Colorado - Respite Care Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-09

The Colorado Department of Public Health and Environment (CDPHE) licenses Respite Care Services under the Home Care Agency (Class A or Class B) regulations at 6 CCR 1011-1 Chapter 26, while the Department of Health Care Policy and Financing (HCPF) funds the service through Home and Community-Based Services (HCBS) waivers such as EBD, SLS, and DD. Providers deliver this short-term relief care to allow an unpaid primary caregiver to step away without the member losing supervision or support.

Before submitting a Medicaid enrollment application to HCPF, prospective providers must first submit a Letter of Intent (LOI) to CDPHE and obtain the appropriate Home Care Agency license. Additionally, applicants must complete the mandatory HCBS Provider Training Course through the Train Learning Management System to receive the certificate required to even begin the HCPF Provider Web Portal application.

1. Service Definition and Scope

In Colorado, Respite Care is defined as services provided to a consumer who is unable to care for himself or herself on a short-term basis because of the absence or need for relief of those persons normally providing care. It is designed to maintain the health and safety of the member while offering a temporary reprieve to the primary unpaid caregiver.

The service can be delivered in the member's home, a provider's home, or an approved facility setting, depending on the specific HCBS waiver authorizing the care. It does not replace standard day program services or routine nursing care.

• Service Purpose: Short-term relief for unpaid primary caregivers.
• Delivery Settings: Member's home, provider's home, or licensed facility.
• Waiver Availability: Covered under multiple HCBS waivers including EBD, SLS, DD, and CES.
• Limitations: Cannot be used to substitute for regular daycare or employment support.
• Skilled vs. Unskilled: Can be provided as skilled care (requiring a Class A license) or personal care (requiring a Class B license).

2. Regulatory and Oversight Agencies

Two primary state departments oversee Respite Care in Colorado. The Colorado Department of Public Health and Environment (CDPHE) handles the health facility licensure and certification, ensuring agencies meet safety and operational standards.

The Department of Health Care Policy and Financing (HCPF) serves as the state Medicaid agency, managing provider enrollment, waiver administration, and claims payment through its fiscal agent, Gainwell Technologies.

• Licensing Agency: Colorado Department of Public Health and Environment (CDPHE) Health Facilities Division (https://cdphe.colorado.gov/health-facilities)
• Medicaid Agency: Department of Health Care Policy and Financing (HCPF) (https://hcpf.colorado.gov)
• Fiscal Agent: Gainwell Technologies operates the Provider Web Portal (https://hcpf.colorado.gov/provider-enrollment)
• Licensure Portal: CDPHE Colorado Health Facilities Interactive (COHFI) Portal (https://www.cohfi.colorado.gov)
• Training Platform: Train Learning Management System for mandatory HCBS training (https://www.train.org/colorado)

3. Gatekeeping Prerequisites: Who Can Even Apply

Colorado does not require a Certificate of Need (CON) or a competitive procurement (RFP) process to become a Respite Care provider. However, there are strict sequential prerequisites that block an application from being accepted if not completed.

An applicant cannot enroll with HCPF without first securing a Home Care Agency license from CDPHE, which itself is gated by a mandatory Letter of Intent (LOI). Furthermore, HCPF requires proof of completion of a specific online training course before the enrollment application will be reviewed.

• CDPHE Letter of Intent (LOI): Must be submitted and approved before a licensure application is granted access in the COHFI portal.
• Facility Licensure: A Class A or Class B Home Care Agency license must be active before Medicaid enrollment.
• Mandatory Training: HCBS/CFC/MFP Provider Training Course certificate from the Train Learning Management System is a hard prerequisite for HCPF enrollment.
• Tax Identification: A unique Employer Identification Number (EIN) is required; providers cannot change a Tax ID on an existing record without a new application.
• Service Location: Each physical service location must be enrolled separately with its own application and fee.

4. Licensure and Certification Requirements

Respite Care providers must be licensed as a Home Care Agency under 6 CCR 1011-1 Chapter 26. Agencies providing skilled care or services delivered by a licensed professional must hold a Class A license, while those providing only personal care or unskilled respite hold a Class B license.

The licensure process involves submitting an application through the COHFI portal, paying the required base and admission fees, and passing an initial CDPHE survey to verify compliance with state health and safety regulations.

• Regulation Citation: 6 CCR 1011-1 Chapter 26 governs Home Care Agencies.
• Class A License: Required if the agency provides skilled home health services.
• Class B License: Required if the agency provides only non-skilled personal care or respite services.
• Application Portal: All initial applications and renewals are processed through the COHFI system.
• Fee Structure: Base fee applies, with a $100 deduction for Medicaid-certified agencies, plus potential branch office fees.

5. Medicaid Provider Enrollment

Once licensed, the agency must enroll as a Health First Colorado (Medicaid) provider via the HCPF Provider Web Portal. Providers submit one application for the HCBS provider type that includes all specialties or services they provide, rather than separate applications for each waiver.

The enrollment requires uploading specific IRS documentation, a recent W-9, and banking information for electronic funds transfer. Revalidation is required at least every five years.

• Enrollment Portal: HCPF Provider Web Portal managed by Gainwell Technologies.
• IRS Documentation: Must attach SS-4 or IRS 147c EIN Verification letter.
• W-9 Requirement: Must include a copy of a W-9 signed within the last six months matching the application address.
• Bank Verification: Requires a voided check or a bank letter signed within the last six months including account and routing numbers.
• Revalidation: Required every 5 years per 42 CFR 455.414.

6. Staffing, Training and Background Checks

Agencies must ensure all staff providing respite care meet the qualifications outlined in the HCBS waiver and CDPHE regulations. This includes passing comprehensive background checks before having direct contact with members.

Staff administering medications must hold a valid Qualified Medication Administration Person (QMAP) certification. All direct care workers must receive training on the specific needs of the member as detailed in the care plan.

• Background Checks: Colorado Bureau of Investigation (CBI) criminal history check required for all direct care staff.
• CAPS Check: Colorado Adult Protective Services check required to ensure no history of abuse or neglect.
• Medication Administration: QMAP certification required for staff assisting with medications.
• First Aid/CPR: Direct care staff must maintain current basic First Aid and CPR certifications.
• Competency Training: Agencies must document staff competency in personal care and emergency procedures.

7. Documentation, Policies and Records

Providers must maintain comprehensive records for both the agency's operations and the individual members served. CDPHE and HCPF require strict adherence to documentation standards to justify claims and ensure quality of care.

Agencies must have written policies covering incident reporting, emergency preparedness, and grievance procedures. Member records must include the Prior Authorization Request (PAR) and detailed service logs.

• Service Logs: Must document the date, start time, end time, and specific tasks performed during the respite shift.
• Care Plan: Services must align with the member's authorized Service Plan developed by the Case Management Agency.
• Incident Reporting: Critical incidents must be reported to the Case Management Agency and CDPHE within specified timeframes.
• Personnel Files: Must contain proof of background checks, training certificates, and performance evaluations.
• Record Retention: Medicaid records must typically be retained for a minimum of six years.

8. Billing, Rates and Claims

Respite Care is billed to Health First Colorado using specific HCPCS procedure codes authorized on the member's Prior Authorization Request (PAR). Claims are submitted electronically through the Provider Web Portal or via an approved clearinghouse.

Rates are established by HCPF and published in the HCBS Provider Rate Schedule. Providers cannot bill for respite care if the primary caregiver is not actually absent or receiving relief.

• Prior Authorization: A valid PAR from the Case Management Agency is required before services can be billed.
• Billing System: Claims are processed through the Colorado interChange MMIS.
• Procedure Codes: Typically billed using codes like T1005 or S5150, depending on the specific waiver and increment (15-minute vs. per diem).
• Rate Schedule: Current fees are published on the HCPF Provider Rates and Fee Schedule webpage.
• Claim Timeliness: Claims must generally be submitted within 365 days of the date of service.

9. Approval Sequence and Timeline

The path to becoming a billing provider involves multiple sequential steps across different agencies. The process begins with the CDPHE Letter of Intent and concludes with HCPF Medicaid enrollment.

While HCPF processes clean enrollment applications relatively quickly, the preceding licensure steps with CDPHE can take several months depending on survey scheduling and application completeness.

• Step 1: Submit Letter of Intent (LOI) to CDPHE.
• Step 2: Complete the HCBS Provider Training Course on Train LMS.
• Step 3: Submit initial license application and fees via COHFI.
• Step 4: Pass CDPHE initial health and safety survey.
• Step 5: Submit Medicaid enrollment application via HCPF Provider Web Portal.
• HCPF Processing Time: New applications are currently processed by the fiscal agent within eight (8) business days on average.

10. Common Denials and Survey Findings

Applications for licensure and Medicaid enrollment are frequently delayed or denied due to administrative errors or missing documentation. HCPF specifically notes that missing IRS documents or outdated signatures are common roadblocks.

During CDPHE surveys, agencies often face citations for incomplete personnel files or failure to properly document the specific care tasks required by the member's service plan.

• Missing Training Certificate: Failure to upload the Train LMS HCBS training certificate halts HCPF enrollment.
• Invalid W-9: W-9 forms signed more than six months prior to application submission are rejected.
• Address Mismatches: The address on the voided check or bank letter must exactly match an address on the application.
• Unsigned Bank Letters: Bank letters submitted without a signature or older than six months cause enrollment denials.
• Survey Citations: CDPHE frequently cites agencies for incomplete background checks prior to staff providing direct care.

11. Key Contacts and Resources

Providers should utilize the official state portals and help desks for guidance through the licensure and enrollment processes. Both CDPHE and HCPF maintain dedicated contact channels for prospective agencies.

Case Management Agencies (CMAs) are also critical partners, as they authorize the services and generate the PARs required for billing.

• CDPHE Health Facilities: https://cdphe.colorado.gov/health-facilities
• CDPHE COHFI Portal: https://www.cohfi.colorado.gov
• HCPF Provider Enrollment: https://hcpf.colorado.gov/provider-enrollment
• HCPF Provider Forms: https://hcpf.colorado.gov/provider-forms
• Train LMS Colorado: https://www.train.org/colorado

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