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A two-year pause has been placed on the prior authorization requirements for a series of long-term home health therapies and services for the Medicaid pediatric population in Colorado following complaints from provider organizations about denials and delays. Although 90% of claims are processed without issue, 10% of claims have been initially denied or delayed for clinical or administrative issues for longer than is permitted by federal Medicaid requirements.

In May 2021, the Colorado Department of Health Care Policy and Financing (the Department) contracted with Keystone Peer Review Organization (Kepro) as a utilization management vendor handle prior authorization requests . . .

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Disability Support & Long Term Care Services

Disability and long-term care refers to institutional and community-based care that support individuals with activities of daily living and services related to age or disability. Over the past decade, there has been an increase in the changes and challenges affecting the disability support and long-term care market markets—the move to managed care and subsequently value-based care, the shift to home- and community-based care, the increase in the aging population, and new workforce challenges.

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Approximately 13.5% Of U.S. Civilians Report One Or More Disabilities
Approximately 44.68 million U.S. civilians of all ages living in the community reported one or more disabilities in 2023, representing 13.5% of the noninstitutionalized population. Among adults aged 18 and older, the rate rises to approximately 16%. The analysis is based on data from the U.S. Census Bureau’s 2023 American Community Survey (ACS), which reaches approximately 4.7 million people annually with a response rate of about 85%. The most commonly reported disability type was ambulatory… Read

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