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Fast Facts About Paid Leave in Colorado
CAP 20 | By Molly Weston Williamson
Colorado workers are ringing in the new year with an important new protection: On January 1, 2024, benefits begin under the state’s paid family and medical leave law. Voters passed Proposition 118 in 2020, making the Centennial State the first—and, so far, the only—state in the country to enact paid family and medical leave benefits by ballot initiative. Colorado joins nine states and Washington, D.C., in providing these benefits; four more states will begin providing benefits in 2026.
Here are the key facts about the law.
What will the law do?
Starting January 1, 2024, Colorado’s law will guarantee workers in the state the right to paid family and medical leave when they cannot work due to serious health or caregiving needs.
Who does the law cover?
The law cover nearly all Colorado employees, including both private sector and state government employees. Local government employees are automatically covered unless the local government opts out; when local governments opt out of coverage, individual local government employees can still elect coverage for cash benefits for themselves. The law covers employees regardless of employer size and includes both full-time and part-time workers. As in most state paid leave programs, self-employed people can voluntarily opt in to coverage…
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2024 Medicaid Provider Rate Review Advisory Committee (MPRRAC) Public Quarterly Meetings
It’s time for the 3-year review of HCBS, Home Health, Private Duty Nursing and Pediatric Personal Care Medicaid fee-for-service rates. Stakeholder feedback is critical to the review process, and the more providers and members of the community that show up to the public meetings to speak on issues pertaining to the rates, the better prepared MPRRAC and HCPF are to understand the needs of Coloradans.
All meeting information will be posted on HCPF’s website: https://hcpf.colorado.gov/rate-review-public-meetings. They currently do not have 2024 meeting information posted but hope to soon. The first meeting will likely be in March; please check back on the website frequently for meeting information. |
10 Prior Authorization Updates to Know in 2023
Becker’s Payer Issues | By Andrew Cass
Several payers, including UnitedHealthcare and Cigna, announced prior authorization cuts in 2023. Here is more on that and other prior authorization updates Becker's reported this year:
1. Prior authorization is the most burdensome regulatory issue facing medical groups, with 89% saying it is very or extremely burdensome, according to a Nov. 13 report from the Medical Group Management Association.
2. CMS on Nov. 6 proposed new health equity changes for prior authorization policies and procedures at Medicare Advantage organizations to better determine any disproportionate impact on underserved populations that may delay or deny access to services. The health equity changes would be effective in contract year 2025 and are part of a broader proposed rule from CMS. Comments on the proposal are due by Jan. 5, 2024.
3. Blue Cross Blue Shield of Massachusetts announced Nov. 6 it is removing 14,000 prior authorization requirements for home care services for its 2.6 million commercial members beginning Jan. 1, 2024. The new policy will be effective for Medicare Advantage members in 2025.
4. Blue Cross Blue Shield of Michigan announced Sept. 7 it is cutting approximately 20 percent of its prior authorization requirements and expanding its gold-card program. James Grant, MD, the payer's senior vice president and chief medical officer, told Becker's the changes are part of an evolving process.
5. Cigna said Aug. 24 it removed prior authorization requirements for more than 600 medical procedures, cutting the number of prior authorizations it requires by 25 percent.
6. UnitedHealthcare cut 20 percent of its prior authorizations across two waves, the first on Sept. 1 and the second on Nov. 1. The payer first announced March 29 that it would be eliminating 20 percent of its current prior authorization requirements and said it could implement a national gold care program in 2024.
7. On average, Medicaid managed care organizations denied around 1 in 8 prior authorization requests, according to a July 17 audit from the HHS' Office of Inspector General. Of the 115 MCOs the OIG audited, 12 had prior authorization denial rates greater than 25 percent.
8. UnitedHealthcare backed off a plan to implement a gastroenterology endoscopy prior authorization policy that was set to take effect June 1 and instead set up an advance notification process for non-screening GI procedures.
9. CMS issued a final rule April 5 that, among other things, aims to streamline Medicare Advantage and Part D prior authorizations and clamp down on misleading marketing practices. The rule requires that coordinated care plan prior authorization policies may only be used to confirm the presence of diagnoses or other medical criteria and/or ensure that an item or service is medically necessary.
10. Texas' physician gold-card rule took effect in October 2022, but providers are not seeing the results they hoped for, the American Medical Association reported March 1. |
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No Surprises Act Dispute Portal Reopens Again Amid ‘Challenging’ Policy Rollout
Healthcare Dive | By Susanna Vogel
The CMS has repeatedly stopped and restarted arbitration this year as court cases snarl regulatory efforts to resolve surprise billing disputes.
Dive Brief:
- The CMS announced on Friday it completed its overhaul of the No Surprises Act dispute resolution process, fully reopening the resolution portal including batched disputes and single disputes for air ambulance services.
- The agency has been incrementally restoring dispute resolution services this year, after a series of lawsuits filed by a Texas provider group prompted the CMS to pause the IDR process multiple times.
- The most recent pause in arbitrations likely contributed to procedural delays and increased the backlog of disputes weighing down the system, according to a new report released by the Government Accountability Office. The report characterized the roll out of the IDR process as “challenging.”
Dive Insight:
The No Surprises Act, which went into effect in January 2022, is meant to protect patients from unexpected medical bills after receiving care from out-of-network providers at in-network facilities.
The dispute resolution process for payments between insurers and providers was meant to be simple. Parties submit a payment offer to a third-party arbiter, who then selects one amount in what is called a final-offer or baseball-style arbitration process.
However, since the NSA rolled out last year, IDR entities, providers and insurers have reported a fraught IDR process. The dispute portal has been overloaded with claims and subject to multiple pauses after being targeted by lawsuits…
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CMS Approves Mobile Crisis Services for People with Medicaid in Colorado
CMS Roundup
December 4: CMS approved a state plan amendment (SPA) for mobile crisis services in Colorado. Authorized under President Biden’s American Rescue Plan (ARP), mobile crisis intervention services provide rapid, critical services to people experiencing mental health or substance use crises by connecting them to a behavioral health specialist 24 hours per day, 365 days a year. This option helps states integrate these services into their Medicaid programs, a critical component in establishing a sustainable, public health-focused support network. This is the 14th mobile crisis SPA approved by CMS. |
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