Colorado Medicaid suspends new PACE enrollments at InnovAge centers follow audit findings

The Colorado Department of Health Care Policy & Financing (Department) suspended new enrollments into InnovAge Colorado’s Program for All-inclusive Care for the Elderly (PACE). The Department has concurrently directed a corrective action process requiring InnovAge Colorado to address patient care concerns in all their Colorado sites. The decision follows extensive audit findings of InnovAge Colorado, the state’s largest provider of PACE services. This suspension applies to the enrollment of all new InnovAge Colorado Medicaid beneficiaries, including people who are eligible for both Medicare and Medicaid. The audit was prompted by complaints related to the health, safety, and welfare of Health First Colorado (Colorado’s Medicaid program) members receiving PACE services from InnovAge Colorado. Approximately 75% of Health First Colorado members enrolled in PACE – a program for senior Health First Colorado members – receive those services from InnovAge Colorado.

The Department’s audit was conducted concurrently with audits by the Centers for Medicare & Medicaid Services (CMS) and the Colorado Department of Public Health & Environment (CDPHE). The audit findings of CMS were released separately while CDPHE findings are forthcoming. The enrollment sanction will remain in effect until CMS and the Department are collectively and individually satisfied that InnovAge Colorado has corrected the causes of the violations cited and InnovAge Colorado fully demonstrates the violations are not likely to recur as outlined in an approved corrective action plan.

In general terms, the Department’s audit identified numerous deficiencies on the part of InnovAge Colorado in the delivery of care, the timeliness of care and staffing in both center-based operations as well as in-home care. The findings put InnovAge Colorado in breach of its contractual obligations with the Department in serving Medicaid seniors and people with disabilities under the PACE program and in violation of the federal PACE requirements. More detailed information on the Department’s audit findings, the Notice of Action to InnovAge, and an FAQ document can be found on the Department’s website. The Department determined the seriousness of these deficiencies requires the suspension of any new Health First Colorado beneficiary enrollment at all InnovAge Colorado centers, furthering the focus of InnovAge Colorado on the care, health, safety and well-being of the current Medicaid members in their care.

The Department will require InnovAge Colorado to submit a Corrective Action Plan (CAP) within 30 days unless an extension is granted by the Department. The CAP will outline required actions for compliance and corrections for the cited deficiencies, improving the  care provided to Medicaid members by InnovAge Colorado.  Actions by InnovAge to address care deficiencies will be monitored by the Department until it is satisfied that the root causes of the violations cited have been addressed and InnovAge Colorado fully demonstrates the violations are not likely to recur.

“Protecting the health, safety and welfare of our Medicaid members is a top priority for our Department. This is especially important to our frail seniors and individuals with disabilities, who we are honored to serve,” said Kim Bimestefer, executive director for the Department. “The actions we have taken , in collaboration with CDPHE and our federal partners, are in the best interest of our members and will ensure that InnovAge Colorado takes comprehensive action to the betterment of the health and well-being of the Medicaid members in their care.”

From May 2021 through July 2021, the Department conducted an audit of InnovAge Colorado, including all its Colorado centers. The suspension of new enrollments apply to new Health First Colorado beneficiaries for all InnovAge Colorado centers:

  1. Aurora PACE Center – 3551 N. Chambers Aurora, CO 80011
  2. Denver PACE Center – 1265 South Broadway Denver, CO 80210
  3. Lakewood PACE Center – 8405 W. Alameda Ave. Lakewood, CO 80226
  4. Northern Colorado PACE Center – 1303 E. 11th St. Loveland, CO 80537
  5. Pueblo PACE Center – 401 W. Northern Ave. Pueblo, CO 81004
  6. Thornton PACE Center – 445 E. 124th Ave. Thornton, CO 80241

This press release was provided by the Colorado Department of Health Care Policy & Financing.