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)

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 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: