Colorado Medicaid Home Health Care


Paper Claim Reference Table

State officials speak to AIM Home Health termination notice

The information in the following table provides instructions for completing form locators as they appear on the paper UB-04 claim form. Instructions for completing the UB-04 claim form are based on the current National Uniform Billing Committee UB-04 Reference Manual. Unless otherwise noted, all data form locators on the UB-04 have the same attributes for the Health First Colorado as those indicated in the NUBC UB-04 Reference Manual.

All code values listed in the NUBC UB-04 Reference Manual for each form locator may not be used for submitting paper claims to the Health First Colorado. The appropriate code values listed in this manual must be used when billing the Health First Colorado.

The UB-04 Institutional Certification document must be completed and attached to all claims submitted on the paper UB-04. Completed UB-04 paper Health First Colorado claims, including hardcopy Medicare claims, should be mailed to the correct fiscal agent address listed in Appendix A, under the Appendices drop-down section on the Billing Manuals web page.

The Paper Claim Reference Table below lists the required, optional and/or conditional form locators for submitting the paper UB-04 claim form to Health First Colorado for home health claims.

Percentage Of Home Care Agencies That Accept Medicare

It is difficult to determine exactly what percentage of home health care agencies in Colorado accept Medicare because there is no complete list of home health care agencies. According to our data, approximately 30% of Colorado home care agencies are certified by Medicare. We have found 422 Colorado certified Medicare home health care agencies and anoother 195 Colorado home care companies. Realize that while Medicare provides a great deal of data about certain agencies,those agencies are also likely to be the type with trained nursing staff and therapists. If that isn’t the type of care you or your loved one needs, be sure to examine all home care agencies in your area.

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Home Care From Our Compassionate & Experienced Team

Patients often thrive when they are in comfortable and familiar surroundings, which make the caring services of Home Health Care Professionals, Inc. so important. With our experienced medical team, we offer home nursing care, social work, and speech, occupational, and physical therapy. We will give you the best care that you can possibly receive at home.

Finding Affordable Care In Colorado

Should Colorado Let People Buy into Medicaid?

After familiarizing oneself with the wide range of senior care costs in Colorado, there is clear reason to reach out to multiple providers in order to find the most affordable services. Though average costs in various parts of the state do not vary too widely, the costs between different types of care do vary widely. It is important for families to consider which type of care is most affordable and beneficial to them. Our free service assists in matching care services to specific individual needs. .

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Early And Periodic Screening Diagnostic And Treatment

Hospice benefits are provided in accordance with Early and Periodic Screening, Diagnostic, and Treatment requirements as listed in 8.280.4.E: Other EPSDT Benefits 8.280.4.E reads as follows:

Other health care services may include other EPSDT benefits if the need for such services is identified. The services are a benefit when they meet the following requirements:

  • All goods and services described in Section 1905 of the Social Security Act are a covered benefit under EPSDT when medically necessary as defined at 10 C.C.R. 2505-10, Section, regardless of whether such goods and services are covered under the Colorado Medicaid State Plan.
  • For the purposes of EPSDT, medical necessity includes a good or service that will, or is reasonably expected to, assist the client to achieve or maintain maximum functional capacity in performing one or more Activities of Daily Living and meets the criteria set forth at Section – g.
  • The service provides a safe environment or situation for the child.
  • The service is not for the convenience of the caregiver.
  • The service is medically necessary.
  • The service is not experimental or investigational and is generally accepted by the medical community for the purpose stated.
  • The service is the least costly.
  • Providers can ask for these additional services by following the PAR process as outlined for this benefit.

    More information regarding EPSDT may be found on the EPSDT web page.

    Questions about EPSDT may be directed to

    Find Home Care Agencies Near You

    To find quality home care providers near you, simply input the zip code or city where you would like to start your search. We have an extensive directory of home care agencies all across the nation that includes in-depth information about each provider and hundreds of thousands of reviews from seniors and their loved ones.

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    Medicaid Assistance Programs For The Elderly

    In the state of Colorado, the Medicaid state plan is called Health First Colorado. It covers the cost of some personal care assistance, as well as the cost of nursing home care. However, many elderly individuals prefer to remain living in their homes, which is also less costly for the state. Colorado currently has one state Medicaid waiver plan, also referred to as a Home and Community Based Services Waiver. Waivers are intended for elderly and/or disabled residents. It provides them with assistance, so that they can remain living independently. However, unlike the state Medicaid program, HCBS Waivers have caps on the number of individuals who can enroll in the programs. This means that even if one is eligible for a Medicaid waiver, there may be a wait list for services.

    Waiver for the Elderly, Blind and Disabled This self-directed waiver program provides care services at home and alternative care facilities, like assisted living, instead of at costlier nursing homes. Other benefits include home modifications, personal emergency response systems, adult day care, respite care, and non-medical transportation. Learn more here.

    Under the Waiver for the Elderly, Blind and Disabled, there is an option called Consumer Directed Attendant Support Services . This option allows seniors greater flexibility and freedom when choosing care providers. Even family members can be hired to provide care. Learn more about the benefits here.

    How To Know If Youre Eligible For Medicaid In Colorado

    Nursing Shortage Continues Through Pandemic In Colorado

    Applicants must meet income and resource requirements to be eligible for Medicaid in Colorado. Income must be less than 300% or three times the monthly Supplemental Security Income allowance. In 2022, the maximum monthly amount was $841 per month for individuals, which comes to $10,092 annually, and $1,261 per month for couples, which is equivalent to $15,137 annually. Resources must be less than $2,000 for singles and $3,000 for couples.

    2022 Medicaid Income Limits for Seniors in Colorado


    *Per year

    Applicants must be at risk of placement in a nursing facility, an intermediate care facility or a hospital. Other requirements include being:

    • Aged 65 or older, blind or disabled
    • A Colorado resident
    • A U.S. citizen, U.S. national or eligible immigration status

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    How Do I Know If I Am A Caregiver

    Family Caregiver Alliance defines a caregiver as a spouse, partner, family member, friend, or neighbor involved in assisting others with activities of daily living and/or medical tasks. Anyone who is caring for a loved one with a disability, or who is elderly or chronically ill is a caregiver. It doesnt have to be full time. Although, in many cases, caregiving is 24/7 work.

    No matter full or part time, caregiving takes a toll. The burden of caregiving can greatly impact the following areas: financial, friendships and family life, physical and mental health, and a caregivers job or career.

    Long Term Home Health

    Intermittent Home Health services required for the care of chronic long-term conditions, and/or on-going care that exceeds the acute HH period . All Long-Term Home Health services must be prior authorized.

    Services Include: Skilled nursing, skilled certified nurse aide, telehealth services. Pediatric members may also receive physical therapy, occupational therapy and speech therapy.

    If a member experiences a new acute event that would warrant acute Home Health service, the agency may move the member to acute care, when:

    • At least ten calendar days has elapsed since the member’s last acute Home Health episode,and
    • There is new onset of illness, injury or disability or when the member experiences an acute change in condition from the member’s past acute HH episode.

    Providers should refer to the Code of Colorado Regulations, Program Rules , for specific information when providing Home Health care.

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    Long Term Care Colorado Medicaid

    Colorado Medicaid Application Complete (2015

    Long Term Care Colorado Medicaid

    The following information for Medicaid services for Colorado is limited to long term care of the Elderly, Blind and Disabled . Care is provided through Home and Community Based Services , Program for All Inclusive Care of the Elderly , and Medicaid long-term care. HCBS and PACE are referred to as EBD waiver programs. An applicant must be eligible medically, as well as qualify on the basis of income and resources, for participation in one of these care programs.

    Waiver benefits are delivered in your home or community, have special program rules and can have waitlists. They also provide all Colorado Medicaid covered services except nursing facility and long-term hospital care.

    Medical Eligibility for Medicaid Long Term Care

    To be eligible for Medicaid long-term care or HCBS benefits, an applicant must be over age 65, blind or disabled and must also require a nursing home level of care. The applicant must be assessed functionally by the Colorado DHCPF Single Entry Point assessment contractor. The applicant must be found by the contractor to be unable to perform two Activities of Daily Living or have a very significant need for supervision. The activities of daily living are dressing, transferring, mobility, bathing, eating, and toileting.

    Financial Eligibility for Medicaid Long Term Care

    Treatment of Assets: The Income and Resource Tests

    The Income Test

    The Resource Test

    Burial Insurance. Irrevocable burial insurance is exempt

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    Colorado: Incorporating Quality Of Life Into Medicaid Reimbursement

    In state FY2009, Colorado Medicaid implemented a pay-for-performance program for nursing facilities, with financial incentives tied to both quality-of-care and quality-of-life measures. A first-year evaluation suggests that it succeeded in stimulating culture change in nursing homes. State budget constraints and a cap on the annual nursing facility provider fee have resulted in the cancellation of P4P payments for applications submitted in the year ended June 30, 2010, but the model Colorado developed may serve as a blueprint that could be replicated in other states and could be reinstated in Colorado, as budgets permit.

    “The application itself is almost a manual or set of instructions on how to implement cultural change in a home,” said Richard Gallagher, long term benefits acting operations section manager, Colorado Department of Health Care Policy and Financing, in a 2010 report issued to the Department of Health Care Policy and Financing by the Public Consulting Group.

    Implemented by the Colorado Department of Health Care Policy and Financing , the program was developed with input from a range of public and private stakeholders. Its implementation oversight board included the state’s Ombudsman, HCPF, nursing home providers, the state nursing facilities contract auditor, and the Colorado Foundation for Medical Care.

    Reimbursable Home Health Service Locations

    The Home Health program reimburses for skilled nursing, skilled certified nurse aide, physical therapy, occupational therapy, and speech therapy services that are provided on an intermittent or per visit basis to Health First Colorado members in their place of residence.

    Health First Colorado pediatric members may receive Home Health services outside of their place of residence when:

    • The Home Health services can be provided safely and adequately in a location other than the member’s residence,
    • Home Health service and interventions will be at least equally effective in a location other than the member’s residence,
    • It is clinically appropriate for the Home Health services to be provided in a location other than the member’s residence,
    • It is not primarily for the convenience of the member, member’s family, physician or other care provider,
    • It is not provided in a group home, nursing facility, hospital or other facility, and
    • It is not provided on public school grounds or as a part of an Individualized Education Program.

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    Reimbursable Home Health Services

    The licensed and certified Class A Home Care shall not utilize staff that has been excluded from participation in federally funded health care programs by the US Department of Health and Human Services /Office of Inspector General and shall be in good standing with the Colorado Department of Regulatory Agencies or other regulatory agency:

    Registered Nurses and Licensed Practical Nurses must have a current, active license in accordance with the DORA Colorado Nurse Practice Act at § 12-38-111, C.R.S.

    • Acute Home Health: All nursing services provided during the acute Home Health period shall be billed under revenue code 550. No PAR is required.
    • Long-Term Home Health: Nursing services provided during Long-Term Home Health shall be billed using the appropriate revenue codes based on the purpose and complexity of the nursing visit. Standard, infrequent or complicated nursing visits may be billed using revenue code 551. Nursing visits that are uncomplicated in nature or visits that are uncomplicated with frequent revisits completed by the nurse shall be billed using revenue codes 590 and 599).
    • Long-Term Home Health nursing visits for the sole purpose of assessing a member may be reimbursed for a limited time when managing, and reporting to the member’s physician on specific conditions and/or symptoms which are not stable.

    Certified Nurse Aides must have a current, active license in accordance with the DORA Colorado Nurse Aide Practice Act at § 12-38-111, C.R.S.

    How To Find An In

    Colorado family fights medicaid over mental health treatment

    Whether you are looking for yourself or a loved one, finding a quality home care provider can be a stressful process. When you hire an in-home care aide youre placing a lot of trust in the hands of the person by inviting them into your home, so youll want to be diligent in your search. At, were here to help weve created a helpful checklist below that can help guide you through the process of both determining your needs and finding a home care agency that will provide the best care possible.

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    Home Care Waiver Programs In Colorado

    Elderly, Blind and Disabled Waiver

    The Home and Community-Based Services Waiver for Elderly, Blind and Disabled persons provides an alternative to nursing home care and allows recipients to remain in their homes. Through this waiver, recipients receive long-term supports and services not available through the Health First Colorado State Plan.

    Applicants must be age 65 or older with a functional impairment, blind or aged 18 to 64 with a physical disability or HIV or AIDS diagnosis to qualify for the HCBS-EBD. They must meet financial and program criteria and be willing to receive services in their home or community. Waiver enrollees receive regular Health First Colorado benefits, as well as services specific to the HCBS-EBD waiver:

    • Adult day services
    • Personal care
    • Respite care

    Applicants not enrolled in Health First Colorado must apply for Medicaid first. Those already enrolled should contact their local Single Entry Point to start the waiver application process. Applicants with questions about the waiver program should contact their SEP agency or the Member Contact Center.

    Medicare And Medicaid Certification For Health Care Facilities

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  • Certification is an optional process that allows providers to bill Medicare or Medicaid for reimbursement. Most types of facilities are eligible for Medicare and Medicaid. Some are eligible for Medicaid only. The process can be confusing, and we are here to help. Certification starts with a letter of intent.

    CMS Medicare/Medicaid certification requirements for health care facilities

    Facilities subject to Medicare/Medicaid certification must meet requirements established by the Centers for Medicare and Medicaid Services .

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    Enjoy Care Plan Based Visit Notes For Your Caregivers

    Need assurance that your nurse or clinician completed the individual tasks required within the patients plan of care? No worries Alora generates patient-specific visit notes which are derived from the Plan of Care. Home Health aides and nurses can complete documentation directly within Aloras EVV interface simplifying workflow and resulting in improved focus on patient care.

    When Did Colorado Evv Begin

    Medicaid versus Medicare

    Colorados EVV systems original go-live date was on October 1, 2019, and providers were able to begin using the State EVV Solution or a Provider Choice System at that time. Using EVV in the state was considered voluntary until August 3, 2020. Between October 1, 2019 and August 3, 2020 the state was in a phase called the Soft-Launch. The Soft-Launch was an opportunity for providers and caregivers to become familiar with electronic visit verification before claims integration, test and interface provider choice systems, inform policy and system changes, and assist the Colorado Department of Medicaid with identifing and developing supplemental training materials. The EVV phases process was:

    AS of this date, EVV was mandated in Colorado. Providers not utilizing EVV must provide a written implementation plan to the Department, upon request.

    Providers not utilizing EVV were required to provide a written implementation plan to the Department, upon request. Submitted claims without EVV will still pay but would be subject to recoupment if no EVV records accompany claims.

    Providers not utilizing EVV must now provide a written implementation plan to the Department, upon request. All claims that require EVV records must have a valid EVV record or will be subject to denial or suspension before payment.

    For questions on Colorado EVV, click here to visit the Colorado Department of Healthcare & Financings EVV FAQ Page

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