[{"_1":2,"_88":-5,"_89":-5},"loaderData",{"_3":4,"_26":27},"root",{"_5":6,"_17":10,"_18":19,"_20":21,"_22":10,"_23":-5,"_24":-5,"_25":10},"user",{"_7":8,"_9":10,"_11":10,"_12":-5,"_13":-5,"_14":15,"_16":-5},"roles",[],"isAuthenticated",false,"isPremium","planName","subscriptionStatus","featureFlags",{},"insightsBudget","isDevelopmentHost","userPreferences",{},"recaptchaSiteKey","6LcvOJcUAAAAAHsB-gPGfGktcRlKpH7OTIU_dMTD","isImpersonating","impersonation","affiliateStatus","isFreedomPortal","routes/v2/article/layout",{"_28":29,"_30":31},"notFound",true,"relatedArticles",[32,76],{"_33":34,"_35":36,"_37":38,"_39":40,"_41":42,"_43":44,"_45":46,"_47":48,"_49":50,"_51":52,"_53":54,"_55":56,"_57":58,"_59":60,"_61":62,"_63":64,"_65":66,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},"mediaId",6385762,"mediaKeyId","2119194-8b5fe721fa628fa70bad1090f5a91d48","parentId",2119194,"title","State auditor finds problems in Colorado’s Medicaid RAC program; recommends contract and process changes","audioSeconds",478,"startMs",2178000,"endMs",2656000,"viewUrl","/Search/View?dp=1&key=2119194-8b5fe721fa628fa70bad1090f5a91d48&start=2178&end=2656","thumbnailUrl","https://assets.pipeline.soar.com/2119194-8b5fe721fa628fa70bad1090f5a91d48/thumbnail_2178000.jpg","articleUrl","/articles/6385762/Colorado/State-auditor-finds-problems-in-Colorados-Medicaid-RAC-program-recommends-contract-and-process-changes","mediaUrl","https://secure.pipeline.soar.com/6385762-f9839f9932d8735fb9070278ea5d87ab/orig.mp4?Expires=1771106582&Signature=H~Sr0Qi5jzx740bOw9GVd4a8IqHSn4Ff7YWApyBY2X4g2mLKOYs7hnJ~eyplQ4eGOh0G~-nNlXqI4o59HLRUAZPEWEqbIj5L06z2bp4aEqJLR04aHzzoOi3OOsJ8cGLDULGS~hb15uciGaiNyWXnA52fCcX97UTqgPycC0t3WSPWVpfERRRfLJDF2jO7sgbwCyk1s8G9uXOZAE3N63u4UVcH3mCWbxW0YcjLnbaWuSYyE7Yf4c7oLFVRJ3j9quNUp3SeBZJPfnZdW5KLUMp6K21eLxPu50NPlNaUXpnz58dRzGOczTWlRiuB1W8JdpcBDZRqRzT~F54d3DiqyQJ6FA__&Key-Pair-Id=KUT5TJCACFTXG","author","Joint Budget Committee","date","2025-01-06T00:00:00Z","article","An independent evaluation required by House Bill 231295 and presented to the Joint Budget Committee on Jan. 8 concluded Colorado’s Medicaid Recovery Audit Contractor (RAC) program has weaknesses in scenario design, contract controls and oversight that have created provider appeals, rescinded findings and potential legal risk.

Carrie Hunter, state auditor, introduced the contracted evaluation carried out by Barry Dunn and associates. Barry Dunn managers summarized the report’s findings: auditors reviewed 31 HMS (the RAC vendor) audit scenarios and found multiple instances where scenarios used inconsistent, unclear or outdated standards to identify overpayments. The auditors said HCPF sometimes approved scenarios without sufficient subject-matter review, producing avoidable audit findings; in one example HCPF rescinded more than $13 million in findings after the issue was raised.

Auditors also reported a contract provision that allowed the vendor to be paid on the total amount of overpayments “identified” rather than the amounts actually recovered. The report noted federal rules and Colorado statute require contingency fees to be based on recovered amounts. The audit recommended HCPF amend its contract to remove the provision; HCPF told auditors it agreed to implement the change (auditors recorded an implementation target of Aug. 2024).

Other findings included inconsistent use of contract transmittals to provide vendor direction; insufficient monitoring of vendor staff credentials (auditors could not verify credentials for many vendor personnel); and concerns about an acquisition (Gainwell’s purchase of HMS) that created an appearance-of-conflict risk because Gainwell also performs fiscal-agent services for Medicaid claims processing. Auditors recommended HCPF obtain disclosures from the vendor and document assessments and communications to providers about conflict mitigation.

The report highlighted provider complaints that some large provider systems (hospitals) routinely bypassed informal reconsideration or exit-conference steps and filed formal appeals, a practice that auditors said increases costs and delays resolution; in one set of hospitals appeal rates exceeded 90% of audited claims. Auditors recommended statutory or program changes that could require providers to exhaust certain preliminary processes before filing appeals, and suggested HCPF improve processing timeliness, documentation of reviewer qualifications, and provider outreach and education.

Auditors also analyzed Colorado’s 7‑year look-back period (the length of time claims may be audited). They found 93% of audited claims were less than five years old and 66% less than three years. The report estimated that shortening the look-back to three years would cut the number of claims audited by about 58% and reduce recoveries by roughly 30% (about $26 million) absent other program changes. Auditors presented the estimate as information for the legislature rather than a recommendation.

HCPF and its RAC contractor provided responses during the hearing and told the committee they accepted many recommendations; on some items (for example, how to rely on third‑party accreditation to verify vendor staff credentials) HCPF described alternative approaches. Auditors said HCPF agreed to implement many of the recommended controls by late 2024.

Ending: The auditor’s contracted evaluation offered 7 findings and 7 policy considerations to reduce erroneous audits, realign vendor incentives, strengthen contract controls, improve provider support and document conflict-mitigation steps. Several recommendations require contract amendments and operational changes at HCPF; the committee flagged follow-up oversight of implementation.","mediaType","Video","parentTitle","Joint Budget Committee [Jan 06, 2025]","oneSentenceSummary","An independent evaluation of Colorado’s Medicaid Recovery Audit Contractor program found inconsistent audit scenarios, a contract pay provision at odds with federal guidance, insufficient vendor-credential monitoring, and an unassessed acquisition that raised conflict concerns.","taxTitle","Joint Budget Committee, YEAR-ROUND COMMITTEES, Committees, Legislative, Colorado","taxId",45208,"location","Colorado","headline","","shortSummary",{"_33":77,"_35":36,"_37":38,"_39":78,"_41":79,"_43":80,"_45":81,"_47":82,"_49":83,"_51":84,"_53":85,"_55":56,"_57":58,"_59":86,"_61":62,"_63":64,"_65":87,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6385767,"State architect warns Colorado’s state-owned buildings face rising backlog; urges larger, sustained funding for controlled maintenance",1010,32000,1042000,"/Search/View?dp=1&key=2119194-8b5fe721fa628fa70bad1090f5a91d48&start=32&end=1042","https://assets.pipeline.soar.com/2119194-8b5fe721fa628fa70bad1090f5a91d48/thumbnail_32000.jpg","/articles/6385767/Colorado/State-architect-warns-Colorados-state-owned-buildings-face-rising-backlog-urges-larger-sustained-funding-for-controlled-maintenance","https://secure.pipeline.soar.com/6385767-e1766b0e01da47fdd53461f6b4f68da6/orig.mp4?Expires=1771106582&Signature=OVXk5JUqJmYy~OI9hcFlnc0DwkY7yPyN2EsghUvBADk7kUujPgFOqu-8BBszX-TjwgF4lfUDzUF-latT0NEBb170O31yh77BAwA99cFcUx9p1h7DJnbgLFhtF-gjY5js7Uxr98S3Za825BGvSO0wrK4AQ596mBCweEq3VEVgszCXY0nrpiZqxSOpKbOrEhAfwSLkdHpHjGo9g576I~Jhmab43kTSfzF4FwvR65zPskvZbWxgnK3~-i0LN4pNJU1bHVYenp412z4lqf~C7a5WzwDOqNWD3N7y6CLo7mGU2Eu6vW7E6py7BsQwn~6cTv3BSzGD-yWaOzmvn54K0tiumA__&Key-Pair-Id=KUT5TJCACFTXG","Tiana Lane, state architect with the Division of State Property in the Department of Personnel and Administration, told the Joint Budget Committee on Jan. 8 that Colorado’s inventory of state-owned buildings is aging and funding for controlled maintenance and capital renewal is far below recommended levels.

Lane said OSA’s inventory shows many buildings fall in age cohorts — 41 to 100 years old — that typically require major repairs and mechanical or envelope replacement. “Under 10 years old, we call that the honeymoon phase… Buildings left alone will reach their useful life at about 40 years old,” she said.

The nut of OSA’s presentation: current funding does not match need. Lane described OSA’s annual scoring and review process — agencies submit requests that OSA scores for life-safety, operational disruption, risk of failure and criticality; OSA does on-site visits and recommends phasing and delivery methods. She said the office recommends dedicating about 2.5% of current replacement value to capital improvements (1% for controlled maintenance and 1.5% for capital renewal). Applied to higher-education and general-funded inventories, Lane said that would imply hundreds of millions more than current levels: “1% would be $202,000,000 and then the 2.5 would be $506,000,000,” she said.

OSA described how controlled-maintenance scoring and a priority multiplier are used to allocate limited funds so smaller campuses get some projects while larger agencies get a set number of priority slots. Lane acknowledged that can create trade-offs and said OSA uses optional scoring criteria and subject-matter review to adjust for unusual urgency: “If it’s a unique and an immediate threat to staff life safety… we considered that very unique and immediate,” she said, citing corrections security-software failures as an example.

Lane highlighted a growing emergency workload: OSA approved 26 emergency projects in 2023 and 38 in 2024, averaging about $3.3 million per emergency project so far in the fiscal year. In response to committee questions she said OSA requests about $23 million per year for the emergency controlled-maintenance fund but that boilers or major campus projects costing tens of millions would vastly exceed that fund’s capacity.

The office explained a recent change to the controlled-maintenance threshold (raising the minimum cash-project reporting threshold from $2,000,000 to $4,700,000) and reported that although the higher threshold enabled some projects to cross finish lines, most level‑1 projects still stayed below $3,000,000 and only one project could not be phased. Lane and committee members discussed whether intermittent pauses on new construction to focus on maintenance should be considered, and Lane said the office tracks those trade-offs but does not set statewide construction priorities.

Lane closed by warning that construction inflation and escalating backlog mean controlled maintenance will not disappear even with increased annual investment, urging longer-term funding strategies and continued work on space utilization and strategic investments.

Ending: The committee heard OSA describe a detailed scoring process and emergency workload that together argue for larger and steadier controlled-maintenance and capital-renewal funding. Lane offered to provide further detail to senators who requested an itemized pipeline cost estimate.","The Office of the State Architect (OSA) told the Joint Budget Committee its building portfolio is aging, controlled-maintenance backlog is growing, and current funding falls far short of recommended levels; OSA staff described scoring, emergency requests and a request for larger, sustained capital renewal funding.","actionData","errors"]

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State auditor finds problems in Colorado’s Medicaid RAC program; recommends contract and process changes

State architect warns Colorado’s state-owned buildings face rising backlog; urges larger, sustained funding for controlled maintenance