Colorado's state policies ignore agreed-upon Medicaid payments, hospital execs say

Kelly Gooch - Print  | 

Colorado hospital executives say policies enacted by the state have led to "significant problems" for hospitals and patients related to billing, payment and medical care, according to the Colorado Springs Independent, which cites a letter from the executives to state officials.

The state "is endangering patients, putting their health information at risk, and ignoring the agreed-upon contracts and reimbursements with hospitals," the letter states. "Though we have repeatedly raised these concerns for years, the [Colorado] Department [of Health Care Policy & Financing] has failed to adequately address the issues."

The letter was signed by Peter D. Banko, president and CEO of Centura; Tom Coburn, CMO and  acting CEO of Middle Park Medical Center; Elizabeth B. Concordia, president and CEO of UCHealth; Lydia Jumonville, president and CEO of SCL Health; Margo Karsten, Banner Health CEO, northern Colorado; and president of Banner Health's Western region; Larry E. Leaming, CEO of Estes Park Health; Sylvia Young, president and CEO of HealthONE; and Kevin Zachary, CEO of Colorado Plains Medical Center.

Specifically, the hospital executives reference the state's new system of prior authorizations and concurrent review, which they say delays patients' surgeries and admissions for urgent healthcare needs by at least a week. They contend some patients' outcomes are also negatively affected by the delays.

They also contend that Colorado's Medicaid program "inappropriately denies claims for patients placed in observation over 48 hours, further increasing the difficulties of placing these patients in rehabilitation and long-term care facilities."

"Tens of thousands of claims have been erroneously denied since 2017, and hundreds of patients' accounts still have not been corrected," they said.

Additionally, the hospital executives contend the state regularly refuses billing responsibility for mental health patients and has refused to pay hospitals for the cost of the drugs they administer to patients.

The Independent reached out to Gov. Jared Polis as well as former Gov. John Hickenlooper for comment but had not reported updates as of late afternoon Nov. 21.

Read the full letter in the Independent's report


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