C.R.S.
Section 25.5-5-419
Accountable care collaborative
- reporting
- rules
(1)
In 2011, the state department created the accountable care collaborative, also referred to in this title 25.5 as the medicaid coordinated care system. The state department shall continue to provide care delivery through the accountable care collaborative. The goals of the accountable care collaborative are to improve member health and reduce costs in the medicaid program. To achieve these goals, the state department’s implementation of the accountable care collaborative must include, but need not be limited to:(a)
Establishing primary care medical homes for medicaid clients within the accountable care collaborative;(b)
Providing regional care coordination and provider network support;(c)
Providing data to regional entities and providers to help manage client care;(d)
Integrating the delivery of behavioral health, including mental health and substance use disorders, and physical health services for clients;(e)
Connecting primary care with specialty care and nonhealth community supports;(f)
Promoting member choice and engagement;(g)
Promoting telehealth and telemedicine;(h)
Utilizing innovative care models and provider payment models as part of the care delivery system, including capitated managed care models within the broader accountable care collaborative;(i)
Receiving feedback from affected stakeholder groups;(j)
Establishing a flexible structure that would allow for the efficient operation of the accountable care collaborative to further include medicaid populations and services, including long-term care services and supports; and(k)
Establishing a care delivery system and provider payment platform that can adapt to changing federal financial participation models or funding levels.(2)
The state department shall facilitate transparency and collaboration in the development, performance management, and evaluation of the accountable care collaborative through the creation of stakeholder advisory committees.(3)
On or before December 1, 2017, and on or before December 1 each year thereafter, the state department shall prepare and submit a report to the joint budget committee, the public health care and human services committee of the house of representatives, and the health and human services committee of the senate, or any successor committees, concerning the implementation of the accountable care collaborative. Notwithstanding the provisions of section 24-1-136 (11)(a)(I), the report required pursuant to this subsection (3) continues indefinitely. At a minimum, the state department’s report must include the following information concerning the accountable care collaborative:(a)
The number of medicaid clients enrolled in the program;(b)
Performance results with an emphasis on member health impacts;(c)
Current administrative fees and costs for the program;(d)
Fiscal performance;(e)
A description of activities that promote access to services for medicaid members in rural and frontier counties;(f)
A description of the state department’s coordination with entities that authorize long-term care services for medicaid clients;(g)
Information on any advisory committees created, including the participants, focus, stakeholder feedback, and outcomes of the work of the advisory committees;(h)
Future areas of program focus and development, including, among others, a plan to study the costs and benefits of further coverage of substance use disorder treatment; and(i)
Information concerning efforts to reduce medicaid waste and inefficiencies through the accountable care collaborative, including:(I)
The specific efforts within the accountable care collaborative, including a summary of technology-based efforts, to identify and implement best practices relating to cost containment; reducing avoidable, duplicative, variable, and inappropriate uses of health-care resources; and the outcome of those efforts, including cost savings, if known;(II)
Any statutes, policies, or procedures that prevent regional entities from realizing efficiencies and reducing waste within the medicaid system; and(III)
Any other efforts by regional entities or the state department to ensure that those who provide care for medicaid clients are aware of and actively participate in reducing waste within the medicaid system.(4)
On or before December 1, 2017, the state department shall submit a report to the joint budget committee, the public health care and human services committee of the house of representatives, and the health and human services committee of the senate, or any successor committees, outlining the statutory changes needed to part 4 of this article 5 relating to the statewide managed care system, as well as any other sections of the Colorado Revised Statutes, in order to align Colorado law with the federal “Medicaid and CHIP Managed Care Final Rule”, CMS-2390-F.(5)
The state board shall promulgate rules implementing the accountable care collaborative.(6)
The state department shall consider new technologies and business practices for medical management reform that would reduce medical costs due to misuse, overuse, waste, fraud, and abuse. Better drug management, especially of avoidable prescriptions and inefficient use of specialty drugs, would allow the entire prescription drug cost continuum to be managed more effectively to contain costs and achieve better patient outcomes. New technologies and business practices for medical management reform may also benefit Colorado by providing a more powerful medicaid enrollment platform that properly enrolls only those individuals who are truly eligible for medicaid benefits.
Source:
Section 25.5-5-419 — Accountable care collaborative - reporting - rules, https://leg.colorado.gov/sites/default/files/images/olls/crs2023-title-25.5.pdf (accessed Oct. 20, 2023).
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