In this series of Policy Perspectives, ADVOCACYDENVER is providing synopses of meetings of the Colorado Commission on Medicaid. This edition covers the meeting held on October 7, 2026 at 10am. The Colorado Commission on Medicaid is working toward the goal of creating a sustainable Medicaid program for the state. The Commission will present their final report to the General Assembly and Governor in December.
Agenda & Materials:
The meeting agenda and materials can be found HERE.
Recording of the meeting can be found HERE.
Present for this Meeting:
- Senator Judy Amabile (D), Chair
- Representative Kyle Brown (D), Vice Chair
- Senator Jeff Bridges (D)
- Representative Carlos Barron (R) (departed at 4:30 pm)
- Senator Lisa Frizell (R) (participating remotely)
- Representative Lindsay Gilchrist (D)
- Senator Barbara Kirkmeyer (R) (departed at 10:40 am; returned at 12:40 pm)
- Senator Kyle Mullica (D)
- Representative Emily Sirota (D)
- Representative Rick Taggart (R)
I. Call to Order and Opening Remarks
Commission Chair Amabile called the meeting to order at 10:02 am. The Commission facilitator pointed members to materials for the day and reminded all in attendance that the work of the Commission is ultimately about people. (The main slide deck for this meeting can be found HERE.) The facilitator told the Commission that she has compiled results from all stakeholder feedback into two documents. (Find the compiled stakeholder input HERE. Find the compiled docket of suggested sustainability measures HERE.)
The facilitator identified that the focus of today’s meeting is Behavioral Health. She then identified five themes about Behavioral Health that are prominent in the stakeholder feedback the Commission has received:
- Care keeps people out of costlier places.
- Hard to get into, hard to stay in.
- Administrative burden is a cost.
- Providers asked for targeted fixes, not blanket cuts.
- People want to see evidence.
(See slide 4 of the main slide deck for this meeting.)
The facilitator closed this section by identifying her commitment to ensuring that accountability is built into the recommendations in the Commission’s report. (See slide 6 of the main slide deck for this meeting.)
II. Department of Health Care Policy and Financing (HCPF) and Behavioral Health Administration Presentation on Behavioral Health Spending Growth
Health Care Policy and Finance (HCPF) Executive Director Gretchen Hammer, Behavioral Health Administration (BHA) Commissioner Stephanie Beasley, and HCPF Deputy Medicaid Director and Office Director for Colorado Medicaid and CHP+ Behavior Health Initiatives and Coverage Cristen Bates presented this section of the meeting. (The slide deck they used for this part of the meeting can be found HERE.)
Director Hammer introduced Commissioner Beasley and Deputy Director Bates and said that they would lead this presentation. Commissioner Beasley began by identifying the three functions of the BHA: system reform, purchasing service, licensing & regulating providers. Senator Amabile asked if there a strategy for the number of entities BHA regulates. Beasley stated that if an entity meets the standards, it can be a licensed BH entity. Hammer added that licensure and contracting are not the same. The state can make strategic decisions about which entities contract with the BHA. Amabile then asked Beasley to identify the strategy that BHA uses for contracting with entities. Beasley stated that the Behavioral Health Administrative Service Organizations (BHASOs) are responsible for contracting within their region. (Colorado has four regional BHASOs.) Taggart stated that the distinction between licensing and contracting isn’t clear to providers. Licensed providers believe they will automatically receive a contract, which causes conflict.
Mullica stated that he would like to go back to the presentation. He said he sees collaboration between HCPF and BHA, but duplication of effort and services also exist. He hopes that Beasley and Bates will address this in their presentation. Kirkmeyer then asked about how the BHA determines network adequacy. Beasley said that BHASOs determine network adequacy using several indicators. Kirkmeyer followed up about how the BHA determines that the BHASOs do this. Beasley said that BHA does this and oversees the BHASOs. Beasley’s assessment of statewide BH adequacy is that “We have work to do.”
Deputy Director Bates then shared how HCPF has expanded BH services since 2018 and the state created the BHA in 2022. (See slide 2.) “The policy direction has been consistent: expand access, strengthen the continuum, and make accountability more explicit.” With this expansion has come the implementation of a Prospective Payment System (PPS) for all Comprehensive Safety Net Providers (CSNP) in July 2024. Bates asked the Commission if they had any questions about PPS or CSNPs.
Amabile asked for clarity about overhead for the CSNPs. She stated that she has heard that some get 15% overhead and some get 40% overhead. Bates answered that there is no limit on overhead in statute right now. Every cost is reviewed to determine if it is allowed. If it’s allowed, it’s allowed. Many indirect rates account for no-show appointments, trainings, etc. Kirkmeyer asked for verification about 40% overhead rates. Hammer said that HCPF will research to confirm. Kirkmeyer asked Bates about the average overhead rate for CSNPs. Bates said she does not have that information but will get it to the commission. Kirkmeyer then asked if there were any caps on overhead rates for CSNPs. Bates stated that there is no cap on indirect or overhead costs. Amabile followed by asking Bates about how many CSNPs are necessary for the state. Bates said that HCPF does not have an estimate of this but could develop an estimate.
Beasley moved on to “BHA by the Numbers” (slide 3). She said that the numbers are showing improvement in BH adequacy across the state. Colorado is seeing a decrease in the number of people referred, a decrease in the number of children in care, and a decrease in the number of days from patient contact to seeing a provider. Over 95% of the calls to 988 are answered in less than a minute. Bates then moved on to “Who We Serve” (slide 4). BHA serves a BH population that is broader than the BH population served by Medicaid. Amabile asked for clarification about the overlap across various types of Medicaid enrollment and an explanation of how the Medicaid providers fit in across the BHA network of CSNPs. Bates answered that if you are on a Medicaid waiver for BH, you are not in the expansion population. She will provide additional clarification to the Commission. Hammer added that federal match rates vary according to the individual served, even when multiple individuals receive the same service. Kirkmeyer asked about how the PPS system impacts the volume of services delivered by the CSNPs. Bates said that usually when an individual receives more services, the cost per service goes down.
Right now we are seeing significant increases in the amount of costs under the PPS model. We expect this to stabilize over time, but we do need to better examine what is and what is not allowable. Kirkmeyer asked for numbers to quantify the amount of the increase in PPS. Bates said that she does not have that number right now. Kirkmeyer pushed back by asking Bates for an estimate because Bates said there was a significant increase. Bates said that she does not have this information with her today.
Beasley presented the BHA part of the “Who We Are” slide (slide 4). Unlike Medicaid, BHA is not a member-based agency. BHA is meant to create capacity and a system that is adequate to serve the state. BHASOs serve 276 provider organizations, including 20 CSNPs. BHA spends the most on emergency and crisis services. Amabile asked Beasley about the percentage of BHA costs that are related to substance use and the percentage that are related to serious mental illness (SMI). Beasley said that she will get that breakdown to Amabile. Kirkmeyer asked Beasley for her thoughts about the adequacy of BHA providers across the state. Beasley said that BHA publishes a quarterly adequacy report. Kirkmeyer pushed in for an answer. Bates said that we have a need to understand our data and refine our services for high-acuity, youth substance use, and crisis response, among others. Amabile said that members of the Commission are hearing from providers that there is significant grift happening in the provider space. The Commission is trying to get at this. Do we have too many providers? Are we contracting with the correct providers?
Mullica asked if any providers contracting with both a RAE and a BHASO? If so, what does this look like? Is there duplication in licensing? Etc.? Hammer said that this does happen. Beasley said that BHA does pay out for some Medicaid claims through BHASOs because we always bill commercial insurance first. Mullica said, “We’re going to have to figure out how to tighten our belts.” To put providers through contracting, licensing, and other processes twice is inefficient. Hammer said that we could expand this question to the entire health care system. Individual providers often contract with multiple entities. Mullica about how many BHA patients are Medicaid members. Beasley said that she does not have that figure. She explained some circumstances in which people might be doubly enrolled. Bates said that about 24% of Medicaid patients receive BH services. Taggart asked if any segment of the Medicaid population (e.g., expansion population, waiver population) use BH services at a much higher rate. Bates agreed to get this analysis to the Commission.
Mullica opened a conversation about restructuring, streamlining, and possibly combining BHA and HCPF. What is stopping the integration of BHA into HCPF? Is there anything that a RAE does that would legally prevent them from doing what a BHASO does? Beasley said that we need to investigate how we can better align these agencies and reduce administrative burden for providers and members. The functions of the agencies are different, however. BHA establishes a network and capacity for the state. BHASOs’ role is to ensure that across Colorado people receive the care they need in a timely manner. BHA is not a member-based agency. Mullica said that why he appreciates this point, he still does not understand why we need a separate agency for these functions. Hammer said that the Commission will hear about this in a panel that is coming up today.
Bates moved on to the “Where the Growth Is” slides (slides 6 & 7) and pointed the Commission to a fact sheet in their packets. (This fact sheet is available HERE.) Bates said that while SUD costs are increasing, this growth was expected because we created a new benefit. Within SUD, we are seeing unstainable growth in individual and group psychotherapy services, peer and supportive services, and substance use ASAM residential. Bates said that peer and supportive services are very effective, but they are only beneficial when they are a part of evidence-based programs, part of a broader service plan, and managed by a licensed clinical expert. We know this isn’t happening in all instances and we need to immediately catch and stop this. HCPF is already working on doing this. Gilchrist asked about the efficacy of partial hospitalization or intensive outpatient programs. Bates said that we see better outcomes for many patients in these programs, and in doing so, keep people out of residential programs that come at a much higher cost. We would like to see the growth concentrated in outpatient programs and decrease in residential programs.
Bates shifted to “Administration and Delivery” (slide 8). She reviewed the benefits of a managed care system. RAEs are able to terminate contracts with providers more easily than HCPF can. Bridges asked about how closely HCPF and BHA watch cost increases from individual providers. Bates said that this is an area where HCPF and BHA need to coordinate and have been coordinating but also could be doing better. Some ways to monitor providers are administratively burdensome for providers, but they are necessary. We have priced out the cost of some of these actions and they will save us money. Bridges followed up by asking about how often payments go out to providers. Bates said that provider payments are made withing 90 days of when HCPF receives the claim (not the date of service). We often pay within 30 days. Hammer added that HCPF does have the opportunity to conduct pre-payment review of claims.
Taggart asked to return to the “Where the Growth Is” slides. He said that when HCPF shares that there is 124% growth but does not present an analysis of why the growth is occurring. This makes the work of the Commission very challenging. The Commission may choose an action that doesn’t help or may make the situation worse. Brown clarified that the growth in Substance Use ASAM Residential is because of legislation passed in 2018.
The growth is faster than anticipated. Bates answered, “Correct.” She added that HCPF also over-corrected for earlier slower-than-expected growth. Brown asked if the growth in Peer and Supportive Services is also due to a bill. Bates answered, “Yes.” She also said that Medicaid requires that we have licensed providers. Peers are not licensed providers. HCPF has allowed for this and didn’t put restrictions on it, other than a licensed provider needs to sign off on the peer counselor. HCPF has seen misuse of this process, but HCPF opened the gates without restrictions. There is value in peer services, but we need to adjust our policies to ensure that we’re only paying for services connected to clinical teams.
Hammer moved to “Actions to Address Growth” (slide 11). Hammer reviewed the actions that HCPF is currently taking and then shared actions being taken by RAEs (slide 12). All actions taken are based on evidence that HCPF is seeing. Sirota said that Commission members are hearing from agencies and providers that these changes are not adequately communicated. Amabile asked Hammer to articulate how these actions are saving money because RAEs receive capitated payments that are predetermined. Hammer said that the Office of State Planning and Budget (OSPB) has requested that HCPF not share estimates of costs saved through these actions. HCPF is still working on establishing authority to take the actions from MSB or the federal government and cannot articulate savings until they have the authority to make the changes. Mullica expressed frustration with OSPB over this decision. Hammer said that the FY26-27 budget process will be open and transparent. Only the current year’s savings from action plans are not being shared. Mullica again articulated his frustration. Amabile asked if a policy gets changed in the middle of the year, would the RAEs give money back to the state. Hammer replied, “Yes.”
Amabile asked if there is a plan to streamline the shared work of the BHA and HCPF. Beasley answered that the two agencies will be working on streamlining care coordination. But the function of the BHA is different from the function of HCPF. The BHA team is working on system mapping to identify efficiencies. Brown asked Beasley to make the case for the work that the BHA does. Beasley said that the BHA has four years under its belt and has established BH infrastructure for the state. BHA is one year into the BHASO model, and that is decreasing wait time for people to access service. BHA’s work is not done. Gilchrist emphasized the importance of work that BHA and HCPF have done to ensure care is available for high-acuity youth
III. Behavioral Health Panel A
Senator Amabile called a panel of representatives of RAEs and BHASOs to the front of the room. Panelists included:
- Meg Taylor, Chief Behavioral Health Officer, Rocky Mountain Health Plans (RMHP is both a RAE and a BHASO)
- Patrick Gordon, Chief Executive Officer, RMHP
- Daniel Darting, Chief Executive Officer, Signal Behavioral Health Network (Signal is a BHASO)
- Lauren Snyder, Executive Director, People First Behavioral Health Alliance
Gordon started the panel’s presentation by sharing that RMHP is able to give the perspective of both a RAE and BHASO since it serves in both roles. He wants to help clarify the distinction between a RAE and a BHASO. Medicaid is a coverage program; it is an insurance program. BHASOs are not coverage programs. BHASOs do not have eligibility or claims like with an insurance provider. RMHP contracts with both HCPF and BHA. The contracts are distinct because the federal and state regulations are distinct, the purposes are distinct. The distinctions matter, but it’s also important to consider the amount of integration between the programs. Being both a RAE and a BHASO requires some amount of creative thinking in how RMHP delivers services to people.
Amabile asked Gordon to clarify a statement he made that there is no overlap in care coordination between the RAE and the BHASO. Does the same person act as care coordinator within your RAE and BHASO roles? Or does one cover an aspect for a member and another aspect for the same person? Gordon answered that high intensity services cost a lot to deliver with fidelity. The ability of the BHA to deliver financing to the system, especially to safety net providers, is essential. BHA can cover some services that Medicaid does not cover. Care coordination serves unique people in different settings. There is not a lot of overlap between care coordination as a RAE and as a BHASO, though they have many functions that are complimentary.
Mullica asked Gordon to further explain the efficiencies provided by being both a RAE and BHASO. Mullica said that as a policymaker, the system feels “really inefficient” to him. Gordon answered that, “You can’t begin to promote the integration of behavioral health in clinical settings or on the ground if systems aren’t integrated.” He went on to say that, “We’re not here to talk about how to organize state programs or agencies… We’re here to talk about the what, not the who.” He said that HCPF and the BHA both serve important and distinct functions.
Amabile returned to her question about care coordination and asked for further clarification. She said that while she heard that there is not overlap in care coordination between the BHASO and the RAE, she wonders if there is overlap with the BHA. Taylor answered that there are very distinct programs in the BHA with specific roles for care coordinators. What the BHASOs do is more general. We work together to connect people.
Amabile asked how someone would know to call the RAE or the BHASO. She said that she hears that RAEs and BHASOs are conducting outreach, but she also regularly hears from 400 families who are dealing with serious mental illness. They are not receiving outreach or care coordination. No one is helping them. What are you doing to help these families who need services? We are spending a lot of money on this. Gordon stated that he thinks Amabile is right to question care coordination. The system is not perfect. If you are engaging with a care coordinator, you are less likely to need to access acute care. But establishing trust with a care coordinator matters.
Darting said that he would share the perspective of the BHASO he represents, Signal. BHASOs ensure that essential BH services are available to those who need them or can’t afford them. If HCPF and BHA were to be combined, we would still need the ability to provide BH services to non-Medicaid members. Coordination and integration of some BHA and HCPF functions makes total sense. He urged the Commission to fully implement all components of BHA initially planned, which is not currently happening. The problem is that we have only started on some of the many things that the BHA was designed to do. Amabile said that she is hearing Darting’s and others’ requests that we need to do more for BH, but we have a huge budget crunch. She is not hearing that we are going to be filling the needs of those who are the neediest; she is not hearing about people as much as we need to hear.
Mullica asked Darting to clarify his call that HCPF and BHA better serve the state: “You spoke about… that there’s a lot of room to be better… When is that happening?” He asked Darting to share his thoughts about integrating BH and physical health. Darting said that he agrees with the commitment to integrated health care. It saves money and leads to better outcomes. He said that providers need better and more cohesive support from agencies in the executive branch, and the General Assembly to provide a budget that supports one cohesive system, not budget lines scattered across many entities. Mullica asked that if the BHA is not accomplishing its goal, why are we continuing to move forward with it? Darting replied, “If we start over again… We never follow through… We will see results when we follow through…” He is not convinced that we need more money. We need to be thoughtful about how we use our investments.
Kirkmeyer stated that BHA is supposed to be creating a system of care for the state. “Where is the system of care?… We’re not even close.” BHASOs and RAEs are complimentary, but they work with the same providers. How adequate is our statewide network? We want to get as many services as we can within the budget that we have. Gordon answered that our system of care is not where it needs to be. The state has BH deserts, particularly in rural areas. With Medicaid we need to strike a balance between access, cost, and quality. “There are plenty of opportunities to make the program more efficient, but it will entail some difficult decisions and actions.
Snyder started by saying that People First Behavioral Health Alliance is a newly formed organization made up of BH providers, payers, and advocates. The organization is here today to bring solutions and options to the Commission. She said that we do not have an adequate care network. BH spending beyond BHA and HCPF is significant. Counties spend a great deal on BH as well. People First sees value in the BHA and supports it continuation, though in a much contracted form. The policy and regulatory structure should stand. We don’t want to just move BHA functions to HCPF without eliminating duplication. People First also recommends changes to payment and benefit design. These changes include peer support services, including caps on hours, limits on groups sizes, and utilization management. Mullica asked Snyder to share her thoughts on oversight for peer support services by licensed providers. Snyder answered that we need better regulations for this role. Kirkmeyer asked Snyder to share the percent of peer support spend that is going to unlicensed versus licensed providers. Snyder said that she is not in a position to have that information. Taggart asked Snyder about moving all state-sponsored BH programs and budget lines to the BHA. Why has this not taken place? The previous BHA commissioner said it was too political to do this, and that the General Assembly would need to do this. If our Executive branch won’t do what the blueprint says, “I’m ready to do it.” The Commission briefly discussed what this change would entail, as well as how to strategically make cuts to programs. Snyder closed by saying that as we have fewer and fewer dollars to spend, “we need to get straight on our priorities.” Serving those in the most need and with the most significant mental health challenges must be our priority. People First sent a more complete list of recommendations to the Commission.
IV. Behavioral Health Panel II
A second BH panel came to the front of the room. This panel consisted of:
- Breeah Kinsella, Chief Executive Officer, Colorado Providers Association (COPA)
- Dr. Kelly Phillips-Henry, Chief Executive Officer, Aurora Mental Health & Recovery, a Comprehensive Safety Net Provider
- Dana Erpelding, Vice President, Behavioral Health Operations, Vail Health
- Teri Smith, Chief Executive Officer, K’enekt, Peer Support Services
- Yvonne Maina, Coalition on Refugee and Immigrant Mental Health
Kinsella started by saying that COPA runs a credentialing program for peer and family specialists in Colorado. She shared handouts with the Commission and said that this panel would start with the providers present. She welcomes questions from the Commission after the providers speak.
Phillips-Henry started by saying that Aurora Mental Health & Recovery is a Comprehensive Safety Net Provider (CSNP), and Essential Safety Net Provider (ESNP), and a certified Community Behavioral Health Clinic. She described what a month looks like for a high-acuity patient. For the client she described, Aurora Mental Health & Recovery provided nine services in a month that they billed and thirteen services that they did not bill. They bundled services to do this. They also provided additional non-billable services. She said it would be very difficult to sustain this intensive level of care in a fee for service system. Under the Prospective Payment System (PPS), Aurora is able to provide for the whole continuum of services a client needs. She stated that any cuts made to BH spend by the state need to maintain the PPS system. Aurora and other comprehensive providers have been under four payment models in the last eight years. They need stability.
Amabile stated that although CSNPs are supposed to take all patients, we know that they do not do so. She understands why, too. Should we lower payments for CSNPs with the condition that they not take the most challenging cases? Could we send those cases to the most intensive care settings? Amabile shared that she had received outreach from a constituent who tried to have Aurora place a hold on their family member but the facility told the family that a hold was not medically necessary. The individual subsequently died. Phillips-Henry said that the requirement of no refusal is something CSNPs are committed to, though it is appropriate to do so when we don’t have the services the client needs. Problem solving and focusing on continuity of care and support from state agencies are part of the work here. She said that today, providers are able to see patients on virtual platforms that can help sustain continuity of care for patients with the highest needs. Gilchrist asked what providers need to take on these clients with high levels of need, particularly those that are violent. Phillips-Henry said that highly specialized care can be provided online. Doing so takes resources and creative thinking. She emphasized that client choice in their care must be considered both ethically and because of stipulations in the law. Amabile shared her frustration that the people with the most significant mental health challenges are not getting the care they need. Brown expressed his disappointment with how Phillips-Henry answered Amabile’s question about a person who was denied care at Aurora and subsequently died. Phillips-Henry said that she has to be careful about how she answers such questions because of HIPAA. Brown said that there has been no personal health information shared so HIPAA is not relevant. Phillips-Henry said that the law dictates whether or not any provider can place a hold on a patient.
Erpelding stated that Eagle County was a BH desert with no brick and mortar facilities in the county. Prior to 2020 Vail Health went through years of planning and the county implemented a marijuana tax to fund creation of a BH clinic. Priorities changed in 2020 because of COVID. Every provider added was immediately fully booked with patients. Vail then sought out funding sources and built a crisis program and inpatient program in the county from the ground up. Today, about 40 percent of Vail’s patients come from Mesa County and it serves communities all across the Western Slope. Vail is operating at a loss because Medicaid does not cover costs. There is still an inadequate BH network across the state. Mullica referenced a bill in 2025 for licensing under the Vail Hospital’s license. He asked if licensing complications and other regulations like this take away from the work of serving patients. Erpelding explained what happened and why the licensing change was needed, and that streamlining administrative and regulatory processes would be helpful.
Smith said that she is the founder and CEO of a peer support provider. Organizations that provide peer support can obtain from the state the designation as a Recovery Support Services Organization (RSSO). Kirkmeyer asked about the kind of training is needed to get the RSSO license. Smith said that RSSO is a license an individual can obtain. K’enekt is licensed as a Behavioral Health Entity (BHE). The RSSO license requires 60 hours of training. Once the 60 hours are complete, the individual can work for a licensed provider and start working on their practical hours, 250 practical hours are needed for the license. These practical hours are always under supervision of a licensed provider who can bill Medicaid. Mullica asked how many peer support counselors can work under a licensed provider to bill Medicaid. Smith said that there is no cap on the number of peer counselors a licensed provider can supervise. Taggart asked Smith to say what she feels would be an appropriate ratio. Smith said that 2 licensed providers to 10 peer support counselors is a ratio she has had that has worked well. Smith said that many providers take advantage of this. She will not defend poor quality or oversight, but will defend the peer support work. Kirkmeyer asked how many patients can a peer counselor see at a time. Smith said 20 to 30 is reasonable.
Taggart asked Kinsella if COPA is in a position to make recommendations about these ratios? Kinsella answered “yes.” She shared a packet of recommendations with the Commission. COPA is recommending that peer support counselors be required to be licensed and that COPA has established a credential for these counselors. She expressed concerns about Qualified Behavioral Health Assistant (QBHA) and how the guardrails for billing for QBHAs are non-existent. She is concerned that any controls placed on billing for Peer Support Services will be ineffective in cutting costs without controls also being put in place for QBHAs. Taggart asked for clarification about QBHAs. Kinsella said that QBHA is separate credential but there is no accountability, code of ethics, etc. This credential was created for those who are pursuing clinical licensing. Kirkmeyer asked about the requirements for the COPA peer support credential. Kinsella explained the requirements and said that RSSOs can only employ peer support counselors with the credential. Providers do not need to be RSSOs to provide or bill for peer support services, however.
Maina shared that changes to Medicaid have “intensely and immensely” impacted whether and how immigrant and refugee communities can access BH services. Immigrants and refugees are fearing having providers come into their communities. We are seeing immigrants and refugees becoming unable to access BH care, which will likely lead to uncompensated increases in emergency room use. The Coalition has identified four areas of concern for the Commission: access to care, integration, coherence, and equity. Immigrants and refugees are in need of expanded access to services rather than increased restrictions.
Kirkmeyer asked how Medicaid provided for peer support services prior to the legislation in 2021 that authorized Medicaid payment for them, and how much peer support providers are paid per hour. Kinsella pointed out the hourly wages for peer support counselors is between $22 to $25 per hour. Anecdotally, wages vary wildly by agency and can be exorbitant. Kirkmeyer asked how we can stop this. Kinsella answered, “Training, policy, and enforcement.” Amabile asked how much Medicaid pays for peer services. Smith said that the highest rate her organization receives is $28 per hour from one of the RAEs. She added that organizations are continually changing billing codes in search of higher payment rates, as is happening when organizations are billing for QBHAs rather than peer support. She also added that organizations are billing for peer support groups at individual rates, and billing for peer support services and QBHAs for the same individual working with the same group. Commission members spoke extensively about how some providers are taking advantage of this billing strategy, particularly those who are owned by private equity firms. Erpelding added that some outpatient providers are taking advantage of similar strategies. She also added that the Commission should consider strengthening non-emergency transportation for rural areas of the state. This has been a challenge for Vail Hospital when releasing BH patients.
Amabile asked further about PPS and overhead rates for CSNPs. She asked for clarity. Phillips-Henry said that Aurora Mental Health & Recovery does not directly bill for peer services, but per encounter. Many services are bundled into an encounter. Aurora’s rate is $400 per encounter. Mullica asked Phillips-Henry to share Aurora’s overhead rate. She answered that they set their rate according to a federal indirect rate, which they currently have set at 24%. Mullica asked about how much income this overhead generates for Aurora. Phillips-Henry estimated that Aurora’s overhead amounts to $15 million per year. She added that they must return all profit from RAE payments to the RAEs. They earn no profit from RAEs. Amabile shared that she received a text from a constituent that Aurora’s overhead rate listed in their cost report was 33% last year and 44% the year prior. Phillips-Henry answered that she does not have that information in front of her. Amabile and Kirkmeyer agreed that the PPS may perpetuate exorbitantly high overhead rates and other ways that providers are taking advantage of the payment system. Phillips-Henry said that PPS is a federal model that is used by 40 states. It tries to account for the higher costs of caring for high-acuity patients. Much evidence shows that this payment model helps patients. Mullica asked whether PPS should allow for overhead rates that are higher than 40%. We need to direct as much to patients as possible. Amabile agreed with Mullica and added that she does not believe the system is serving high-acuity patients, as she previously shared during this meeting.
V. HCPF Action Plan Presentation
Executive Director Hammer shared HCPF’s Current Fiscal Year Action Plans with the Commission. (The slide deck for this portion of the meeting is HERE.) These action plans are intended to reduce costs for the current fiscal year. Action Plans are focused in four areas:
- Driving administrative efficiencies
- Aligning benefits and services to maximize impact and value
- Ensuring program integrity and fiscal accountability
- Maximizing federal and non-general fund resources.
Hammer reviewed specific cost-savings strategies within each of the major areas.
Taggart asked why the hiring freeze is not extending to instances for which interviews had occurred but no offer extended. Hammer said that this was a judgement call by the department and only applied to a small number of instances. Taggart encouraged Hammer to discontinue this exemption to the hiring freeze.
Amabile asked Hammer to provide an estimate of the cost savings expected from the action plans. Hammer said she is unable to do so. (In the opening section of the meeting, Hammer stated that OSPB had asked her not to give estimates of savings from action plans.) Mullica expressed his frustration with this. Hammer said that not all areas of savings have been priced out and are not yet certain to happen because they require federal approval. She said that sharing the action plans today is meant as a “temperature check” to see if the Commission believes HCPF is taking the rights steps to cut costs. Mullica said that it is impossible to give that assessment without an estimate of the savings expected. Taggart asked for clarification on how the Medical Service Board’s (MSB) current work interacts with the work of the commission. Hammer said that the MSB is authorized to set policy including assisting the Executive Director in keeping costs within the allotted budget. Hammer stated that HCPF is considering many other cost-saving actions that are still being examined for conformity with laws and regulations.
VI. Commission Member Working Session
The Commission facilitator directed members to what she refers to as the “Docket,” the compiled set of recommendations received from stakeholders. (Click HERE to view the Docket.) Items included in the docket have been sorted and labeled by several variables, including but not limited to who has authority to make the change, the type of change (administrative, services, waivers, etc.), anticipated savings, etc. The Commission discussed how it will evaluate and consider each of the recommendations. The Commission decided that each member will evaluate each recommendation on their own and determine whether they want to consider the item; they need more information; or they consider the recommendation a “no-go.” They will send their recommendations to the facilitator who will compile and share the evaluations. If one member of the Commission wants to consider a recommendation, the Commission will discuss the recommendation. The Commission also discussed the specificity of each recommendation it puts forth. Some will ultimately need to be formally adopted by another body (e.g., the General Assembly, the Medical Services Board). They ultimately decided that some recommendations will need to be more general in nature, with specifics worked out by other bodies. They also considered whether recommendations will be short-term or long-term in nature. They ultimately decided that they need to consider both, though they acknowledged that they need to focus more on long-term, structural, and system issues.
VI. County Administration and the HB26-1429 Transition
The Commission called a panel forward to discuss HB26-1429. (The slide deck for this panel is located HERE.) Panelists included:
- Shelley Banker, Director of the Office of Economic Security, Colorado Department of Human Services.
- Jamie Ulrich, Weld County Human Services Director
- Deb Ruttenberg, Grand and Jackson Counties Human Services Director and President of the Colorado Human Services Directors Association
- Tamara Pogue, Summit County Commissioner
- Sarah Barnes, Colorado Children’s Campaign
All panelists are members of an Implementation Working Group (IWG) established to guide the implementation of HB26-1429.
HB26-1429 requires HCPF, the Department of Human Services (DHS), and the Department of Early Childhood (CDEC) to establish aligned requirements for county departments of human or social services through a performance-based contract. Ultimately, this bill will create a new service delivery model for Medicaid, Children’s Basic Health Plan (CHP+), Supplemental Nutrition Assistance Program (SNAP), childcare assistance program (CCCAP), Temporary Assistance for Needy Families (TANF), and adult financial programs. Panelists updated the Commission on implementation of HB26-1429. They have met several targets and will have an Implementation Plan submitted in January 2027. Monthly legislative reports and updates on implementation are available HERE.
The Commission questioned the panelists about how the IWG is proceeding and whether they feel that the Group is working in a manner that will lead to meaningful change that leads to cost-savings that maintain adequate support for people who need it. Representatives of the counties on the panels said that they are not receiving adequate data from the IWG facilitator to make informed decisions. They also discussed that a change may be needed from what is stated in the bill to how the state deals with fraud. Commission members expressed concern with the ability of the IWG to meet the January 2027 deadline. At the request of several panelists, Commission members offered some suggestions to help the IWG shape the recommendations it puts forward. Mullica asked the panelists to ensure they consider how to better use technology to advance efficiencies. Panelists expressed concerns with the ability of the state to have the needed technology available in the timeframe given in the bill. Members of the Commission expressed similar concerns and the impact on individuals accessing the services they need in a timely manner.
VII. Public Testimony
The Commission heard testimony from 18 individuals. These include providers and representatives of provider agencies, including peer support service providers; parent caregivers; and representatives of advocacy organizations. Topics covered included:
- The need for a forensic audit of HCPF
- Family caregiver soft caps
- Peer support services oversight and accountability measures
- Peer support licensing
- Olmstead provisions and PETI
- Regulatory complexities
- Agency and provider overhead and profit margins
- Caps on homemaker services
- Provider rates
- Maintaining coverage for immigrants and refugees.
IX. Adjourn
Senator Amabile adjourned the meeting at 6:21 pm.
Policy Perspective is a publication of ADVOCACYDENVER. If you have any questions, please contact Paul Baumann, Policy Outreach Specialist, at pbaumann@advocacydenver.org or 303.974.2535.