Rocky Mountain HMO, Colorado Reach Agreement on Medicaid Reimbursement Rates

Colorado's Department of Health Care Policy and Financing and Rocky Mountain HMO, which covers 24,000 Medicaid recipients, have reached an agreement concerning Medicaid reimbursement rates, the Denv er Post reports. The debate stretches back to late last year, when Rocky Mountain sued the state, saying officials had withheld back payments. In May, a district judge awarded Rocky Mountain $18 million in back payments, a decision the health department has appealed. The "latest stalemate" came earlier in November when Rocky Mountain CEO Mike Weber "complained" that the department had not complied with court- upheld standards for computing reimbursement rates and was setting its 2001 Medicaid rates "too low." In response, the department notified Rocky Mountain that it would not renew its Medicaid contract with the HMO (Lofholm, Denver Post, 11/14). Over the weekend, both sides held "nonstop meetings" to determine a process under which the department could compute "accurate and fair Medicaid reimbursement rates." According to the agreement, the state and Rocky Mountain each will select a "third-party" actuary to analyze the way the state sets its rates (Perrault, Denver Rocky Mountain News, 11/14). If the actuaries cannot agree on "proper rate terms," a "third independent actuary will be brought in and that actuary's findings will become binding." The actuaries' rates will be grandfathered in to cover reimbursements back to July 2000. The agreement also extends Rocky Mountain's Medicaid contract, scheduled to expire Dec. 31, until the end of April 2001. Both Weber and Gov. Bill Owens (R) expressed "satisfaction" with the agreement (Denver Post, 11/14).