NURSING SERVICES PROVIDER IN COLORADO
- Fatumata Kaba
- 2 days ago
- 3 min read
DELIVERING SKILLED, INDIVIDUALIZED HEALTHCARE TO MEDICAID MEMBERS IN HOME AND COMMUNITY SETTINGS
Nursing Services in Colorado provide essential medical care and oversight to individuals with chronic illnesses, disabilities, or complex medical needs. These services are delivered in-home or community-based settings and are covered under Colorado Medicaid, including Home and Community-Based Services (HCBS) Waivers such as the Elderly, Blind, and Disabled (EBD) waiver, the Brain Injury (BI) waiver, and Children’s HCBS Waivers.
1. GOVERNING AGENCIES
Agency: Colorado Department of Health Care Policy and Financing (HCPF)
Role: Authorizes and reimburses Medicaid-funded nursing services and ensures alignment with waiver programs
Agency: Colorado Department of Public Health and Environment (CDPHE)
Role: Licenses Class A and Class B home care agencies and enforces regulatory standards
Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Provides federal guidance on Medicaid reimbursement and HCBS compliance
2. NURSING SERVICE OVERVIEW
Nursing Services support waiver participants through ongoing health assessments, treatment administration, care planning, and monitoring. These services must be ordered by a physician and outlined in the participant’s individualized care plan.
Approved providers may deliver:
Skilled nursing visits (wound care, injections, catheter care, etc.)
Medication setup, administration, and monitoring
Chronic condition management (e.g., diabetes, seizures, respiratory care)
Health assessments and reassessments
Delegation and oversight of non-licensed staff (as needed)
Education for participants and families
Documentation of all nursing interventions and outcomes
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register business with the Colorado Secretary of State
Obtain EIN from the IRS and NPI (Type 2)
Obtain a Class A or Class B Home Care Agency license from CDPHE
Class A: Skilled medical services including nursing
Class B: Non-medical services only (nursing not included)
Enroll as a Medicaid Nursing Services Provider via the Gainwell Technologies Medicaid Provider Portal
Employ licensed RNs and/or LPNs with appropriate supervision
Maintain liability and malpractice insurance
4. PROVIDER ENROLLMENT PROCESS
Step 1: CDPHE Home Care Agency Licensing
Submit application for Class A licensure, including policies, clinical supervision, and safety protocols
Undergo facility inspection and complete background checks
Step 2: Medicaid Enrollment with Gainwell
Apply through the Colorado Medicaid Provider Web Portal
Submit NPI, licensure documents, and staffing information
Step 3: Network with CMAs and Referring Entities
Coordinate with Case Management Agencies (CMAs) and hospitals for referrals
5. REQUIRED DOCUMENTATION
Articles of Incorporation or business registration
IRS EIN Letter
NPI confirmation
CDPHE Class A license
Colorado Medicaid provider ID
Policy & procedure manual including:
Intake and physician order verification
Care planning and skilled nursing documentation templates
Medication administration logs and delegation protocols
Incident reporting and critical event management
Infection control and emergency procedures
Client rights, consent forms, and HIPAA compliance
Staff credentials, CEUs, and supervision documentation
6. STAFFING REQUIREMENTS
Role: Registered Nurse (RN)Requirements:
Active Colorado RN license
Experience in home health or long-term care preferred
CPR certification, background check, TB clearance
Role: Licensed Practical Nurse (LPN)Requirements:
Licensed in Colorado
Works under RN supervision per care plan
Role: Clinical Supervisor (required for Class A agencies)Requirements:
Colorado RN with supervisory experience
Oversight of documentation, assessments, and team training
Training Requirements for All Staff:
HIPAA and confidentiality
Abuse prevention and reporting
Medication safety and infection control
Documentation standards and emergency protocols
Ongoing CEUs for license renewal
7. MEDICAID WAIVER SERVICES
Nursing Services are reimbursed under:
HCBS-EBD (Elderly, Blind, and Disabled) Waiver
HCBS-BI (Brain Injury) Waiver
Children’s HCBS Waivers (e.g., CHCBS, CLLI)
State Plan Home Health (if skilled nursing is prescribed outside waiver)
Approved providers may deliver:
Direct nursing care based on approved hours and physician orders
Monitoring of medical conditions and health status changes
Coordination with primary care and specialist providers
Documentation aligned with waiver requirements and audits
8. TIMELINE TO LAUNCH
Phase: Business Formation
Timeline: 1–2 weeks
Phase: CDPHE Class A Licensing
Timeline: 60–90 days
Phase: Medicaid Enrollment
Timeline: 30–60 days
Phase: Staff Onboarding and Referral Network Development
Timeline: Ongoing
9. CONTACT INFORMATION
Colorado Department of Public Health and Environment (CDPHE) – Health Facilities Licensure
Phone: (303) 692-2800
Website: https://cdphe.colorado.gov
Colorado Department of Health Care Policy and Financing (HCPF)
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 NURSING SERVICES PROVIDER
We help registered nurses, home care agencies, and healthcare entrepreneurs launch compliant Nursing Services under Colorado Medicaid and HCBS Waiver programs.
Scope of Work:
Business registration (LLC, EIN, NPI)
CDPHE Class A Home Care Agency license application support
Medicaid provider enrollment and billing guidance
Policy & procedure manual for skilled nursing delivery and compliance
Templates for care plans, nurse visit logs, and delegation forms
Website, domain, and email setup
Staff credentialing trackers and CEU documentation tools
Client intake packet, consent forms, and emergency procedures
Incident reporting systems and audit preparation tools
Referral networking with hospitals, CMAs, and case managers
Our Client Portal offers a wealth of resources that you can explore related to various programs and state requirements.
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