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Joint Budget Committee Hearing:
Executive Director’s Office
December 13, 2017
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Tom Massey, Interim Executive Director
John Bartholomew, Chief Financial Officer
Josh Block, Budget Director
Gretchen Hammer, Medicaid Director
Chris Underwood, Health Information Office Director
Dr. Judy Zerzan, Chief Medical Officer
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Our Mission
Improving health care access and
outcomes for the people we serve
while demonstrating sound
stewardship of financial resources
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Examples of Department
Administered Programs
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Health First Colorado
(Medicaid)
Child Heath Plan Plus (CHP+)
Old Age Pension (OAP) Medical
Programs
Colorado Indigent Care
Program (CICP)
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Who We Serve
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Source Note: FY 2016-17 data, the sum does
not equal 100% due to rounding and
exclusion of individuals who receive partial
coverage.
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Who We Serve
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2017 Federal Poverty Levels
by Family Size*
Family of 1 Family of 4
133% $16,044 $32,724
260%
(CHP+)NA $60,625
*Some earning more may still qualify.
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FY16-17 Data
Our Members
Caseload Expendituresby Population by Population
*Age 20 & younger and qualifying former foster care youth
*
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Medicaid’s Funding Resources
FY16-17 Data
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FY16-17 Data
Who Gets Paid for Services?
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EDO Budget Requests• R6 - Electronic Visit Verification
• R7 – HCBS Transition Services Coordination
• R8 - Medicaid Savings Initiatives
• R9 - Provider Rate Adjustments
• R10 - Drug Cost Containment Initiatives
• R11 - Administrative Contracts Adjustments
• R12 – Children’s Habilitation Residential Program Transfer
• R13 - All Payer Claims Database (APCD) Funding
• R14 – Safety Net Program Adjustments
• R15 - CHASE Administrative Costs
• R16 - CPE for Emergency Medical Transportation
• R17 – Single Assessment Tool Financing
• R18 – Cost Allocation Vendor Consolidation
• R19 – IDD Waiver Consolidation Administrative Funding
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General Program, Eligibility &
Benefits
Questions 2-16
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Electronic Visit Verification
(Home Health & Personal Care
Services)
Questions 17-21
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Provider Rates &
Transportation
Questions 22-34
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R8 Medicaid Savings
Initiatives
Questions 35-44
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What We Can Change:
Policy Levers
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Program Innovation
Questions 45-57
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Regional Accountable EntitiesRegion Vendor Ownership Structure
1 Rocky Mountain Health
United HealthCare Services [Inc., a Minnesota corporation, which is a
wholly owned subsidiary of UnitedHealth Group Incorporated, a Delaware
corporation.]
2Northeast Health
Partners
Corporate members: Plan de Salud de Valle Inc., North Range Behavioral
Health, Centennial Mental Health Center, Sunrise Community Health (Own
25% each)
3 Colorado Access
Corporate members: University of Colorado Health and University of
Colorado Medicine (collectively, the University), Children’s Hospital
Colorado, and the Colorado Community Managed Care Network
4 Health Colorado, Inc.
Owners: Valley-Wide Health Systems, Inc., Health Solutions, Beacon Health
Options Inc., San Luis Valley Behavioral Health Group, Solvista Health Group,
Southeast Health Group (Own 16 2/3 % each)
5 Colorado Access
Corporate members: University of Colorado Health and University of
Colorado Medicine (collectively, the University), Children’s Hospital
Colorado, and the Colorado Community Managed Care Network.
6Colorado Community
Health Alliance
Members: Colorado Community Health Alliance, LLC (a partnership between
Physician Health Partners, LLC, Primary Physician Partners, LLC, and Centura
Ventures, LLC), and Anthem Partnership Holding Company, LLC, a wholly
owned subsidiary of Anthem, Inc.
7Colorado Community
Health Alliance
Members: Colorado Community Health Alliance, LLC (a partnership between
Physician Health Partners, LLC, Primary Physician Partners, LLC, and Centura
Ventures, LLC), and Anthem Partnership Holding Company, LLC, a wholly
owned subsidiary of Anthem, Inc.
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Pharmacy
Questions 58-67
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Our Work to Date
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Combating the Opioid Crisis
Pre-2012:
Quantity limits on long-
acting opioids; Made
Suboxone a covered
benefit without a limited
time of coverage
2012:
National Governor’s
Association Prescription
Drug Abuse Reduction
Policy Academy
2013:
Colorado
Consortium for
Prescription Drug
Abuse Prevention
2014:
Pain resource page on
Department’s website;
Tightened policy on
short-acting opioids
2015:
DUR letters to
prescribers;
Consultation services
through DUR contractor;
Project ECHO; Physical
Therapy Rate Increase
2016:
MME policy;
Buprenorphine
Project ECHO
program
2017:
Quantity limit on
short-acting opioids
for treatment naïve
members;
Reducing MME
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Financing & COMMIT
Questions 68-69
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Children’s Health Insurance
Program (CHIP)
Questions 70-73
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Options for General Assembly
• Option 1: Let Program End
• Option 2: Establish State-Only Program
• Option 3: Expand Medicaid for Kids & Pregnant
Women
• Option 4: Expand Medicaid and Create CHP+ Buy-In
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Miscellaneous
Questions 74-82
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Thank You!
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