Colorado Department of Health Care Policy & Financing officials told hospital stakeholders on a November engagement call that multiple payment and regulatory changes are moving through implementation and federal review.

Andrew Abalos, the department’s facility rate section manager, said the department plans to implement the Emergency Ambulatory Payment Group (EAPG) version 3.18 transition and a previously enacted 1.6% inpatient base‑rate increase at the same time. The fiscal agent Gainwell is targeting completion of the required system change request and installations by about Dec. 17, and the department intends to reprocess affected claims so that providers should not need to take system-level action.

“This should have the system fully updated to pay using version 3.18, and no action should be required on the provider’s part because we will be reprocessing any of those impacted claims to pay at their correct rate version,” Abalos said.

Abalos also described a software service-pack that was released Oct. 23 and installed Oct. 27 to apply quarterly CPT/HCPCS and ICD‑10 updates. The vendor change addressed an interface issue for some EAPG claims that staff said has been resolved without the need for reprocessing.

On regulatory matters, Abalos said the department submitted a State Plan Amendment in August 2025 to implement a change tied to the 340B program (reducing a percent discount from 80% to 65%) and is in ongoing conversations with the Centers for Medicare & Medicaid Services (CMS). He also said an inpatient rebasing State Plan Amendment was submitted Sept. 30 and that inpatient rates had already been uploaded into the MMIS so payments should be correct while CMS reviews the submission.

Separately, staff converted an earlier emergency rule about rate‑setting authority (allowing certain modifications via executive order) into a regular rule to preserve the change beyond the temporary emergency‑rule period; that rule is scheduled to be presented to the Medical Services Board on Nov. 14. Diana Lam, inpatient hospital rates analyst, described housekeeping rule edits to Colorado rule sections 8.3005(a) and 8.3005(a)(5) to fix alphabetical peer‑group references and to clarify that border‑state hospitals are assigned inpatient peer groups based on geography and receive in‑state peer‑group averages; stakeholders were invited to submit comments by end of day Dec. 8 before the item goes to the Medical Services Board.

The department encouraged hospitals with questions about timing or impacts to contact the facility rates team and said it will issue e‑mail notices to its provider list when the SCR and reprocessing schedules are finalized.

What’s next: staff said they will notify providers when the system change request is complete and when reprocessing will occur. The Medical Services Board will consider the rate‑setting regular rule and the housekeeping peer‑group rule according to the posted rulemaking timeline.