SB 18-266

Senate Bill 18-266, titled "Controlling Medicaid Costs," aims to help manage and reduce costs within Colorado's Medicaid program. The bill requires the Department of Health Care Policy and Financing to provide detailed cost and quality information about medical services and pharmaceuticals to participating providers. It also allows the department to use technology to review claims for errors before payment and implement strategies like value-based payments to control spending growth in Medicaid. Before any changes are made, stakeholders must have a chance to comment on them. The bill has been signed into law, meaning these measures will now be implemented to help control costs in the Medicaid program.

Official Summary

Joint Budget Committee. The bill directs the department of health care policy and financing (department) to provide information to providers participating in the accountable care collaborative regarding: Cost and quality of medical services provided by hospitals and other medicaid providers; and Cost and quality of available pharmaceuticals prescribed by medicaid providers. The department may make the same information available to other medicaid providers. The department shall automatically review claims to identify and correct improper coding prior to payment and may obtain commercial technology to conduct the reviews. The department is authorized to pursue cost-control strategies, value-based payments, and other approaches to reduce the rate of expenditure growth in the medicaid program. The department shall allow recipients, providers, and stakeholders an opportunity to comment and shall report to the joint budget committee prior to implementing any strategies or measures. The department is required to contract for an independent evaluation of any measures pursued and to provide reports to the joint budget committee on the evaluations. Subject to federal approval, the department is also directed to design and implement an evidence-based hospital review program to ensure that utilization of hospital services is based on a recipient's need for care. Prior to implementing any changes, the department shall allow recipients, providers, and stakeholders an opportunity to comment and shall report to the joint budget committee. The department shall also report to the joint budget committee on the estimated savings from the changes. (Note: This summary applies to the reengrossed version of this bill as introduced in the second house.) , Read More

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