Statewide Managed Care System

The bill amends, repeals, and relocates provisions of part 4 of article 5 of title 25.5, Colorado Revised Statutes, relating to managed care provisions under the medical assistance program to align with the federal 'Medicaid and CHIP Managed Care Final Rule of 2016', and to reflect the implementation of the accountable care collaborative as the statewide managed care system. The bill: Updates the definition of the statewide managed care system and makes conforming amendments throughout the statutes; Integrates medicaid community mental health services into the statewide managed care system; Includes capitated rates specifically for community mental health services; Establishes the medical home model of care for the statewide managed care system; Relocates provisions relating to graduate medical education; Clarifies that the statewide managed care system is authorized to provide services under a single managed care entity (MCE) or a combination of MCE types, including primary care case management entities authorized under federal law; Removes duplicate provisions relating to the medicaid reform and innovation pilot program; Relocates provisions relating to the requirement that MCEs certify capitation payments as sufficient; Removes outdated language referencing behavioral health organizations; Updates the definitions for 'managed care' and 'managed care entities' and adds definitions for 'medical home' and 'primary care case management entities'; Aligns provisions in statutes relating to the features of MCEs with new and existing federal managed care regulations that require: Criteria for accepting enrollees and protecting enrollees from discrimination; Provisions relating to network adequacy standards; Revised communication standards; Updated provisions relating to grievances and appeals; Participation in a comprehensive quality assessment and performance improvement program; and Administration of a program integrity system; Removes certain provisions from statute relating to prescription drug contracting practices that were relevant to a competitive managed care organization model or that duplicated provisions established in rule; Removes references to the obsolete primary care physician program; Increases the timeline for the rate setting process for capitation rates to meet new federal review requirements; Repeals statutory sections that contain provisions that are relocated or revised and included in other statutory sections in the bill, and repeals statutory sections that include obsolete programs or policies; and Updates statutory references to reflect the relocated, revised, or repealed provisions.(Note: This summary applies to the reengrossed version of this bill as introduced in the second house.) Read More