Home Health Program

The Home Health benefit for Health First Colorado (Colorado's Medicaid program) member s provides services from a licensed and certified Home Health Agency (HHA) for members who need Intermittent Home Health Services.

There are two types of home health services:

1. Acute Home Health: Skilled Home Health services are provided to members who experience an acute health care need that necessitates skilled Home Health care. Acute Home Health services are allowed without prior authorization for up to 60 calendar days or until the acute condition is resolved, whichever comes first. (If the member is on a Health First Colorado Managed Care Program, prior authorization for acute Home Health may be required by the Managed Care Organization.)
   
2. Long-Term Home Health (LTHH): Skilled Home Health services provided to members who require ongoing Home Health services beyond the Acute Home Health period. Prior authorization is required for Long-Term Home Health Services.

Who Qualifies?

Health First Colorado Member s who:

• Require Home Health Services for the treatment or amelioration of an illness, injury, or disability, which may include mental illness
• Are unable to perform the health care tasks for him or herself, and he or she has no family member or caregiver who is willing and able to perform the skilled tasks
• Require services that cannot appropriately or effectively be received in an outpatient treatment office or clinic or for which the member's residence is the most effective setting to accomplish the care required by the member's medical condition
• The services meet medical necessity criteria and are provided in a manner consistent with professional practice

Benefits and Services

• Skilled Nursing (provided by a Registered Nurse or Licensed Practical Nurse)
• Certified Nurse Aide (CNA) services (may also be referred to as a Certified Nursing Assistant or Home Health Aide)
• Physical Therapy (PT)
• Occupational Therapy (OT)
• Speech/Language Pathology (SLP) services (or Speech Therapy)

Pediatric LTHH PAR Pause Updates

Effective December 1, 2023, the Department of Health Care Policy and Financing (HCPF) is extending the Pediatric Long-Term Home Health (PLTHH) temporary PAR pause through at least January 2025. This means that there is no PAR requirement for PLTHH services at this time, for the following services:

• Pediatric LTHH Certified Nursing Assistant (CNA) services
• Pediatric LTHH Therapies: Occupational Therapy (OT), Physical Therapy (PT), and Speech/Language Pathology (SLP) services
• Pediatric LTHH intermittent skilled nursing

View Informational Memo IM 23-044 for additional information.

If you are a provider looking for additional information, visit the COPAR website

Stakeholder Engagement Opportunities

HCPF is committed to working collaboratively with stakeholders to allow providers and members to interact at their comfort level and as their schedule permits without missing pertinent information.

All meetings are open to any interested stakeholder. If you would like to participate in the upcoming workgroups for the Long-Term Home Health (LTHH) Benefit, please complete the Stakeholder Engagement Interest Form.

LTHH Stakeholder Engagement Kickoff Meeting

• April 4, 2024
  Webinar Recording
  Presentation
  • Informational meeting to discuss plans for the upcoming year and hot topics related to the Home Health Benefit.
  • This meeting will review updates made to the Home Health webpage as well as the updated Frequently Asked Questions (FAQs).
  • During this meeting, the proposed rule revision process will be discussed and feedback on future stakeholder engagement opportunities will be gathered.

  Policy Team Office Hours

  • Join us on the second Tuesday of each month from 1:00 to 2:30 p.m.
    Join via Google Meet
    Join via Phone: 1-321-430-0021‬ PIN: ‪928 613 877‬#
    • Virtual meetings will be held for training and technical assistance and will be hosted by HCPF policy staff on the second Tuesday of every month.
    • The meetings will be an open forum for questions and information sharing.
    • Stakeholders can submit questions or topics for discussion before the meeting via email to homehealth@state.co.us or submit them through the live queue.
    • View meeting calendar on the Office of Community Living Stakeholder Engagement Page
    • Submit questions/topics of discussion via the Stakeholder Engagement Interest Form

    Quarterly Home Health Newsletter

    • LTHH and PDN Newsletter (inaugural issue) - July 1, 2024
    • Sign up to receive newsletters via the Stakeholder Engagement Interest Form
      • Topics will include an overview of meetings held during the previous quarter, a summary of progress from workgroups, education and training topics, collaborative topics with CDPHE, program reminders, and notices of upcoming events.
      • Newsletters will be housed for reference on the Home Health webpage.

      PAR Restart Workgroup

      Next meeting:

      • September 11, 2024 from 1:00 to 2:20 p.m.
        Join via Google Meet
        Join via Phone: Toll Free 1-541-972-3555‬ PIN: ‪545 248 421‬#
        • Ad hoc workgroup meeting for all interested stakeholders to discuss options for Pediatric Long-Term Home Health (PLTHH) Prior Authorization Request (PARs) to be reinstated
        • Proposed ideas will be presented for discussion and feedback from stakeholders.

        Meeting Materials:

        Rule Revision Workgroup

        Next Meeting:

        • September 18, 2024 from 1:00 to 2:20 p.m.
          Join via Google Meet
          Join via Phone: Toll Free 1-385-999-6425 PIN: 739 624 131#
          
          • Meetings will be held as needed with a volunteer workgroup dedicated to Home Health rule revisions.
            • Participants will be provided meeting materials, including the agenda and sections of the draft rule to review at least two weeks prior to the meeting.
            • Participants will be able to discuss proposed changes and provide feedback during the meeting. Workgroup members will collaborate with HCPF staff on in-meeting edits to redline the draft language of the rule.
            • Updates and progress made during the workgroup will be posted on the Home Health webpage following each meeting.

            Meeting Materials:

            • September 18, 2024
              • 8.520 Home Health Services Rule Revision-Draft - September 2024
                
              • Agenda
              • Presentation
              • Webinar Recording

              Reasonable accommodations will be provided upon request for persons with disabilities. Auxiliary aids and services for individuals with disabilities and language services for individuals whose first language is not English may be provided upon request. Please notify John Barry at 303-866-3173 or John.R.Barry@state.co.us or the Civil Rights Officer at hcpf504ada@state.co.us at least one week prior to the meeting to make arrangements.

              Additional Resources and Information

              • Home Health FAQ Page
              • Home Health Billing Manual
              • Home Health Regulations 10 CCR 2505-10 8.520
              • Letter Re: Community Providers in a School Setting - May 3, 2024
              • Pediatric Personal Care Benefit
              • Pediatric Assessment Tool

              Contact Us

              Email HomeHealth@state.co.us or call 303-866-5638 if you have further questions