Evidence record
Medicaid Correspondence Performance Audit
- Jurisdiction
- Colorado
- Publishing agency
- Colorado Office of the State Auditor
- Publication date
- September 29, 2023
- Source record
- Original document linked
Findings
3
Recommendations
0
No formal recommendations were issued in this record.
Overall conclusion
The audit concluded that the Department of Health Care Policy & Financing’s Medicaid correspondence exhibits significant clarity, accuracy, and completeness problems across CBMS and non-CBMS letters, including duplicated and contradictory messages, missing information, noncompliant deadlines, and inconsistent formats. Vendor correspondence for prior authorization often failed to meet standards, and the Department lacks formal, institutionally supported ongoing monitoring, governance, and implementation processes for improving Medicaid correspondence. Strong need for comprehensive, agency-wide improvements to ensure compliant, understandable, and timely member communications and to establish accountable roles and robust monitoring.
Scope
Comprehensive performance audit of the Department of Health Care Policy & Financing (Colorado Medicaid) correspondence, focusing on all Medicaid member communications generated from CBMS and non-CBMS systems during January and February 2023, including four primary CBMS letter types (Notices of Action, Information Request Letters, Income Discrepancy Letters, Renewal Letters) and related correspondence from the Department’s Office of Community Living (OCL) via the BUS and the CCM system, as well as letters issued by nine Prior Authorization Request vendors. The audit evaluated both CBMS-generated and non-CBMS letters for compliance with the Medicaid Correspondence Improvement Act (25.5-4-212, C.R.S.), federal regulations (e.g., 42 C.F.R. 435), and state rules. It also examined the Department’s monitoring processes, testing practices, and stakeholder feedback channels (MEAC, County Correspondence Questionnaires, Member Contact Center) and incorporated data sources including CBMS, BUS/ CCM, and PAR vendor letters. The work was performed Jan 2023 through Aug 2023, with a focus on letters sent by the Department to members — through CBMS (and its four letter types) and non-CBMS sources (OCL CCM and BUS), plus PAR vendor letters — across 64 counties and 11 Medical Assistance sites, during the period surrounding January–February 2023, in the context of the public health emergency (PHE) ongoing earlier and the end of continuous coverage in March 2023. The audit relied on samples, case studies, and documentation to assess clarity, accuracy, and completeness and to evaluate the Department’s ongoing correspondence improvement process.
Findings (3)
Each finding has a stable link.
- F-620
Finding 1—Medicaid Eligibility Correspondence: Problems with CBMS and OCL letters including duplicated information, contradictory or confusing messages, unclear status, and missing required elements; noncompliant dates and inconsistent deadlines observed; high prevalence of errors (at least 1 problem in 72 of 80 CBMS letters reviewed, or 90%).
- F-621
Finding 2—Vendor Prior Authorization Correspondence: Prior Authorization Request (PAR) letters from vendors did not meet standards for Medicaid correspondence, resulting in inaccurate and incomplete letters that do not align with plain language requirements and did not comply with rules giving members adequate time to appeal decisions.
- F-622
Finding 3—Medicaid Correspondence Management: Department lacks comprehensive processes to identify, review, and implement changes to correspondence; insufficient assignment of responsibilities, policies, or procedures; limited monitoring and testing of correspondence.
Recommendations (0)
This record contains no formal recommendations.