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

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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

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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

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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

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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

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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

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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

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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

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10. 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