Expected Hospital Reimbursement Rates Under the Colorado Affordable Health Care Option

Expected Hospital Reimbursement Rates Under the Colorado Affordable Health Care Option

Download the Expected Hospital Reimbursement Rates

On March 6, 2020, the Colorado Division of Insurance (DOI) and the Department of Health Care Policy and Financing (HCPF) released the expected reimbursement rates for all Colorado hospitals under the state’s recently introduced Colorado Affordable Health Care Option (details on the full bill here).

In an accompanying press release, DOI and HCPF report that, on average, Colorado hospitals are able to cover their costs with a reimbursement rate of 143 percent of Medicare rates. The state agencies then note that the current bill text sets the base reimbursement level for all hospitals at 155 percent of Medicare, and includes a series of upward adjustment factors based on hospital-specific characteristics (i.e., whether the hospital is an independent or Critical Access Hospital; whether they serve a higher-than-average percentage of Medicare or Medicaid beneficiaries; or, whether hospitals efficiently manage administrative costs).

In these projections, DOI and HCPF include estimates ranging from 155 percent to a maximum reimbursement estimate of 238 percent of Medicare rates.