Community First Choice (CFC) Billing Manual

• General Information
• Prior Authorization Requests (PARs)
• PAR Submission
• Consumer Directed Attendant Support Services (CDASS)
• Claim Submission
• Denver Regional Pricing
• Community First Choice
• Community First Choice Procedure Code Table
• Community First Choice Paper Claim Reference Table
• Timely Filing
• Community First Choice Manual Revision Log

Return to Billing Manuals Web Page

General Information

As of the program’s effective date of July 1, 2025, Community First Choice (CFC) provides select Home and Community Based Services (HCBS) and service delivery options to Health First Colorado (Colorado's Medicaid program) State Plan Members who meet the eligibility criteria. Receipt of CFC services does not preclude members from receiving services across other Health First Colorado programs and/or authorities, such as HCBS waiver programs. Members may receive HCBS services on one HCBS Waiver concurrent to CFC, as long as services are not duplicative. Such members must meet all required targeting criteria for each waiver in order to be eligible, as well as the receipt of one monthly waiver service.

CFC does not create a new eligibility category under Health First Colorado and does not increase the financial eligibility threshold for Members seeking Long-Term Care. To be financially eligible for CFC, members must either be eligible for Health First Colorado or an HCBS waiver, receiving at least one waiver service per month, and meet an institutional level of care (LOC) as determined by a Case Management Agency (CMA). Level of care determinations are made annually by the CMA using the state prescribed Level of Care assessment. 

CFC services are available to Members of all ages and are not based on disability or diagnosis. The receipt of CFC services is not permitted in institutional settings such as nursing facilities or long-term hospitals. When a Member chooses to receive services under CFC, the services must be provided by certified Health First Colorado providers. 

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Prior Authorization Requests (PARs)

All CFC services require Prior Authorization (PAR) before they can be reimbursed by Health First Colorado unless otherwise noted. Case Management Agencies complete the PAR for their specific programs according to instructions published in the regulations for the Department of Health Care Policy & Financing (the Department).

Refer to Appendix A located on the Billing Manuals web page under the Appendices drop-down for telephone numbers.

Provider Agencies may contact the CMA, or the Provider Services Call Center for the status of the PAR or inquire electronically through the Health First Colorado Web Portal. When contacting the Provider Services Call center, providers must have the Member’s Medicaid ID number and the member’s ten-digit PAR ID number.

The CMAs’ responsibilities include, but are not limited to:

• Informing Members and/or legal guardians of the eligibility process.
• Developing the appropriate PAR
• Submitting the Prior Authorization information to the authorizing agent. Refer to Appendix D  located on the Billing Manuals web page under the Appendices drop-down for a list of authorizing agents.
• Assessing the Member's health and social needs.
• Arranging for face-to-face contact with the Member within 10 calendar days of receipt of the referral.
• Monitoring and evaluating services.
• Reassessing each Member.
• Demonstrating continued cost-effectiveness whenever services increase or decrease.

Prior authorization of services does not guarantee Health First Colorado payment and does not serve as a timely filing waiver. Prior authorization only assures that the approved service is a medical necessity and is considered a benefit of the Health First Colorado. All claims, including those for prior authorized services, must meet eligibility and claim submission requirements (e.g., timely filing, Provider information completed appropriately, required attachments included, etc.) before payment can be made.

Prior authorization must be completed thoroughly and accurately. If an error is noted on an approved request, it should be brought to the attention of the Member's Case Manager for corrections. Procedure codes, quantities, etc., may be changed or entered by the Member's Case Manager.
The authorizing agent or Case Management Agency is responsible for timely submission and distribution of copies of approvals to agencies and Providers contracted to provide services.

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PAR Submission

The CFC PARs are submitted electronically via the Bridge by CMA Case Managers. The Bridge directly interfaces with the Colorado interChange System. Access to the Bridge is accomplished via the Medicaid Enterprise User Provisioning System (MEUPS). Only Case Managers employed by CMAs are authorized to access the Bridge.

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Consumer Directed Attendant Support Services (CDASS)

For Members authorized to receive CDASS, Case Managers will need to enter the data into one of the web-based systems in addition to creating a PPA and a PAR in the Bridge. Members have the option to receive Financial Management Services (FMS) from one (1) of two (2) FMS vendors:

• Palco
• Public Partnerships, LLC (PPL)

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Claim Submission

Submission of claims for services rendered must not be duplicative. Provider Agencies cannot be reimbursed for delivering the same service to the same Member on the same day at the same time, whether such services are billed on the same claim or on multiple/different claims. Additionally, Provider Agencies are barred from billing services that share or have overlapping service definitions but are described by different procedure codes on the same day to the same Member. Collectively referred to as duplicate claims, reimbursement for such claims requires clear documentation of the necessity of the service and that there was not duplicative service delivery.

Refer to the service definitions on the Colorado Code of Regulations website to identify if claims are duplicative based on services rendered. Refer to the Provider specialty code enrollment requirements on the HCBS Provider Specialty Code List web page to identify services that may be provided by an individual provider. Provider Agencies may only bill for services approved in Members’ service plans.

In any instance in which duplicate claim submission results in Medicaid reimbursement, the Department has the authority to recoup funds from Provider Agencies.

Refer to the General Provider Information Manual located on the Billing Manuals web page under the General Provider Information drop-down menu for general billing information, including claims submission.

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Denver Regional Pricing

Certain CFC services delivered to members while they are within the City and County of Denver are eligible for higher rates.  Information relative to these services, and guidance on the applicability of these rates to certain services, can be found in the Denver Minimum Wage Pricing Appendix, on the Billing Manuals web page under “HCBS/Community First Choice (CFC)”.

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Community First Choice

The Community First Choice benefit provides a variety of services to individuals across the age spectrum, as an alternative to nursing facility, and inpatient hospitals to qualified Members. Members meeting program eligibility requirements are certified by the Case Management Agency as eligible for these services. Below is a description of services available to eligible Members on CFC. Whether a member receives any of the services below depends on the Member’s unique situation and service plan.

• Electronic Monitoring (Medication Reminders) - Medication reminders are devices, controls, or appliances which enable an individual at high risk of institutionalization to increase their abilities to perform activities of daily living, such as medication administration. Medication reminders shall include devices or items that remind or signal the member to take prescribed medications. Medication reminders may include other devices necessary for the proper functioning of such items and may also include durable and non-durable medical equipment not available as a State plan benefit.
• Homemaker - Services consisting of general household activities to maintain a healthy and safe home environment for the member and provided by a trained homemaker. Provided when the individual regularly responsible for these activities is temporarily absent or unable to manage the home and care for him or herself or others in the home.
• Personal Care - Services provided to an eligible member to meet the member’s physical, maintenance, and supportive needs through hands-on assistance, supervision, and/or cueing. These services do not require a nurse’s supervision or physician’s order. Services are incidental to the care provided or are essential to the health and welfare of the individual, rather than the individual's family. Payment will not be made for services provided to a minor by the child's parent (or stepparent), or to an individual by the person's spouse.
• Personal Emergency Response System (PERS) – Ongoing remote monitoring through a device designed to signal trained alarm monitoring personnel in an emergency situation. Includes the installation, purchase, or rental of electronic monitoring device. Device is required because of a member’s illness, impairment, or disability and is essential to prevent institutionalization of the member.
• Consumer-Directed Attendant Support Services (CDASS) - CDASS is a service delivery option that offers CFC Members the opportunity to direct personal care, homemaker, and health maintenance tasks. Members may also designate an authorized representative to direct these activities on their behalf.
• Home Delivered Meals – Delivery of meals to members who have dietary restrictions or specific nutritional needs, are unable to prepare their own meals, and have limited or no outside assistance. At the member’s request, this service may also include nutritional counseling and meal planning. Must demonstrate need for the service in Service Plan: lacks outside assistance, services, or resources through which they can access meals, is unable to prepare meals, and the member’s inability to access or prepare meals demonstrates a risk to the member’ health, safety, or ability to live in the home or community. Home Delivered Meals are limited to two (2) meals per day up to 14 meals per week, up to 365 days. Home Delivered Meals may be authorized past 365 days on a case by case basis if there is a demonstrated need.
• Remote Supports – provision of support by staff at a HIPAA compliant Monitoring Base who engage with the Member through live two-way communication to provide prompts and respond to the Member’s health, safety, and other needs identified in the Member’s support plan. These supports can help a Member live more independently in their home and community. Remote Supports Technology is included to purchase and install devices that support the delivery of Remote Supports.
• Transition Setup - Coordination and coverage of one-time, non-recurring expenses to establish a basic household upon transition from an institutional setting or Regional Center to a community living arrangement not operated by the state. 
  Note: This is not available for transition to Provider-owned settings (e.g., Alternative Care Facility [ACF], Host Home, Group Home, or Supported Living Program [SLP]. This is not available in a community-to-community transition.)
• In-Home Support Services (IHSS) - IHSS includes health maintenance activities, support for activities of daily living or instrumental activities of daily living, personal care service and homemaker services. Additionally, IHSS Providers are required to provide the core independent living skills.
  • Health Maintenance Activities – includes routine and repetitive health-related tasks which are necessary for health and normal bodily functioning that a person with a disability is unable to physically carry out.

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Community First Choice Procedure Code Table

Providers may bill the following procedure codes for CFC services:

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Community First Choice Paper Claim Reference Table

The following paper form reference table gives required and/or conditional fields for the paper CMS 1500 claim form for CFC claims:

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Timely Filing

Refer to the General Provider Information Manual located on the Billing Manuals web page under the General Provider Information drop-down for more information on timely filing policy, including the resubmission rules for denied claims.

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Community First Choice Manual Revisions Log