§ 25.5-4-213 — Audit of medicaid member correspondence - definition

Colorado § 25.5-4-213

• Jurisdiction: Colorado
• Title 25.5: Health
• Art.: Colorado Medical Assistance Act -

Text

(1) As
used in this section, unless the context otherwise requires, member
correspondence has the same meaning as defined in section 25.5-4-212.

(2) During the 2020 calendar year and the 2023 calendar year, the office of
the state auditor shall conduct or cause to be conducted a performance audit of
member correspondence. Thereafter, the state auditor, in the exercise of the state
auditor's discretion, may conduct or cause to be conducted additional performance
audits of member correspondence pursuant to this section. The audit must include
correspondence generated through the Colorado benefits management system, as
well as correspondence that is not generated through the Colorado benefits
management system.

(3) The performance audit conducted pursuant to this section must include:

(a) A review of available data from counties, from the state department's
customer service contract center, and from assistors within the health benefit
exchange, created in article 22 of title 10, regarding customer service contacts that
are related to member or applicant confusion regarding correspondence received
by medicaid members or applicants;

(b) A review of the accuracy of member correspondence at the time the
correspondence is generated;

(c) A review of whether member correspondence satisfies the requirements
of any state or federal law, rule, or regulation relating to the sufficiency of any
notice;

(d) A review of any member correspondence testing process conducted by
the state department and whether testing is done prior to implementing new or
significantly revised member correspondence;

(e) A review of the results of any member correspondence testing, including
member comprehension of the intended purpose or purposes of the
correspondence; and

(f) A review of the accuracy of member income and household composition
information that is communicated electronically, if applicable.

(4) If audit findings include findings that information contained in member
correspondence is inaccurate at the time the correspondence was generated, the
audit must identify, if possible, the source of the inaccurate information, which may
include but is not limited to computer system or interface issues, county input error,
or applicant error.

(5) Based on the findings and conclusions identified during the performance
audit conducted pursuant to this section, the office of the state auditor shall make
recommendations to the state department for improving member correspondence.
On or before December 30, 2020, December 30, 2023, and December 30 in any
calendar year in which an audit is conducted pursuant to this section, the office of
the state auditor shall submit the findings, conclusions, and recommendations from
the performance audit in the form of a written report to the legislative audit
committee, which shall hold a public hearing for the purposes of reviewing the
report. The report must also be submitted to the joint budget committee, the public
health care and human services committee of the house of representatives, the
health and human services committee of the senate, and the joint technology
committee, or any successor committees.

Legislative History

Source: L. 2017: Entire section added, (HB 17-1143), ch. 67, p. 211, � 1, effective August 9; (1) amended, (SB 17-121), ch. 303, p. 1653, � 2, effective August 9. L. 2024: Entire section amended, (SB 24-176), ch. 152, p. 630, � 28, effective August 7.