Jan. 31, 2023
General Assembly Newsletter
Stay up-to-date on what's new at the Department of Health Care Policy & Financing with our newsletter created specifically for the Colorado General Assembly.
Editor's Note
This newsletter is published monthly while the legislature is in session, and quarterly outside of the legislative session.
Please continue to direct any questions or constituent issues to the Department's legislative team: 

A Message from Executive Director Kim Bimestefer 
Kim Bimestefer
PHE Coverage Update; Legislative and Affordability Priorities

Thank you for your partnership in another unprecedented year for health care. Together, we are now successfully serving 1.74 million Coloradans, representing an additional 490,000 people — an increase of 39% since the start of the pandemic. Related, H.R.2617, the federal budget signed into law on Dec. 29, 2022, indicates that beginning April 1, 2023, states can start disenrolling individuals who no longer qualify for Medicaid through the eligibility redetermination process. In partnership with the counties, and after many months of planning and preparation, Colorado will take 12 months (14 months including noticing) to complete this process, leveraging the member’s annual renewal date and our modernized, member-centric processes. We are analyzing the related guidance from CMS received on Jan. 5 and will make any refinements to our plans, accordingly. With continuity of coverage top of mind, we are collaborating with Connect for Health Colorado and others to connect members who are no longer eligible for our programs to other affordable health coverage. More than 550 community partners joined us at our Jan. 25 Community Partner webinar to learn more; we will be posting the recording soon and please visit our website to help us achieve our shared goal of keeping Coloradans covered through this transition.

At our Jan. 12 SMART Act hearing, we shared more about HCPF priorities, our legislative agenda, performance against published goals and more. For further details, please visit our website. We also welcome your review of our FY 2021-22 annual report. Amidst the unprecedented growth in membership during the COVID-19 Public Health Emergency (PHE), we kept Health First Colorado per member per month cost trends flat while evolving innovations that drive industry transformation, improve quality, reduce disparities and improve the health of our members. Our leadership in driving affordability will continue to help us manage our own budget (about 30% of the state’s overall budget), while helping save Coloradans and employers money on health care as well.

As we begin the legislative session, feel free to visit 2023 Legislative Agenda Overview to learn more about our emerging legislative agenda, which currently includes:
  • Nursing Facility Sustainability and Transformation to implement the 2022 Nursing Facility Reimbursement Recommendations and ensure the industry continues to transform and innovate to meet the needs of Colorado’s growing older adult population and individuals with disabilities, while ensuring industry fiscal stability.
  • Removal of Most Medicaid Co-Pays consistent with our R-7 Provider Rate Adjustments budget request. This would help us make care more accessible to members, reduce health disparities, improve provider reimbursements while lowering provider administrative burden. 
  • Public Health Emergency (PHE) Unwind Alignment to ensure the necessary state authority to continue to access federal COVID-19 funding while mitigating future federal non-compliance clawbacks of the $1.5 billion received from the 6.2 points of added FMAP to date and related funding still to come.  
  • Medicaid Provider Rate Review Advisory Committee (MPRRAC) which supports the JBC in enabling targeted Medicaid provider rate adjustments more frequently - every three years instead of every five. 

To save Coloradans, the state and our employers money on health care, on Dec. 5, the Polis-Primavera administration and HCPF submitted Colorado’s proposal to the U.S. Food and Drug Administration (FDA) to import prescription drugs from Canada. The plan identifies 112 drugs with an average savings of over 60% that could be available through this program, once approved by the FDA. Additionally, Colorado Medicaid executed its third pharmaceutical value-based contract. These contracts will help deliver savings to taxpayers, state and federal budgets in the form of manufacturer refunds if the respective drug does not meet expected health outcomes for Medicaid members who are taking them. Last, a huge thank you to the more than 10,000 Health First Colorado prescribers (44%) who are using the affordability module of our prescriber tool. Through emerging value-based payment methodologies, we are taking the necessary steps now to share the millions in savings generated through the tool with providers starting next fiscal year.

Thank you for your continued partnership, and best wishes for a healthy, rewarding, transformational 2023!
HCPF 2023 Legislative Agenda
The Department is working hard at the Capitol on bills like HB23-1040 - Prader-Willi Syndrome, which would make a technical change to statute by removing outdated and inconsistent language related to Prader-Willi Syndrome. Prader-Willi Syndrome is a rare genetic disorder that results in a number of physical, mental and behavioral complications. 

We are also driving efforts to remove co-payments in Medicaid, align with the PHE unwind at the federal level and ensure the nursing facility industry continues to move forward with innovative practices aimed at improving their long-term sustainability. Other Department Agenda Bills include:

  • Nursing Facility Sustainability and Transformation, which would implement HCPF’s recommendations in the 2022 Nursing Facility Reimbursement Recommendations Report and ensure the nursing facility industry continues to move forward with innovative practices aimed at improving their long-term sustainability.
  • Removal of Most Medicaid Co-Pays, a companion bill to the Department’s R-7 Provider Rate Adjustments budget request, would grant the Department authority to eliminate co-pays for most Medicaid benefits.
  • Public Health Emergency (PHE) Unwind Alignment would ensure the Department has the necessary state authority to continue to access federal funding related to COVID-19 response and recovery activities for the 14-month period after the end of the PHE.
  • Medicaid Provider Rate Review Advisory Committee (MPRRAC) would support the JBC in enabling targeted Medicaid provider rate adjustments more frequently - every three years instead of every five.

We look forward to working with you on each of these important bills this session. Please also check out our Legislative Agenda Overview.
HCPF 2023-2024 Budget Agenda Summary
The Department’s Budget Agenda Summary outlines discretionary budget requests submitted to the Colorado General Assembly for consideration as part of the Governor’s Fiscal Year (FY) 2023-24 budget, which runs from July 1, 2023 – June 30, 2024. 

The Department’s budget requests focus on improving health equity for Health First Colorado (Colorado’s Medicaid program) members, stakeholder engagement, tools to improve quality and ensure compliance, supporting children and youth with complex needs, supporting Behavioral Health Administration claims processing, increasing provider rates, and improving case management to align with federal and state requirements. 

Additional detail is available on our website. The budget becomes final after the Colorado General Assembly passes the Long Bill and the Governor signs it into law.
We had our SMART hearing on Jan. 12, 2023. You can find materials for it at our Legislator Resource Center.
JBC Hearing
The Department presented to the JBC on the Department’s overall budget requests for FY 2023–24 on Dec. 21, 2022. All of our hearing responses and presentation materials are at our Legislator Resource Center.
Hospital Reports
Earlier this month, the Department released three hospital transparency reports detailing how large hospital systems in Colorado have profited during the pandemic. The reports illustrate that while each of the metrics is moving in the right direction overall, specific hospitals could be making far more impactful strategic decisions to greatly improve community impact from the $965 million in community investments that Colorado’s not-for-profit hospitals make in lieu of paying taxes. Advances in hospital affordability is a top priority for the Polis-Primavera administration in Saving People Money on Health Care, and these reports will help policymakers and communities drive solutions that save Coloradans and employers money on health care.

Read more about the reports in our Jan. 18 press release.

Read the reports here: 

New Legislator 101
The Department is looking forward to hosting a series of live meetings that will take a deep dive into various aspects of health care and Medicaid in Colorado. This series will cover topics like how our budget works, Colorado’s approach to the delivery system, behavioral health coverage in Medicaid, prescription coverage and affordability initiatives, hospital costs and transparency, and the end of continuous coverage. Please be on the lookout for an invitation, as we will host the first meeting on Feb. 15 from 8-8:45 a.m.
HCPF Submits New Reports & LRFIs to the General Assembly
County-By-County Resources
These county fact sheets provide an annual snapshot by fiscal year for Health First Colorado (Colorado’s Medicaid Program) activity, including average annual caseload and top five claim types for each county.
Legislator Resource Center 
TheLegislator Resource Centeron our website is available to help legislators and legislative staff easily find information. It includes links to reports, fact sheets and overviews of the budget process to help inform legislators. 

We invite legislators and legislative staff to follow us on social media to stay informed of news and happenings at the Department. For the 2023 legislative session we are posting daily HCPF 101 facts to help you learn more about the services we provide, our members and the ways we work to keep Coloradans healthy. You can follow us on Facebook, Twitter and LinkedIn.
Follow HCPF on Social Media
We invite legislators to follow us on social media to stay informed of news and happenings at the Department. You can follow us on FacebookTwitter and LinkedIn.