HOME HEALTH SERVICES PROVIDER IN COLORADO

DELIVERING SKILLED NURSING AND THERAPEUTIC CARE TO MEDICAID MEMBERS IN THE COMFORT OF THEIR OWN HOMES

Home Health Services in Colorado provide medical, rehabilitative, and personal care to individuals recovering from illness, managing chronic conditions, or requiring support to avoid institutional placement. These services are reimbursed under the Colorado Medicaid State Plan and may also be accessed through certain Home and Community-Based Services (HCBS) Waivers, including the Elderly, Blind, and Disabled (EBD) waiver and Children’s HCBS Waivers.

1. GOVERNING AGENCIES

Agency: Colorado Department of Health Care Policy and Financing (HCPF)

Role: Oversees Medicaid reimbursement and policy for home health services

Agency: Colorado Department of Public Health and Environment (CDPHE)

Role: Licenses Class A Home Care Agencies that provide skilled medical services

Agency: Centers for Medicare & Medicaid Services (CMS)

Role: Provides federal guidance for Medicaid-covered home health services

2. HOME HEALTH SERVICE OVERVIEW

Home Health Services offer short-term or long-term skilled care in a client’s home as prescribed by a physician. Services are designed to prevent hospitalization, promote recovery, and support health at home.

Approved providers may deliver:

• Skilled nursing visits (e.g., wound care, medication administration, IV therapy)

• Physical, occupational, and speech therapy

• Certified nursing aide (CNA) support for ADLs

• Medical social work and care coordination

• Health status assessments and care plan updates

• Education for patients and families

• Documentation of outcomes and physician communication

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

• Register your business with the Colorado Secretary of State

• Obtain EIN from the IRS and NPI (Type 2)

• Obtain a Class A Home Care Agency license from CDPHE

• Meet Medicare Conditions of Participation (if seeking dual certification)

• Enroll as a Home Health Agency Provider via the Gainwell Medicaid Provider Portal

• Employ qualified licensed and certified professionals (RN, PT, OT, etc.)

• Carry general liability, professional liability, and workers’ comp insurance

4. PROVIDER ENROLLMENT PROCESS

Step 1: CDPHE Class A Home Care Agency License

• Submit application, clinical policies, and safety protocols

• Pass inspection and background screening

Step 2: Medicaid Enrollment via Gainwell

• Apply through the Colorado Medicaid Provider Enrollment Portal

• Submit license, business documents, and staff qualifications

Step 3: Referral Network Development

• Coordinate with hospitals, physician offices, and CMAs for referrals and authorizations

5. REQUIRED DOCUMENTATION

• Articles of Incorporation or business registration

• IRS EIN Letter

• NPI confirmation

• CDPHE Class A Home Care Agency license

• Medicaid provider ID

• Policy & procedure manual including:

  • Admission and physician order verification process

  • Skilled nursing, therapy, and aide documentation templates

  • Infection control and emergency response plans

  • HIPAA compliance and patient confidentiality protocols

  • Supervision and quality assurance plans

  • Incident reporting and change of condition protocols

  • Client rights, consent forms, and service agreements

  • Staff credentialing, CEUs, and supervision documentation

6. STAFFING REQUIREMENTS

Role: Registered Nurse (RN)

Requirements:

• Colorado nursing license

• Skilled nursing experience

• CPR certification, background check, and TB screening

Role: Home Health Aide / CNA

Requirements:

• Active CNA license in Colorado

• Supervised by RN

• ADL support training

Role: Therapist (PT, OT, SLP)

Requirements:

• State licensure and experience in home care

Training Requirements for All Staff:

• Infection control, HIPAA, and safety training

• Abuse prevention and emergency response

• Documentation and plan of care protocols

• Annual CEUs and in-service training

7. MEDICAID WAIVER SERVICES

Home Health Services are reimbursed under:

• Colorado Medicaid State Plan

• HCBS-EBD (Elderly, Blind, and Disabled) Waiver

• HCBS-BI (Brain Injury) Waiver

• Children’s HCBS Waivers (e.g., CHCBS, CLLI)

Approved providers may deliver:

• Skilled intermittent care per physician orders

• ADL support by certified aides (if ordered)

• Therapy and case coordination

• Timely documentation for billing and oversight

8. TIMELINE TO LAUNCH

Phase: Business Formation

Timeline: 1–2 weeks

Phase: CDPHE Licensing Process

Timeline: 60–90 days

Phase: Medicaid Enrollment via Gainwell

Timeline: 30–60 days

Phase: Staff Onboarding and Referral Activation

Timeline: Ongoing

9. CONTACT INFORMATION

Colorado Department of Public Health and Environment (CDPHE) – Facility Licensing

Phone: (303) 692-2800

Website: https://cdphe.colorado.gov

Colorado Department of Health Care Policy and Financing (HCPF)

Email: hcpf_hcbs_questions@state.co.us

Website: https://hcpf.colorado.gov

Colorado Medicaid Provider Enrollment (Gainwell Technologies)

Website: https://portal.co.gov

WAIVER CONSULTING GROUP'S START-UP ASSISTANCE SERVICE — COLORADO HOME HEALTH SERVICES PROVIDER

We help nurses and healthcare organizations launch fully licensed, Medicaid-compliant Home Health Agencies across Colorado’s waiver and Medicaid programs.

Scope of Work:

• Business registration (LLC, EIN, NPI)

• CDPHE Class A Home Care Agency licensing assistance

• Medicaid enrollment and HCBS waiver alignment

• Policy & procedure manual for clinical care, safety, and compliance

• Templates for physician orders, nursing notes, and therapy plans

• Website, domain, and email setup

• Staff credentialing trackers and CEU documentation

• Client intake packet, consent forms, and emergency procedures

• Incident reporting systems and audit preparation tools

• Referral networking with hospitals, physicians, and CMAs

Continue To Our Client Portal To Get Started

Our Client Portal offers a wealth of resources that you can explore related to various programs and state requirements.