Colorado Medicaid panel outlines $5.1 million and $100.4 million rate options

The chair of Colorado’s Medicaid Provider Rate Review Advisory Committee outlined two alternative provider-payment packages to the state Joint Budget Committee on Nov. 13: a $5.1 million “pragmatic” option and a $100.4 million “ideal” option, the chair told the committee.

The smaller package would raise fee-for-service mental-health rates from 78% to 80% of the state benchmark and Nurse Home Visitor Program rates to 80%. It also includes adjustments for non-emergency medical transportation, dental services for people with developmental disabilities, State Dental Plan services and ambulatory surgical centers. To offset some increases, it would lower certain surgical-service rates from 88% or 90% of benchmark to 85%. The chair said those reductions would generate several million dollars in savings.

The larger package includes the smaller one and adds broader increases. It would raise State Dental Plan rates from 97% of benchmark and pediatric behavioral-therapy rates from 92% to 100%. It would also bring non-emergency medical transportation codes below the benchmark up to 100%; the chair estimated that change alone would cost $21 million. He said the main transportation codes were already above the benchmark.

The chair described both package amounts as total-fund estimates, without a breakdown of the state general-fund share. For the Nurse Home Visitor Program, he cited a separate department estimate of about $4 million to $5 million to bring codes to benchmark and discussed tobacco-settlement funds and a reserve as possible funding sources. He also described per-member-per-month payments as a possible cost-neutral alternative to code-based rates if set at the same payment level.

Neither package was adopted during the Nov. 13 presentation; both remain proposals, not approved spending or adopted rate changes.