2020 Colorado Revised Statutes
Title 25.5 - Health Care Policy And Financing
Article 4. Colorado Medical Assistance Act - General Medical Assistance
Section 25.5-4-422. Cost control - legislative intent - use of technology - stakeholder feedback - reporting - rules.

(1) It is the intent of the general assembly that:

1. The department of health care policy and financing pursue strategies to control costsin the medicaid program authorized in the "Colorado Medical Assistance Act";

2. The state department dedicate permanent staff and resources to pursue cost-controlstrategies, value-based payments, and other approaches to reduce the rate of expenditure growth in the medicaid program; and

3. This section not preclude the state department from pursuing other cost-containmentactivities that are not specifically described in this section.

(2) (a) The state department shall provide information regarding medicaid expenditures and the quality of medical services provided by providers participating in the medicaid program to providers participating in the accountable care collaborative pursuant to section 25.5-5-419.

2. The state department shall provide information regarding medicaid expenditures andthe quality of available pharmaceuticals prescribed by providers participating in the medicaid program to providers participating in the accountable care collaborative pursuant to section 25.55-419.

3. The state department may provide the information described in subsections (2)(a) and(2)(b) of this section to other providers participating in the medicaid program.

(3) (a) The state department shall utilize the medicaid management information system to ensure that claims are automatically reviewed prior to payment to identify and correct improper coding that leads to inappropriate payment in medicaid claims.

(b) The state department may procure commercial technology to implement the requirements of subsection (3)(a) of this section.

(4) (a) The state department shall pursue cost-control strategies, value-based payments, and other approaches to reduce the rate of expenditure growth in the medicaid program.

(b) Prior to implementing and reporting on any new measures authorized by this section, the state department shall provide an opportunity for affected recipients, providers, and stakeholders to provide feedback and make recommendations on the state department's proposed implementation.

(5) By November 1, 2018, the state department shall provide a report to the joint budget committee concerning:

1. The feedback received pursuant to subsection (4)(b) of this section;

2. The timelines for implementation of any cost-control measures enacted pursuant tothis section; and

3. A description of the expected impact on recipients and recipients' health outcomesand how the state department plans to measure the effect on recipients.

(6) (a) The state department shall contract with a third party to perform an independent evaluation of the cost-control measures authorized pursuant to this section.

(b) The state department shall provide a report to the joint budget committee on November 1, 2019, and November 1, 2020, detailing the results of the independent evaluation, including estimates of the cost savings achieved and the impact of the cost-control measures authorized pursuant to this section on recipients and recipients' health outcomes.

(7) The state board shall adopt any rules necessary for the administration and implementation of this section.

Source: L. 2018: Entire section added, (SB 18-266), ch. 264, p. 1622, § 1, effective May 29.