(1) In 2011,
the state department created the accountable care collaborative, also referred to in
this title 25.5 as the medicaid coordinated care system. The state department shall
continue to provide care delivery through the accountable care collaborative. The
goals of the accountable care collaborative are to improve member health and
reduce costs in the medicaid program. To achieve these goals, the state
department's implementation of the accountable care collaborative must include,
but need not be limited to:
(a) Establishing primary care medical homes for medicaid members within
the accountable care collaborative;
(b) Providing regional care coordination and provider network support;
(c) Providing data to regional entities and providers to help manage member
care;
(d) Integrating the delivery of behavioral health, including mental health and
substance use disorders, and physical health services for members;
(e) Connecting primary care with specialty care and nonhealth community
supports;
(f) Promoting member choice and engagement;
(g) Promoting telehealth and telemedicine;
(h) Utilizing innovative care models and provider payment models as part of
the care delivery system, including capitated managed care models within the
broader accountable care collaborative;
(i) Receiving feedback from affected stakeholder groups;
(j) Establishing a flexible structure that would allow for the efficient
operation of the accountable care collaborative to further include medicaid
populations and services, including long-term care services and supports; and
(k) Establishing a care delivery system and provider payment platform that
can adapt to changing federal financial participation models or funding levels.
(2) The state department shall facilitate transparency and collaboration in
the development, performance management, and evaluation of the accountable
care collaborative through the creation of stakeholder advisory committees.
(3) The state department shall collect information concerning the
accountable care collaborative and include this information in its annual report
submitted to the joint budget committee, the health and human services committee
of the house of representatives, and the health and human services committee of
the senate, or any successor committees, pursuant to section 25.5-5-415 (4)(a).
Notwithstanding the provisions of section 24-1-136 (11)(a)(I), the report required
pursuant to this subsection (3) continues indefinitely. At a minimum, the state
department's report must include the following information concerning the
accountable care collaborative:
(a) The number of medicaid members enrolled in the program;
(b) Performance results with an emphasis on member health impacts;
(c) Current administrative fees and costs for the program;
(d) Fiscal performance;
(e) A description of activities that promote access to services for medicaid
members in rural and frontier counties;
(f) A description of the state department's coordination with entities that
authorize long-term care services for medicaid members;
(g) Information on any advisory committees created, including the
participants, focus, stakeholder feedback, and outcomes of the work of the
advisory committees;
(h) Future areas of program focus and development, including, among
others, a plan to study the costs and benefits of further coverage of substance use
disorder treatment; and
(i) Information concerning efforts to reduce medicaid waste and
inefficiencies through the accountable care collaborative, including:
(I) The specific efforts within the accountable care collaborative, including a
summary of technology-based efforts, to identify and implement best practices
relating to cost containment; reducing avoidable, duplicative, variable, and
inappropriate uses of health-care resources; and the outcome of those efforts,
including cost savings, if known;
(II) Any statutes, policies, or procedures that prevent regional entities from
realizing efficiencies and reducing waste within the medicaid system; and
(III) Any other efforts by regional entities or the state department to ensure
that those who provide care for medicaid members are aware of and actively
participate in reducing waste within the medicaid system.
(4) On or before December 1, 2017, the state department shall submit a
report to the joint budget committee, the public health care and human services
committee of the house of representatives, and the health and human services
committee of the senate, or any successor committees, outlining the statutory
changes needed to part 4 of this article 5 relating to the statewide managed care
system, as well as any other sections of the Colorado Revised Statutes, in order to
align Colorado law with the federal Medicaid and CHIP Managed Care Final Rule,
CMS-2390-F.
(5) The state board shall promulgate rules implementing the accountable
care collaborative.
(6) The state department shall consider new technologies and business
practices for medical management reform that would reduce medical costs due to
misuse, overuse, waste, fraud, and abuse. Better drug management, especially of
avoidable prescriptions and inefficient use of specialty drugs, would allow the
entire prescription drug cost continuum to be managed more effectively to contain
costs and achieve better patient outcomes. New technologies and business
practices for medical management reform may also benefit Colorado by providing a
more powerful medicaid enrollment platform that properly enrolls only those
individuals who are truly eligible for medicaid benefits.