Medicaid is in the middle of approving a change to the way healthcare is managed. Currently there are two different sub-networks that handle the payment of claims and services. These two categories are RCCO and BHO. Currently, Mental Health Providers, for example must not only be in network with Colorado State Medicaid, but they then must apply to the BHO network in their county for claims to be properly paid. The proposed ACC change would request that all providers now be in network and managed by a Regional Accountable Entities (RAE) instead. The payments of services would then come directly from the RAE and Medicaid itself.
Above is the map of proposed counties and RAE regions. There will be a total of 7 RAE regions that manages the entire Health neighborhood: Hospitals, Non-Medical Providers, Other Medical Providers, Oral Health, Specialist. In addition to the entire Health Team: behavioral, certain specialists, and longer-term services and supports. Medicaid patients would be assigned to each RAE to better service and manage all in one services.
As of May 11, 2017 the formal request for proposals was released, to include the above RAE map. However, there were many formal protests. So, while the protesting period is in progress further discussion of the contracts, awards, and negotiations are prohibited. However, the state is planning to continue forward as if the implementation phase will take place.
Ponderosa is working to continue to understand how this change will directly impact providers and the claim and credentialing process. We will update our clients with the news and updates as we receive them from the State of Colorado. In the meantime, please feel free to visit the website that we pulled our information from and made our summary upon: https://www.colorado.gov/hcpf/accphase2