Colorado Health Care Policy & Financing to post rural health clinic rates, consolidate 2025–26 reconciliations and implement 2026 rates

The Colorado Department of Health Care Policy & Financing (HCPF) told rural health clinic providers at a Jan. 2026 bimonthly engagement meeting that it will publish the rates it pays to enrolled rural health clinics on a public website, consolidate outstanding 2025 reconciliations with 2026 cost-report work into a single reconciliation period, and deploy 2026 rates into the department’s Medicaid management information system so prior claims can be mass-adjusted to the correct rate.

HCPF facility rate section manager Andrew Abelos said the posting is intended to add transparency by collating data that are already publicly available through the CMS hospital cost-report database. “We would like to post those rates to our public facing website with the intent of adding some transparency to our existing payment rates,” Abelos said.

Why it matters: rural clinics rely on accurate encounter rates and timely reconciliations to ensure correct Medicaid reimbursement. Abelos told attendees the department has been working with its auditor, Myers & Stauffer, to validate that prospective payment system (PPS) rates do not exceed the Medicare upper payment limit (UPL) and to collect finalized Medicare cost reports for hospital-based RHCs. Once rate letters are issued and cleared through internal review and budgeting, HCPF plans to implement rates into MMIS and perform mass adjustments so previously submitted claims reflect the corrected rates.

How rates are set: Abelos summarized Colorado’s approach: for freestanding RHCs the department pays the higher of statutory PPS rates (as referenced in the meeting) and an alternative payment methodology based on the Medicare UPL; interim rates for new freestanding clinics use averages of other freestanding RHCs’ rates. For hospital-based RHCs the APM can be cost-based, using audited Medicare cost-per-visit information; after audits HCPF reconciles interim and finalized rates, which can result in payments to or recoupments from hospital-based RHCs.

Consolidated reconciliations and timing: HCPF said it fell behind on 2025 reconciliations after an analyst left the team. To address that backlog, staff plan to aggregate 2025 and 2026 cost-report and utilization data into a single reconciliation period and then distribute letters describing any one-time lump-sum payments or recoupments once the work is finalized and cleared. Abelos said department staff expect some of the 2026 rate work to be implemented in the MMIS within the following month and that the contractor generally performs data collection during the final quarter of the prior calendar year.

Managed-care accuracy audits and next steps: Abelos urged clinics to consider the department’s managed-care accuracy audit process, which is intended to determine whether managed-care entities have reimbursed RHCs at least at the encounter rate. Facilities can participate by submitting quarterly data, notifying HCPF they have been paid in full, or submitting data indicating additional payment is due. Kennedy Vance was listed on the meeting slide as the point of contact for that process.

Operational questions from providers: A participant identified in the chat as Rick asked for future sessions focused on “practical implementation approaches that support documentation, audit readiness, and provider led collaboration without changing rates or billing rules,” including for MIH/CP, treat-in-place and telehealth-enabled follow-ups. Abelos said he would consult policy staff (Morgan Anderson and Janelle Gonzalez were listed as policy contacts) and follow up; staff suggested the topic could be on the March meeting agenda.

Staffing and contact information: Abelos said the department is hiring a replacement FQHC/RHC rates analyst and that the new analyst’s contact will be added to future materials when the hire is complete. He closed by reminding participants that the next bimonthly RHC engagement meeting is scheduled for March 5, 2026.

What HCPF said it will do next: post RHC rates publicly; finish the combined 2025–2026 reconciliation; distribute letters describing any payments or recoupments; implement the 2026 rates into MMIS; and follow up on provider requests for operational implementation discussions.

The meeting adjourned after the question-and-answer period; staff said they will follow up by email with providers who raised specific questions.