Program integrity cannot flow in only one direction.

Commission Members,

I am writing to supplement the public comments I submitted for today's September 17 meeting based on testimony I have heard during the meeting.

I need to strongly contest the characterization we just heard regarding providers, Case Management Agencies, and families.

The Commission heard that CMAs reported people arriving for assessments having been “coached by providers,” that this makes it difficult for CMAs to do their jobs, and that provider behavior is connected to increasing utilization.

That is an extraordinarily consequential assertion. Before it becomes part of the narrative used to explain Colorado's LTSS growth—or to justify further restrictions on members—the Commission should demand the data supporting it.

I absolutely support provider accountability. If a provider commits fraud, pressures a member, improperly markets services, offers prohibited incentives, or instructs someone to misrepresent their needs, investigate it and hold that provider accountable.

But please do not conflate that conduct with advocacy, education, assessment preparation, or a family learning how to accurately describe the needs of a person with a significant disability.

Those are very different things.

I also strongly contest the implication that CMAs should automatically be treated as the neutral counterweight protecting members from providers.

That does not reflect the experience of many families navigating this system.

CMAs are part of Colorado's Medicaid administrative structure. They conduct assessments, authorize services, implement HCPF policy, and make decisions that directly affect whether individuals receive the supports they need. Families can and do disagree with those decisions. Members have appeal rights for a reason.

My own family's recent experience illustrates why this distinction matters. We have been dealing with reductions, reassessments, questions about longstanding services, and disputes over how assessments are conducted. When a family prepares for those processes, learns the rules, documents needs, or seeks help understanding what should be captured in an assessment, that should not automatically become evidence of “coaching.”

And members and families must not become the scapegoat for Colorado's Medicaid budget problems.

If the Department believes provider coaching is materially responsible for increased LTSS utilization, I respectfully ask the Commission to request the underlying evidence:

How many documented cases of improper provider coaching have been identified?

How many resulted in a finding that a member's assessment or authorized services were inaccurate?

What percentage of increased LTSS utilization or spending can actually be attributed to that conduct?

How is HCPF distinguishing prohibited coaching from legitimate member education, advocacy, supported decision-making, and assistance preparing for an assessment?

What data come directly from members and families, rather than from CMAs or providers?

And finally, what accountability exists when a CMA gets it wrong?

That last question matters.

Program integrity cannot flow in only one direction. Providers should be accountable. CMAs should be accountable. Contractors should be accountable. HCPF should be accountable. And members should receive services based on their actual assessed needs.

Please preserve this distinction as the Commission develops its findings and recommendations.

There are undoubtedly bad actors in a system this large. Address them with evidence and targeted enforcement.

But please do not allow allegations about some providers to evolve into a presumption that informed families, advocates, or members asking for necessary services are somehow the source of Colorado's Medicaid problem.

We are not.

We are the people the Medicaid program exists to serve.

Thank you for adding this supplemental statement to my comments for today's meeting.

Rob Harris
Grand Junction, Colorado
AdvocateDadCO.org