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

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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

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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 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

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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

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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

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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

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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

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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

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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

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10. SCOPE OF WORK 

• Business registration (LLC, EIN, NPI)
• CDPHE Class A Home Care Agency license application support
• Medicaid provider enrollment and billing guidance
• Policy & procedure manual for skilled nursing delivery and compliance
• Templates for care plans, nurse visit logs, and delegation forms
• Website, domain, and email setup
• Staff credentialing trackers and CEU documentation tools
• Client intake packet, consent forms, and emergency procedures
• Incident reporting systems and audit preparation tools
• Referral networking with hospitals, CMAs, and case managers

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.​​​​​​​​​​​​​​​​​​​