We [& a Lot of other people] Know CO doesn't have Medicaid Network Adequacy ----

That's why these standards are so important

First Five of Elements for Medicaid Network Adequacy Elements in the Code of Federal Regulations

42 CFR 438.68
​
(c) Development of network adequacy standards. (1) States developing network adequacy standards consistent with paragraph (b)(1) of this section must consider, at a minimum, the following elements:

(i) The anticipated Medicaid enrollment.

(ii) The expected utilization of services.

(iii) The characteristics and health care needs of specific Medicaid populations covered in the MCO, PIHP, and PAHP contract.

(iv) The numbers and types (in terms of training, experience, and specialization) of network providers required to furnish the contracted Medicaid services.

​(v) The numbers of network providers who are not accepting new Medicaid patients.
  • Mental Health America ranks CO 48th in Child Mental Health
  • CO has failed to comply with various orders and Settlement Agreements in the Jail Wait Case
  • One of the reasons CO has such inadequate bed space is because it has such inadequate Medicaid intensive mental health services.
  • Further, inpatient hospital service is supposed be a Medicaid Mandatory Service.
  • Some of the intensive services would be less expensive, but Assertive Community Treatment, Residential Services, & Intensive Case Management are offered as ALTERNATIVE SERVICES & they run out.
CO actually has done some work to comply with this --- and like so many other things -- they  are NOT in full compliance with the Law.

Further, those areas of non-compliance are NOT insubstantial.

One of the HUGE problems in CO Medicaid Network Adequacy is intensive mental health services for Adults and Youth.

We really have to get to the failures the Hickenlooper Administration didn't feel they could deal with and didn't.

So What We Really Want to See is:
  • A Document entitled "CO Medicaid Network Adequacy Standards" posted to the website
  • We are asking that this document include the Mandatory Elements for Consideration under 42 USC 368.88 and whatever associated data exists or needs to be obtained.
  • Any exceptions that were requested.
  • Etc.
  • AND the next Governor and Stakeholders really need to make a thoughtful ASK to bring CO in Compliance with Medicaid Network Adequacy requirements.