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

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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

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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

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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

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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

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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

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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

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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 B Home Care Agency license application support
• Medicaid provider enrollment and billing setup
• Policy & procedure manual for personal care, supervision, and safety
• Templates for shift logs, training checklists, and incident reports
• Website, domain, and email setup
• Staff credentialing trackers and supervision tools
• Client intake packet, consent forms, and grievance protocols
• Incident reporting systems and audit preparation tools
• Referral networking with hospitals, CMAs, and community partners

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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.