Colorado Integrated Care and Financing Project

Project Overview

General Approach: The project seeks to demonstrate that the integration of acute and long-term care services in a managed care environment will result in improved client outcomes and improved client satisfaction while not increasing costs. The project will focus on preventive care and client monitoring in order to produce better outcomes for clients.

Implementation Date: Projected to be in summer 2002.

Waivers: None. Authorized under Section 1915(a) of the Social Security Act

Eligible Population: Medicaid-only and dual eligible (Medicare and Medicaid) clients, who meet the nursing facility level of care and reside in the five-county Denver metropolitan area. The area includes Adams, Arapahoe, Denver, Douglas, and Jefferson Counties. Enrollment will be voluntary.

Benefit Package:The Health Maintenance Organization (HMO) will provide: 1) Medicaid acute care services; 2) Medicaid long-term care services, (including nursing facility care, Home and Community Based Services, and Hospice), and 3) for dual eligibles, Medicare Part A and Part B services. The program will not cover services for mental illness or developmental disabilities, as they are covered under other state programs.

Delivery System: A Medicaid HMO that will organize care and contract with long-term care service providers.

Quality Assurance Activities:: The project has three basic quality assurance goals. One primary goal is to ensure that integrated acute and long-term managed care does not compromise quality of care, but improves access to care and the quality of health care service received by participating clients. Secondly, the project seeks to demonstrate that the integration of care results in improved client outcomes without increasing the cost of care. The third goal is to advance the development of outcome-based quality assessment and quality improvement. This includes identification of desired health outcomes, development of reliable and valid quality indicators and implementation of appropriate data collection and analysis. Specific quality indicators were developed for the project, with the assistance of the National Commission on Quality Assurance (NCQA), to address a broad range of issues, such as immunizations, hospital re-admissions, return emergency room visits, time from identification of long-term care needs to treatment of those needs, enrollment and disenrollment rates, and provider network adequacy.

Technical Assistance Activities: NA

Other Information: The Integrated Care and Financing Project was originally developed to be implemented in Mesa County as a fully capitated Medicaid/Medicare managed care pilot program. After several years of negotiation we were unable to reach agreement with HCFA on a Medicare capitation rate methodology. The State then decided to design a program that would integrate Medicaid acute and long term care services for the project's dual eligible enrollees with services provided under the HMO's Part B Cost Contract with Medicare.

Current Status

Enrollment:NA

Recent Accomplishments:

• HCFA approved our waiver terms and conditions in September 1999. Just as the State was going to implement the project in Mesa County, Rocky Mountain HMO decided to put the project on hold. The State asked HCFA to put the 1115 waiver for Mesa County on hold until further notice.
• The State has moved the project's focus to the Denver metropolitan area. Working with the Advisory Committee, the Department completed the design of the project, and program regulations have been approved with an effective date of November 2000.
• The Department is currently negotiating with Medicaid HMOs about program implementation.

Contact Information:

Colorado Department of Health Care Policy and Financing
1575 Sherman Street, 4th Floor
Denver, CO 80203
FAX: (303) 866-2803

Dann Milne
Project Director
Phone: (303) 866-5912
E-mail: dann.milne@state.co.us
Website: http://www.chcpf.state.co.us/icfp/icfpindex.html