“once-in-a-generation” opportunity to revamp the Mental Health System in Colorado

I have been following the articles written by Jennifer Brown from the Colorado Sun with a great deal of interest. She is a great writer and has covered many aspects of the Mental Health System in Colorado over the last few months.  Find links to the articles below.

Jennifer Brown points out, Colorado has a “once-in-a-generation” opportunity to revamp the Mental Health System with funding from the federal Coronavirus Relief Fund established by the CARES Act.

As a provider of Mental Health Services, VitalCare interacts with the seven Regional Accountable Entities (RAE) contracted with Health First Colorado, Colorado’s Medicaid program. The RAEs authorize and manage the mental health benefits of the Health First Colorado members who live in their geographic region. 

One would expect these RAEs to operate similarly and provide the same benefits to their members.  Unfortunately, they all operate differently and have different rules, reimbursement rates, rejection rates/reasons, and pre-authorization requirements. They also have different billing systems.  This complex network creates an “administrative burden” for the providers.

Often, providers decline to work with a particular RAE due to frequent billing denials, lower reimbursement rates, or extended wait times to become credentialed as an authorized provider.  The Health First Colorado members in some regions may have very few providers to choose from, due to these factors. 

As a provider, I would like to see some of the funds allocated to creating a statewide system, with one rule set, one billing system and standardized reimbursement rates like the medical side of Health First Colorado.  The inefficiencies of the current RAE system limit the options available to Health First Colorado members and create regional inequities in the availability and quality of services.

What are your thoughts?  How would you like to see these funds utilized?