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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.
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This newsletter is published monthly while the legislature is in session, and quarterly outside of the legislative session. The next edition will be published in March 2020.
Please continue to direct any questions or constituent issues to the Department of Health Care Policy & Financing (the Department) legislative team:
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Rachel Reiter,
HCPF Deputy Director of Policy, Communications & Administration
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Message from Executive Director Kim Bimestefer
The legislative session is underway, and the Department of Health Care Policy & Financing (the Department) is hard at work supporting efforts to improve health care affordability for all Coloradans and our employers.
Our Department provides health care coverage to more Coloradans than any insurance carrier in the state, covering almost one in four Coloradans with a budget of more than 25 percent of the state's General Funds. Consequently, we are called upon to be a trusted advisor, resource, leader and innovator for responsible health care transformation to the betterment of our members and all Coloradans. At the same time, our leadership in transforming health care better enables our Department and our passionate staff to provide cost-effective access to the critical benefits, services and support programs that so many Coloradans rely on each day.
To that end, together with Lt. Gov. Dianne Primavera and the Office of Savings People Money on Health Care, we released the
Colorado Hospital Cost Shift Analysis report on Jan. 23.
The report reveals that despite significant reductions in Colorado's uninsured rate and uncompensated care, and significant increases in Medicaid reimbursements, Colorado hospitals are persistently increasing the price they charge for their services. Hospital costs represent both the largest component and the most significant driver of rising health care costs; Department reports like this are therefore critical tools to help elected officials and stakeholders form effective affordability policy to the betterment of Coloradans and our employers.
On Dec. 31, the Department submitted the Hospital Transformation Program (HTP) 1115 demonstration waiver application and State Plan Amendment to the Centers for Medicare and Medicaid Service (CMS). The federal comment period for the waiver ended Feb. 9 and the Department is working with CMS on specific program components. At the end of February, the HTP team will begin providing in-person trainings throughout the state to review the requirements and answer questions for hospitals participating in the program. We'd like to thank stakeholders, hospitals and community partners for their participation in the HTP process.
On Jan. 15, the Department submitted the Hospital Expenditure Report to the General Assembly. This report details the activities the Department has undertaken to implement HB19-1001 (Hospital Transparency) and HB19-1320 (Hospital Community Benefit) to date. An addendum to this report will be submitted before the end of the 2019-20 fiscal year, when the detailed data from hospitals has been collected and analyzed.
Together, we can achieve greater health care affordability for Coloradans and our employers. Thank you for your continued partnership on this important work!
Kim
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HCPF 2020 Legislative Agenda
The 2020 legislative session convened on January 8, 2020. A brief overview of the
Department's legislative agenda can be found on the Department's website. This year, our agenda bills focus on:
- Children's Habilitation Residential Program (CHRP) Waiver Rulemaking.
- Renew Overexpenditure and Transfer Authority.
- Skilled Nursing Facilities: Establishing a Demonstration of Need and Technical Changes.
- Remove Annual 3% Increase for Skilled Nursing Facilities.
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HCPF FY 2020-21 Budget Agenda
A summary of the Department's discretionary budget requests submitted for consideration to the Colorado General Assembly, as part of the Governor's Fiscal Year (FY) 2020-21 budget, is now posted on our website. These requests focus on improving customer service, benefits management, compliance and controlling costs. The requests include strategic investments in technology to support pharmacy benefits and payment reforms.
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Colorado Hospital Cost Shift Analysis Report
The Department and Lt. Governor Dianne Primavera released the Colorado Hospital Cost Shift Analysis Report that reveals, despite significant reductions in uninsured rates and uncompensated care, Colorado hospitals are persistently increasing the price of care while receiving significant increases in Medicaid payment rates.
The information in this report is important as hospitals are key partners caring for Health First Colorado members; they also account for a significant portion of our overall claim spending - about 30% of our Medicaid spend, 40%+ of Employer spend, and almost 50% of spend for Individual policyholders.
- Cost increases in Colorado are significantly higher than national averages.
- Hospital profits have increased significantly.
- Hospital prices increased more sharply than the patient volume.
- Uncompensated and charity care decreased significantly.
- Cost shifts are driven by strategic decision by hospitals rather than shortfalls from pubic insurance.
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In response to the report, Reducing Prescription Drug Costs in Colorado, released in December, the Department is engaged in two bills this session that will bring more transparency into drug pricing and production. Both bills are important to addressing rising pharmaceutical costs, especially for new and specialty drugs.
HB20-1160 (Drug Price Transparency Insurance Premium Reductions) requires health insurers, pharmacy benefits management firms and prescription drug manufacturers to provide data and information to the Commission of Insurance. The Commissioner will analyze the information to determine the effect on premiums.
SB20-107 (Drug Production Costs Transparency Analysis Report) authorizes the Department to collect information on the 20 highest-cost prescription drugs by total expenditure and per course of therapy for the Department of Corrections, Human Services, Personnel and Health Care Policy & Financing. The Department will use the information to determine the basis for the wholesale acquisition cost of each drug and issue a report to the General Assembly.
Prescription drug costs are the fastest growing consumer health care expense in the United States. The high cost of prescription drugs has a direct impact on patient compliance with their medications. More than 1 in 10 Coloradans did not fill a prescription due to cost in 2019.
This legislation will give policy makers and the public information to more accurately assess the factors that go into the prices for prescription drugs to better understand the pricing and value of high-priced drugs.
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Substance Use Disorder (SUD) Benefit Update
Regional Capacity Stakeholder Meetings
The Department continues its series of Regional Capacity meetings during January and February 2020. At these public meetings, the Department will be presenting information on SUD treatment capacity and hearing from community members about the needs in that local area. The regional meetings serve as opportunities for the public to provide input and ask questions about the implementation of coverage for residential and inpatient SUD treatment and withdrawal management services.
SUD Implementation Workgroup
The Department convened the SUD Implementation Workgroup on January 15, 2020. The workgroup, comprised of representatives from Regional Accountable Entities (RAEs), Managed Services Organizations (MSOs), Colorado Office of Behavioral Health, and Department staff, will address various issues (utilization management, care coordination, provider enrollment/billing, capacity development, provider training and support, etc.) that need to be addressed prior to the introduction in July 2020 of Medicaid coverage for new SUD treatment benefits.
Federal Authorities for SUD service coverage
The Department is working with the Centers for Medicare and Medicaid (CMS) Services on the three revisions to federal authorities that are required to provide coverage for those services. Those authorities include the 1115 waiver, State Plan and 1915(b) waiver.
For more information, please visit the Department's SUD website.
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Hospital Transformation Program (HTP) Update
Update on federal authorities
On December 31, 2019, the Department submitted the HTP 1115 demonstration waiver application and State Plan Amendment to CMS. The Department would like to thank stakeholders, hospitals and community partners for their participation in the process.
The next steps in the process involve a 30-day federal comment period and well as the Department working with CMS to address any questions that arise during this period.
HTP Road Show training for hospitals
The HTP team will be traveling around the state for in-person trainings to review the requirements and answer questions for hospitals participating in the HTP. Please mark your calendars or contact Joe Sekiya, Hospital Transformation Project Coordinator, for additional information.
- Thursday, February 27 from - University of Colorado Anschutz Medical Campus in Denver
- Friday, February 28 from 10 a.m. to 2:30 p.m. - Yuma District Hospital in Yuma
- Thursday, March 5 from 10 a.m. to 2:30 p.m. - St. Mary's Medical Center in Grand Junction
- Friday, March 6 from 1 p.m. to 5 p.m.- Valley View Hospital in Glenwood Springs
- Friday, March 13 from 10 a.m. to 2:30 p.m. - Heart of the Rockies Regional Medical Center in Salida
Measures updates
At the end of January, updated versions of HTP Measures list, Measures Overview, Scoring Framework and Measures Specifications were posted to the HTP website under the "Hospital Transformation Program Overview & Framework" section.
If you'd like to know more about the HTP, we encourage you to visit
the HTP website as well as read past editions of the HTP Newsletter in
our online archives. If you have additional questions about the HTP, please contact
Courtney Ronner, Hospital Relations and Communication Manager.
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HCPF Submits New Reports & LRFIs to the General Assembly
Since the last newsletter, the Department submitted new reports and Legislative Requests for Information (LRFIs) to the General Assembly. All can be found on the Legislator Resource Center page.
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Medicaid Snapshot and County-by-County Resources
These
County Fact Sheets
provide an annual snapshot by fiscal year for Colorado's Medicaid program activity including average annual caseload and top five claim types for each county.
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Legislator Resource Center
The
Legislator Resource Center
on 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.
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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
Facebook
,
Twitter
and
LinkedIn
.
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Colorado Department of Health Care Policy & Financing
(303) 866-2993 | 1570 Grant Street, Denver, CO 80203
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