Transparency Posting report, which shows that 59% of all Colorado hospitals have a ‘Good’ quality rating, which is about 33% better than the November 2022 measures, reflecting significant improvements in hospital price postings. This tool leverages state and federal legislation that requires hospitals to post their prices by their respective network based product contracts with carriers. Additionally, HCPF launched the Payment Variation Tool that compares hospital inpatient payments to identify low-cost providers. These new transparency tools are part of a shared effort to illuminate and influence more competitive hospital prices that are ultimately paid by Coloradans and employers. Thank you to our hospital partners for your cost and pricing improvements and for your continued collaboration to save Coloradans and our employers' money on health care. 

Continued Partnership to Keep Coloradans Covered

A top priority continues to be to Keep Coloradans Covered, now that Colorado has resumed regular eligibility reviews for people with Health First Colorado and CHP+ after a 3+ year pause during the COVID-19 public health emergency (PHE). Thank you for your active engagement with members, community partners, and advocates leading up to and during the unwind period, and for your continued dialogue to improve the renewal process. Please continue to read our updated website, reporting webpage and newsletters, as well as utilize toolkits to help members and partners complete the renewal process or transition to other affordable health coverage. These are available in the top 11 languages spoken by our members: Update Your Address, Understanding the Renewal Process and Take Action on Your Renewal. Flyers have been developed for employers to distribute to employees to remind them to look for their Health First Colorado renewal packet and where appropriate, how to transition to employer-sponsored coverage, and the importance of doing so in a timely manner. We ask that all stakeholders leverage these tools. 

Timely Updates

Please register to join HCPF and the Behavioral Health Administration for a Medicaid Behavioral Health webinar on Feb. 26 from 11:30 a.m. to 1:30 p.m. The webinar will cover Medicaid behavioral health transformation, relevant policy changes, how changes are impacting communities, and what is coming next.

Finally, we have published the Accountable Care Collaborative (ACC) Phase III Draft Contract, which outlines the emerging contractual requirements for Regional Accountable Entities (RAEs) for Phase III of the ACC that is scheduled to begin on July 1, 2025. The Draft Contract is based on the policy and programmatic recommendations outlined in the ACC Phase III Concept Paper as well as feedback from stakeholders. We have published several documents, available on the ACC Phase III Draft Contract webpage, intended to help stakeholders review and provide feedback. Please provide feedback by March 10 through: Draft Contract Feedback Form, Offeror Questions Feedback Form, or via email at HCPF_ACC@state.co.us.

Mental Health Parity Request for Public Comment:

HCPF has begun work on the annual Mental Health Parity and Addiction Equity Act (MHPAEA) Report to assess the compliance of the Medicaid benefit with mental health parity laws. HCPF is gathering stakeholder thoughts and experiences related to mental health parity. These insights will be used to design the mental health parity analyses and inform an annual report. 

Individuals interested in submitting written comments can do so using our online form. The form will be open until March 15. The purpose is to collect feedback from stakeholders; HCPF will not be responding to submitted comments.  

For more information visit our website. 

Ordering, Prescribing, Referring (OPR) Providers Enrollment Requirement:

Providers are reminded to include Ordering, Referring or Prescribing (OPR) providers on claims and to ensure the OPR provider is currently enrolled with Health First Colorado.

The OPR field on the CMS 1500 claim form is 17b.

Claims with services requiring OPR providers will post Explanation of Benefits (EOB) 1997 - "The referring, ordering, prescribing or attending provider is missing or not enrolled. Please resubmit with a valid individual NPI in the attending field" if the OPR provider is not enrolled with Health First Colorado.

This EOB is an informational message at present, but it will cause claims to deny in the future if claims are not compliant.

Professional Claim Services or items that require an OPR NPI:

• Audiology services
• Durable Medical Equipment/Supplies
• Laboratory services
• Radiology services
• Pediatric Personal Care services
• Physical, Speech and Occupational Therapies

Refer to the program billing manuals on the Billing Manuals webpage for more information and visit the Ordering, Prescribing, and Referring Claim Identifier Project webpage to see what provider types are eligible to be an OPR provider.

eConsult Platform Goes Live:

Colorado Medicaid eConsult is officially live and operational! Health First Colorado providers can now access a secure, statewide electronic consultation platform for free through ColoradoMedicaideConsult.com. 

Colorado Medicaid eConsult aims to improve access to specialty care for members. The platform is designed to assist participating providers in the management of member health care needs with the electronic clinical guidance of specialty providers. It is an alternative to the traditional curbside consultation between providers and reduces unnecessary face-to-face visits for members. 

Interested providers may contact the eConsult Vendor Safety Net Connect (SNC) at Coloradosupport@safetynetconnect.com to enroll as a participating provider or to learn more about the platform.

For more information, refer to the billing guidelines listed in the Telemedicine Billing Manual or email HCPF_econsult@state.co.us.

Recovery Audit Contractor (RAC) Provider Training:

Providers are strongly encouraged to register for training opportunities regarding the RAC program, including:

• What to expect if audited by the Colorado RAC
• Audit timelines
• Usage of the Health Management Systems, Inc. (HMS) Colorado RAC provider portal for audit tracking, record uploads & transparent reporting
• Information on provider rights & responsibilities

HMS and HCPF have created quarterly meetings for different audit types including:

• Complex Audits, Medical Records Reviews
• Hospice Specific Complex Audits, Medical Records Reviews
• Automated Audits, Data & Claims Reviews

Colorado RAC 101: Complex, Medical Records Reviews Training

Feb. 20, 2024, 2 to 3 p.m. MST Registration Link

May 15, 2024, 11 a.m. to 12 p.m. MST Registration Link

Colorado RAC 101: Hospice, Medical Records Reviews Training

March 14, 2024, 1 to 2 p.m. MST Registration Link

June 18, 2024, 2 to 3 p.m. MST Registration Link

Colorado RAC 101: Automated, Data & Claims Reviews Training

April 16, 2024, 10 to 11 a.m. MST Registration Link

Recorded training and presentations for the HMS Colorado RAC 101 and for the HMS Colorado RAC Provider Portal are on the HMS Colorado RAC website at under the tab on the left titled “Resources & Informational Documentation.”

Reminder: Resources to Support Eligibility Renewals Related to the Public Health Emergency (PHE) Unwind:

With the end of the public health emergency (PHE), members are once again required to have their Medicaid eligibility renewal on an annual basis. This is a new process for many members and requires the timely completion of a renewal packet. The following resources are available to support members through the renewal process:

• A guide specifically for helping LTSS members through the renewal process.

• The Renewal Education toolkit can be used by members or partners to familiarize themselves with the basics of the renewal process.

•  Members can learn more about renewals and find FAQs on the Health First Colorado website. Content is available in English and Spanish.

• The KeepCOCovered Toolkit includes information about other health insurance options. 

• FAQs about the end of the Public Health Emergency, including specifics for the LTSS population.

Additionally, HCPF is leveraging flexibility from the Centers for Medicare and Medicaid Services (CMS) to provide a 60-calendar-day extension to complete the renewal process for our vulnerable populations, including long-term care (LTC), members on waivered services, and buy-in recipients who have not returned their renewal packet on time during COVID unwind.

This extension also allows HCPF to do additional outreach to these members when they are up for renewal, while providing extra time for the members to return the information and the counties to process it.

The extension is in effect Sept. 5, 2023, through the remainder of the unwind period, June 2024. It does not affect members who have already submitted their renewal packet to the county or those who have completed the renewal process.

If a member has already turned in their renewal packet and still needs to submit additional information, the county may grant additional time through a Good Faith Extension for a member to turn in this information.

For more information about the extension and frequently asked questions please see the HCPF updates.