When Colorado Optometric Association (COA) requested data from the Colorado All Payer Claims Database in 2013, Colorado Medicaid vision codes had not been reviewed in over 40 years. Medicaid reimbursed optometrists roughly 19 percent of care expenses, making it financially difficult for many doctors to accept Medicaid patients. Some of those who did accept patients had to severely restrict the number they treated, causing an access to care problem especially in rural Colorado.
To combat access issues and increase options for Medicaid patients, COA used CO APCD Medicaid price and utilization data to calculate the financial impact a reimbursement increase would have on the overall Medicaid budget, the number of optometrists, and access to vision care services across the state.
Upon completion of the analysis, COA presented the findings to the Department of Health Care Policy and Financing (HCPF). They were able to adequately demonstrate that the low number of Medicaid participating vision care providers was due to their inability to recover the minimum chair cost (price per patient per hour).
Based on data presented, HCPF made a recommendation to the Governor’s Office of State Planning and Budget to increase the reimbursement rates for certain vision codes. The increased rates became effective July 1, 2014 and the number of participating vision care providers has increased expanding access to services in underserved areas including rural Colorado.
Click here to learn more about how CO APCD data is being used to advance the Triple Aim.