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Colorado Joint Health Committee hears SMART briefings from state agencies to inform 2023 budget requests – State of Reform

Colorado’s Joint Health Committee (JHC) held its State Measurement for Accountable, Responsive, and Transparent (SMART) Government Act briefing on Wednesday and Thursday and heard presentations from various state and health agencies, including the Departments of Public Health and Environment (CDPHE) and Health Care Policy and Financing (HCPF), to gather information for the legislature’s performance-based budgeting system.

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On the Committee’s first day, the director of strategic operations and audit manager at the Office of the State Auditor (OSA), Jenny Page, presented lawmakers with the office’s reportwhich found that 93% of the audit recommendations from July 2016 to June 2021 had been implemented as of July 2022.

“Today, I’m happy to note that most of the departments that you oversee do not have high priority recommendations that need to be implemented,” Page said. “That would include the Department of Human Services, CDPHE, and Connect for Health.

However, HCPF has five high-priority recommendations that it still needs to implement.”

There are 10 audit recommendations in all that relate to implementation of program administration and controls around Medicaid and CHIP payments and eligibility. HCPF has communicated to OSA that the priority recommendations will be implemented in 2023.

CDPHE presented its SMART Act reportwhere the Department’s chief medical officer, Dr. Eric France, gave an update on suicides in the state.

“You may be aware that we are one in the top 10 across the country for suicide rates in Colorado,” France said. “It’s true with the whole Intermountain West. It’s been this way for decades. And you may hear on the street that our rates of suicide in Colorado are rising, particularly our rates among youth, and I would like to dispel that myth. Our rates have not been going up. As a matter of fact, suicide rates in adults have been relatively flat since 2016.

Actually, among our youth 10 to 18, we saw a decrease last year. It’s not statistically significant, but it’s hopefully suggesting something of a trend coming forward.”

France said the Office of Suicide Prevention is using a public health framework to “attack a very complex issue,” citing housing, economy, and mental health as causes for suicide and emphasizing that all departments in the state have a role to play in prevention. The office worked with 12 different departments last year in various ways to improve efforts to reduce suicides, including prevention programs at schools that utilize student leaders and adults who help with stress management and interventions.

“We went from involving maybe six to 12 schools in 2018 to now up to 140,” France said. “We’re even looking at how [this model can] be expanded to the elementary school as well.”

CDPHE has requested $880.3 million in total funds for its FY 2023-24 budget, $142.3 million of which would come from the general fund. It proposes allocating 30% of that budget to the Prevention Services Division and 5% to Health Facilities and Emergency Medical Services.

Members of HCPF, led by Executive Director Kim Bimestefer, presented the department’s report on day two of the hearing. HCPF is requesting $14.9 billion in the upcoming fiscal year, $4.43 billion coming from the general fund. The 2023 request is more than $700 million higher than the appropriation it received in FY 2022-23.

“HCPF provides health insurance coverage and services to 1.74 million people or one in every four Coloradans,” Bimestefer said. “It’s up 39% or 490,000 members since the start of the public health emergency in March of 2020. We cover about 43% of the births in the state and about 43% of the children in the state.

We provide these coverages and supports through Health First Colorado or Colorado Medicaid and CHIP … We pay about 30 million claims a year [to] over 100,000 providers enrolled and we represent about 30% of the state’s budget.”

The department proposes that 75% of its budget go to Medical Services Premiums, 7% to the Office of Community Living, and 8% to Behavioral Health Community Programs.

HCPF plans to use $262 million for provider rate increases, which includes a 0.5% across-the-board provider rate increase. Colorado Medicaid will also eliminate copays for its members in 2023. The funding will also rebalance provider rates based on the annual rate review cycle, addressing critical needs for Nursing Home and Home and Community-Based providers, targeted incentive payments for rural hospitals, and advancing birth equity.

An additional $8.67 million will go to support primary care medical providers’ transition to value-based payments with up-front reimbursement for care expenses. Under the department’s value-based payment methodology, providers will have the option of receiving at least 25% of their revenue up front to allow for increased investment in care improvement.

The department outlined how it plans to meet the governor’s goal of reaching 250,000 Coloradans served by primary care providers utilizing alternative payment models (APMs). The actions include amending contracts with Regional Accountable Entities (RAEs) to promote provider participation in the APM by mid-year and ongoing stakeholder outreach and engagement.

HCPF will also complete its compliance review of Colorado hospitals on price transparency and launch the state’s hospital price comparison tool by midyear.

JHC members also heard from the Department of Human Services (DHS) and the Behavioral Health Administration (BHA) on Wednesday. DHS is seeking $2.3 billion in total funding, $1.1 billion coming from the general fund. DHS proposed allocating 33% of its request to the Office of Children, Youth, and Families, 11% to the Office of Adult, Aging, and Disability Services, and 12% to the BHA.

BHA Commissioner Dr. Morgan Medlock spoke to the progress made last year toward building an “equitable behavioral health ecosystem”.

“First of all, we are glad to have continued funding of the I Matter program which is free therapy for every young person in our state, up to six sessions,” Medlock told committee members. “As I mentioned, we also released $130 million roughly one month ago in grant opportunities and we’re going to be awarding those opportunities on a rolling basis.

With that we also released something called the Community Assessment Toolkit, which supports local leaders in thinking about equity considerations as they apply for these dollars. We are going to emphasize not just awarding funds to the person who writes the best grant, but thinking about the projects that promote equity and truth.”

Medlock said the BHA will release its strategic plan on providing a “whole person health continuum” in Colorado on January 31st. The BHA’s FY 2023-24 budget request proposed $25M to address gaps in the behavioral health continuum of care for local communities, as well as $34M specifically for children, youth, and families.

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