PERSONAL CARE SERVICES PROVIDER IN COLORADO

Fatumata Kaba
Jul 6
3 min read

ASSISTING INDIVIDUALS WITH DAILY LIVING ACTIVITIES TO MAINTAIN INDEPENDENCE IN THEIR HOMES AND COMMUNITIES

Personal Care Services in Colorado support individuals with disabilities, chronic conditions, or age-related limitations by providing non-medical assistance with Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). These services are offered through Colorado Medicaid, particularly under Home and Community-Based Services (HCBS) Waivers, including the Elderly, Blind, and Disabled (EBD) waiver, Brain Injury (BI) waiver, and Community Mental Health Supports (CMHS) waiver.

1. GOVERNING AGENCIES

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

Role: Administers Medicaid and HCBS waiver programs, including authorization and reimbursement of Personal Care Services

Agency: Centers for Medicare & Medicaid Services (CMS)

Role: Provides federal oversight to ensure Personal Care Services meet HCBS rules and person-centered planning standards

2. PERSONAL CARE SERVICE OVERVIEW

Personal Care Services are designed to help individuals remain safely in their homes by assisting with routine daily tasks they cannot complete independently. Services are provided based on a person-centered service plan and must be authorized by a Case Management Agency (CMA).

Approved providers may deliver:

Bathing, dressing, grooming, and hygiene assistance
Mobility support and transferring
Medication reminders (non-administration)
Meal preparation and assistance with eating
Light housekeeping related to personal care
Laundry and linen changes
Toileting and incontinence care
Documentation of hours and tasks completed

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 B Home Care Agency License from the Colorado Department of Public Health and Environment (CDPHE)
Enroll as a Medicaid provider through the Gainwell Technologies Provider Portal
Employ or contract trained Personal Care Workers (PCWs)
Carry liability and workers’ compensation insurance
Maintain compliance with HIPAA, safety, and HCBS documentation protocols

4. PROVIDER ENROLLMENT PROCESS

Step 1: Obtain Class B Home Care Agency License (CDPHE)

Submit application including emergency plans, policies, and staff training procedures
Pass licensing inspection and receive state certification

Step 2: Enroll as a Medicaid Provider

Apply through the Gainwell Technologies Provider Enrollment Portal
Select provider type: Personal Care (under Class B services)

Step 3: Coordinate with Case Management Agencies (CMAs)

Build referral relationships and receive service authorizations based on approved plans

5. REQUIRED DOCUMENTATION

Articles of Incorporation or proof of business registration
IRS EIN Letter
NPI confirmation
CDPHE Class B Home Care Agency License
Medicaid provider approval
Policy & procedure manual including:
- Intake forms and eligibility verification protocols
- Daily task logs and service verification sheets
- Participant rights and grievance procedures
- Confidentiality and HIPAA compliance policies
- Emergency preparedness and abuse prevention
- Staff orientation, training, and supervision documentation
- Incident reporting forms and review procedures

6. STAFFING REQUIREMENTS

Role: Personal Care Worker (PCW)

Requirements:

High school diploma or GED (recommended)
Background check and TB clearance
CPR/First Aid certification (recommended)
Experience or training in ADL/IADL support

Role: Agency Supervisor

Requirements:

Oversight of staff scheduling, supervision, and quality assurance
Familiarity with Medicaid compliance and documentation

Training Requirements for All Staff:

HIPAA and client confidentiality
Abuse prevention and mandated reporting
Infection control and safety procedures
Documentation and service delivery expectations
Annual training refreshers and ongoing competency evaluations

7. MEDICAID WAIVER SERVICES

Personal Care Services are reimbursed under:

HCBS-EBD (Elderly, Blind, and Disabled) Waiver
HCBS-BI (Brain Injury) Waiver
HCBS-CMHS (Community Mental Health Supports) Waiver
Other waivers with documented need for ADL/IADL assistance

Approved providers may deliver:

Scheduled, authorized in-home care based on a person-centered service plan
Documentation and time logs for each shift
Coordination with case managers and waiver teams

8. TIMELINE TO LAUNCH

Phase: Business Formation

Timeline: 1–2 weeks

Phase: CDPHE Class B Licensing

Timeline: 45–90 days

Phase: Medicaid Enrollment

Timeline: 30–60 days

Phase: Staffing and CMA Referral Setup

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

PERSONAL CARE SERVICES PROVIDER IN COLORADO

WAIVER CONSULTING GROUP'S START-UP ASSISTANCE SERVICE — COLORADO PERSONAL CARE SERVICES PROVIDER

We assist caregiving agencies, entrepreneurs, and healthcare professionals in launching compliant Personal Care Services under Colorado’s HCBS Medicaid waiver programs.

Scope of Work: