November 2, 2020
The Insider
The purpose of this newsletter is for the Department of Health Care Policy & Financing (the Department) to provide insightful updates to eligibility sites regarding creation and implementation of Medicaid Oversight & Accountability programs.
Thank you for your feedback and engagement!
The Department has launched a series of new or revised work streams intended to improve eligibility oversight, performance, accuracy, and outcomes for members.

This work includes a new Management Evaluation (ME) Review Program, Eligibility Quality Assurance (QA) Program, Eligibility Site Dashboards and County Administration Rule revisions.

We anticipate you may have a lot of questions about the scope and development of this work. We will begin providing regular updates this new Medicaid Oversight & Accountability Newsletter.
Medicaid Oversight & Accountability Task Group Updates
The Department is working closely with county and eligibility site stakeholders through a joint effort called the Medicaid Oversight and Accountability Task Group. This venue allows the Department to receive valuable feedback from eligibility sites on each of the different workstreams underway.

During the September 2020 meetings, we reviewed the error rates findings from the Office of State Auditor (OSA) 2018-2019 audit, shared the initial concept of the Eligibility Quality Assurance Program and discussed the Measure Galleries for Performance and Accuracy Measures and the Eligibility Site Dashboard.

All task group meeting recordings and resources can be found on the Medicaid Oversight and Accountability Task Group web page.
Management Evaluation (ME) Review Program
The Department is in the process of developing a new in-person oversight program intended to support local administration by eligibility sites and ensure compliance of the Department’s programs to ensure the best outcome for Health First Colorado members.

The ME Review Program will consist of qualitative and quantitative reviews of different “modules” encompassing various Medical Assistance business processes. The “modules” are designed to help improve the Department’s understanding of eligibility site operations and, if needed, to provide targeted technical assistance for those eligibility sites in need of additional support.

The initial concept was shared with eligibility sites in August 2020 and the final concept will be presented to the Medicaid Oversight & Accountability task group in November 2020. This workstream will be in the implementation phase by the end of December 2020, with the first round of ME Reviews to be conducted early 2021.

You can review the Aug. 28, 2020 ME Review Program presentation and recording.
Eligibility Quality Assurance (QA) Program
As outlined in previous communication from Executive Director Bimestefer, the findings of the latest OSA audit pose a significant financial risk to the state if the error rate is not addressed quickly and comprehensively. Colorado could have to pay back any federal funds for an error rate above 3%.

To support eligibility sites in addressing error reports and broader audit findings, the Department is launching a Eligibility QA Program. The Eligibility QA team will perform determination reviews on all eligibility sites by:

  • Reviewing eligibility determinations for accuracy and timeliness.
  • Sampling determinations on a monthly basis to provide more current results.
  • Utilizing data mining in the Colorado Benefits Management System (CBMS) to help focus reviews. 

The QA Program will provide eligibility sites with additional monitoring and support to help refine business processes to limit errors and improve member experience.

The initial concept was shared with the Medicaid Oversight & Accountability task group in September 2020 and the accuracy measures were shared and feedback sessions occurred in September and early October 2020. This workstream will be in the implementation phase in the first calendar quarter of 2021.

You can review the September 25, 2020 Error Rates/QA Program presentation and recording.
HCPF Eligibility Site Dashboard
The Department’s new Eligibility Site Dashboard will be a one-stop-shop for performance and accuracy measures across all eligibility sites using the Performance Management Process (PuMP) methodology. PuMP is an eight-step blueprint/framework used to design and implement meaningful performance measures.

The dashboards will display different elevations of data so that both directors and front-line staff are able to see their performance. A dashboard example can be viewed here.

The initial concept was shared with eligibility sites in August 2020, with follow up meetings in September and early October 2020. This workstream will be implemented in the first quarter of 2021.

You can review the Aug. 14, 2020 PuMP Introduction presentation and recording.

You can review the Sept. 11, 2020 Performance Measures and Dashboard Introduction presentation and recording.

You can review the Oct. 9, 2020 Accuracy Measures and Dashboard presentation and recording.
County Administration Rule Revisions
The nature of our work has changed drastically this year, let alone in the past ten years since the County Administration Rules were last updated.

In an effort to modernize the County Administration Rules to better align with federal and state requirements, current business operations, and other public assistance programs (where possible), the Department has completed a gap analysis and review of all current state and federal regulations, rules and guidance.

This initial concept will be presented to the Medicaid Oversight & Accountability task group in November 2020; a finalized date of implementation has not yet been scheduled.
Contact
Questions? Contact Steve King, County Oversight Administrator.