1

Home and Community Based Services (HCBS) Complementary and Integrative Health (CIH) Manual

 

Return to Billing Manuals Web Page

 

General Information

Waiver programs provide additional Health First Colorado (Colorado's Medicaid program) benefits for specific populations who meet special eligibility criteria.

Level of care determinations are made annually by the Case Management Agencies (CMAs). Members must meet financial, medical, and program criteria to access services under a waiver. The applicant must be at risk of transition to a nursing facility, hospital or ICF/IID (Intermediate Care Facility for Individuals with an Intellectual Disability). To use waiver benefits, Members must be willing to receive services in their homes or communities. A Member who receives services through a waiver is also eligible for all basic Health First Colorado covered services except nursing facility and long-term hospital care. When a Member chooses to receive services under a waiver, the services must be provided by certified Health First Colorado Provider Agency.

Applicants may apply for more than one (1) waiver but may only receive services through one (1) waiver at a time.

Back to Top

 

Prior Authorization Requests (PARs)

Unless otherwise noted, all HCBS services require prior approval before they can be reimbursed by Health First Colorado. Case Management Agencies complete the Prior Approval and/or Cost Containment requests for their specific programs according to instructions published in the regulations for the Department of Health Care Policy and Financing (the Department).

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

For the Home and Community Based Services Complementary and Integrative Health (HCBS-CIH) waiver, the following services must be submitted by the Case Management Agency (CMA) to the Department for approval:

  • All services above cost containment

Provider Agencies may contact the CMA for the status of the PAR or inquire electronically through the Health First Colorado Online Provider Web Portal.

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

  • Informing Members and/or legal guardian of the eligibility process.
  • Transmitting a copy of the approved Enrollment Form to the County Department of Human/Social Services for a Health First Colorado Member identification number.
  • Developing the appropriate Prior Authorization Form of services and projected costs for approval.
  • Submitting the Prior Authorization to the HCPF 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 no less frequently than annually.
  • Demonstrating continued cost effectiveness whenever services increase or decrease.

Approval of a prior authorization 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 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 Authorizations 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 Provider Agencies contracted to provide services.

Back to Top

 

PAR Submission

The HCBS-CIH forms are electronically filed via the "Bridge" which directly interfaces with the Colorado interChange System. Access to the Bridge is accomplished via the Medicaid Enterprise User Provisioning System (MEUPS). Only Case Managers may access the Bridge. Provider Agencies are not afforded access to the Bridge, but may obtain PAR information from Case Managers, the Provider Services Call Center, or through the Provider Web Portal.

This is an electronic process. Paper documents cannot be submitted.

Note: If submitted to the Department's fiscal agent, the following correspondence will not be returned to Case Managers, outreach will not be performed to fulfill the requests, and all such requests will be recycled: 1) Paper PAR forms 2) PAR revision requests. Should questions arise about what fiscal agent staff can process, contact the appropriate Department benefits manager.

Back to Top

 

Consumer Directed Attendant Support Services (CDASS)*

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

  • Palco
  • Public Partnerships, LLC (PPL)

Back to Top

 

Claim Submission

Submission of claims for services rendered must not be duplicative. Duplicate claims are any claims paid across more than one (1) claim number for the same beneficiary, date, procedure code and service state by the same Provider Agency. Duplicate claims can include different procedure codes but with overlapping service definitions. Duplicates claims also include a single Provider Agency offering more than one (1) service simultaneously. All overlapping services rendered and subsequent billing claims must have supporting documentation that clearly identifies the necessity and non-duplication of overlapping services to verify these services were provided separately and independently of one (1) another.

Refer to the service definitions on the Colorado Code of Regulations website to identify if claims are duplicative. Refer to the provider specialty code enrollment requirements on the HCBS Provider Specialty Code List web page to identify services that must be provided by an individual Provider Agency.

In any instance in which duplicate billings result in Medicaid reimbursement, a recovery shall be made by the Department against the Provider Agency.

Refer to the General Provider Information Manual for general billing information and claim submission information.

Back to Top

 

Complementary and Integrative Health (HCBS-CIH)

The Home and Community-Based Services Complementary and Integrative Health (HCBS-CIH) waiver program provides a variety of services to qualified Members with spinal cord injury, brain injury, spina bifida, multiple sclerosis, muscular dystrophy, and cerebral palsy with the inability for independent ambulation as an alternative to an inpatient hospital or nursing facility placement. Members meeting program eligibility requirements are determined functionally eligible for the HCBS-CIH waiver by the Case Manager.

Back to Top

 

Denver Regional Pricing

Certain HCBS 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 Department’s billing manual page under “HCBS”.

Back to Top

Community First Choice (CFC)

Beginning with Certification Periods starting on or after July 1, 2025, certain services on the CIH Waiver will be transitioning to the Community First Choice (CFC) Program, and will not be available after July 1, 2026. Irrespective of the change, providers should bill for services on Members’ Prior Authorizations in accordance with Members’ approved Service Plans.

Services that will gradually transition to CFC are indicated in this manual with an asterisk (*). Additionally, some services will transition away from the waiver as of June 30, 2026 and these services are denoted with two asterisks (**). Providers are encouraged to speak with their Case Managers regarding these services and refer to the CFC Billing Manual posted on the Billing Manuals web page.

This billing manual will be updated in July 2026 when these services are ultimately removed from the Waiver.

Back to Top

 

CIH Standard Procedure Code Table - Outside Denver

Provider Agencies must bill the following procedure codes for CIH services when services are delivered to Members when they are outside of the City and County of Denver: 

Procedure Code Table

DescriptionProcedure CodeModifiersUnits
Specialty 601: Adult Day Services
Adult Day Services, Basic, Tier 1S5100U1, SC1 unit = 15 minutes, maximum of 3 hours per day
Adult Day Services, Basic, Tier 2S5105U1, SC1 unit = 3-5 hours
Adult Day Services, Basic, Tier 3S5105U1, SC1 unit = 3-5 hours
Adult Day Services, SpecializedS5105U1, SC, TF1 unit = 3-5 hours
Specialty 879: Acupuncture - Complementary and Integrative Health (CIH)
Acupuncture97810U1, SC1 unit = 15 minutes
Allowable procedure codes that may be used to bill for services on date of service97810
97811
97813
97814
U1, SC1 unit = 15 minutes
Specialty 880: Chiropractic - Complementary and Integrative Health (CIH)
Specialty 880: Chiropractic - Complementary and Integrative Health (CIH)98942U1, SC1 unit = 15 minutes
Specialty 881: Massage Therapy - Complementary and Integrative Health
Specialty 881: Massage Therapy - Complementary and Integrative Health97124U1, SC1 unit = 15 minutes
Specialty 702: FMS/CDASS
Consumer Directed Attendant Support Services (CDASS) (Cent/Unit)*T2025U1, SC1 unit = $0.01
CDASS Per Member/Per Month (PM/PM)*T2040U1, SC1 unit = 1 month
Specialty 651: Home Modifications
Home ModificationsS5165U1, SC1 unit = per service
Specialty 656: In-Home Support Services
IHSS Health Maintenance Activities *H0038U1, SC1 unit = 15 minutes
IHSS Homemaker*S5130U1, SC, KX1 unit = 15 minutes
IHSS Personal CareT1019U1, SC, KX1 unit = 15 minutes
IHSS Relative Personal Care*T1019U1, SC, HR, KX1 unit = 15 minutes
Specialty 643: Electronic Monitoring
Medication Reminder, Install/Purchase*T2029U1, SC1 unit = 1 month
Medication Reminder, Monitoring*S5185U1, SC1 unit = 1 month
Personal Emergency Response System (PERs) Install/Purchase*S5160U1, SC1 unit = 1 purchase
PERS, Monitoring*S5161U1, SC1 unit = 1 month
Specialty 660: Non-Medical Transportation
Adult Day Services Transportation (Taxi)A0100U1, SC, HB1 unit = one-way trip
Non-Medical Transportation (NMT), TaxiA0100U1, SC1 unit = one-way trip
NMT, Mobility VanMileage Band 1 (0-10 miles)
Mileage Band 2 (11-20 miles)
Mileage Band 3 (over 20 miles)
A0120
A0120
A0120
U1, SC
U1, SC, TT
U1, SC, TN
1 unit = one-way trip
1 unit = one-way trip
1 unit = one-way trip
NMT, Mobility Van To and From Adult DayMileage Band 1 (0-10 miles)
Mileage Band 2 (11-20 miles)
Mileage Band 3 (over 20 miles)
A0120
A0120
A0120
U1, SC, HB
U1, SC, ST
U1, SC, TU
1 unit = one-way trip
1 unit = one-way trip
1 unit = one-way trip
NMT, Wheelchair VanMileage Band 1 (0-10 miles)
Mileage Band 2 (11-20 miles)
Mileage Band 3 (over 20 miles)
A0130
A0130
A0130
U1, SC
U1, SC, TT
U1, SC, TN
1 unit = one-way trip
1 unit = one-way trip
1 unit = one-way trip
NMT, Wheelchair Van To and From Adult DayMileage Band 1 (0-10 miles)
Mileage Band 2 (11-20 miles)
Mileage Band 3 (over 20 miles)
A0130
A0130
A0130
U1, SC, HB
U1, SC, ST
U1, SC, TU
1 unit = one-way trip
1 unit = one-way trip
1 unit = one-way trip
Non-Medical Transportation (NMT), Local Public Transit
RTD Local - Monthly Pass
RTD Local - 10-ride book
RTD Local - Day Pass
RTD Local - 3-Hour Pass
RTD Local - Access-A-Ride Single
RTD Local - Access-A-Ride Book
A0110
A0110
A0110
A0110
A0110
A0110
U1, SC, TT
U1, SC, TK
U1, SC, TF
U1, SC, TN
U1, SC, SE
U1, SC, TG
1 unit = 1 Monthly Pass
1 unit = 1 10-Ride ticket book
1 unit = 1 Day Pass
1 unit = 1 3-Hour Pass
1 unit = 1 Single Ticket
1 unit = 1 6-Ride ticket book
Non-Medical Transportation (NMT), Local Public Transit Adult Day
RTD Local - Monthly Pass
RTD Local - 10-ride book
RTD Local - Day Pass
RTD Local - 3-Hour Pass
RTD Local - Access-A-Ride Single
RTD Local - Access-A-Ride Book
A0110
A0110
A0110
A0110
A0110
A0110
U1, SC, TT, HB
U1, SC, TK, HB
U1, SC, TF, HB
U1, SC, TN, HB
U1, SC, SE, HB
U1, SC, TG, HB
1 unit = 1 Monthly Pass
1 unit = 1 10-Ride ticket book
1 unit = 1 Day Pass
1 unit = 1 3-Hour Pass
1 unit = 1 Single Ticket
1 unit = 1 6-Ride ticket book
Non-Medical Transportation (NMT), Regional Public Transit
RTD Regional - Monthly Pass
RTD Regional - 10-ride book
RTD Regional - Day Pass
RTD Regional - 3-Hour Pass
RTD Regional - Access-A-Ride Single
A0110
A0110
A0110
A0110
A0110
A0110
U1, SC, CG
U1, SC, TJ
U1, SC, TU
U1, SC, EY
U1, SC, HC
1 unit = 1 Monthly Pass
1 unit = 1 10-Ride ticket book
1 unit = 1 Day Pass
1 unit = 1 3-Hour Pass
1 unit = 1 Single Ticket
Non-Medical Transportation (NMT), Regional Public Transit, Adult Day
RTD Regional - Monthly Pass
RTD Regional - 10-ride book
RTD Regional - Day Pass
RTD Regional - 3-Hour Pass
RTD Regional - Access-A-Ride Single
A0110
A0110
A0110
A0110
A0110
A0110
U1, SC, CG, HB
U1, SC, TJ, HB
U1, SC, TU, HB
U1, SC, EY, HB
U1, SC, HC, HB
1 unit = 1 Monthly Pass
1 unit = 1 10-Ride ticket book
1 unit = 1 Day Pass
1 unit = 1 3-Hour Pass
1 unit = 1 Single Ticket
Specialty 754: Peer Mentorship
Peer MentorshipH2015U1, SC1 unit = 15 minutes
Specialty 666: Personal Care/Homemaker
Personal Care*T1019U1, SC1 unit = 15 minutes
Homemaker, Outside Denver County*S5130U1, SC1 unit = 15 minutes
Homemaker, Denver County*S5130U1, SC, HX1 unit = 15 minutes
Personal Care, Relative*T1019U1, SC, HR1 unit = 15 minutes
Specialty 756: Remote Supports
Remote Supports Service*O593TU1, SC1 unit = 15 minutes
Remote Supports Technology (Install/Purchase)*A9279U1, SC1 unit = Monthly Purchase
Specialty 675: Respite
Respite Care, Alternative Care Facility (ACF) S5151U1, SC1 unit = 1 day
Respite Care, In Home S5150U1, SC1 unit = 15 minutes
Respite Care, Nursing Facility (NF)H0045U1, SC1 unit = 1 day
Specialty 752: Home Delivered MealsS5170U1, SC1 unit = 1 meal
Home Delivered Meals*S5170U1, SC1 unit = 1 meal
Home Delivered Meals after 1st discharge from a 24hr hospitalization**S5170U1, SC, TF1 unit = 1 meal
Home Delivered Meals after 2nd discharge from a 24hr hospitalization**S5170U1, SC, TG1 unit = 1 meal
Specialty 636: Transition Setup
Coordinator*T2038U1, SC15 minutes
Setup Expenses*A9900U1, SCOne-time payment
Specialty 753: Life Skills Training
Life Skills TrainingH2014    U1, SC1 unit = 15 minutes
Specialty 683: Wellness Education Benefit
Wellness Education Benefit98960U1, SC1 unit per month

Back to Top

 

Paper Claim Reference Table

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

CMS Field Number and LabelField is?Instructions
1. Insurance TypeRequiredPlace an "X" in the box marked as Medicaid.
1a. Insured's ID NumberRequiredEnter the Member's Health First Colorado seven (7)-digit ID number as it appears on the Health First Colorado Identification card. Example: A123456.
2. Patient's NameRequiredEnter the Member's last name, first name, and middle initial.
3. Patient's Date of Birth/SexRequiredEnter the Member's birth date using two (2) digits for the month, two (2) digits for the date, and two (2) digits for the year. Example: 070114 for July 1, 2014.

Place an "X" in the appropriate box to indicate the sex of the Member.
4. Insured's NameNot required 
5. Patient's AddressNot Required 
6. Client Relationship to InsuredNot Required 
7. Insured's AddressNot Required 
8. Reserved for NUCC UseNot Required 
9. Other Insured's NameNot Required 
9a. Other Insured's Policy or Group NumberNot Required 
9b. Reserved for NUCC Use  
9c. Reserved for NUCC Use  
9d. Insurance Plan or Program NameNot Required 
10a-c. Is patient's condition related to?Not Required 
10d. Reserved for Local Use  
11. Insured's Policy, Group or FECA NumberNot Required 
11a. Insured's Date of Birth, SexNot Required 
11b. Other Claim IDNot Required 
11c. Insurance Plan Name or Program NameNot Required 
11d. Is there another Health Benefit Plan?Not Required 
12. Patient's or Authorized Person's signatureRequiredEnter "Signature on File", "SOF", or legal signature. If there is no signature on file, leave blank or enter "No Signature on File".

Enter the date the claim form was signed.
13. Insured's or Authorized Person's SignatureNot Required 
14. Date of Current Illness Injury or PregnancyNot Required 
15. Other DateNot Required 
16. Date Patient Unable to Work in Current OccupationNot Required 
17. Name of Referring PhysicianConditional 
18. Hospitalization Dates Related to Current ServiceNot Required 
19. Additional Claim InformationConditional 
20. Outside Lab?
$ Charges
Not Required 
21. Diagnosis or Nature of Illness or InjuryRequiredEnter at least one (1) but no more than 12 diagnosis codes based on the Member's diagnosis/condition.

Enter applicable ICD-10 indicator.

HCBS
HCBS may use R69.
22. Medicaid Resubmission CodeConditionalList the original reference number for resubmitted claims.

When resubmitting a claim, enter the appropriate bill frequency code in the left- hand side of the field.
7 - Replacement of prior claim
8 - Void/Cancel of prior claim
This field is not intended for use for original claim submissions.
23. Prior AuthorizationNot Required 
24. Claim Line DetailInformationThe paper claim form allows entry of up to six (6) detailed billing lines. Fields 24A through 24J apply to each billed line.

Do not enter more than six (6) lines of information on the paper claim. If more than six (6) lines of information are entered, the additional lines will not be entered for processing.

Each claim form must be fully completed (totaled).

Do not file continuation claims (e.g., Page 1 of 2).
24A. Dates of ServiceRequired

The field accommodates the entry of two (2)  dates: a "From" date of services and a "To" date of service. Enter the date of service using two (2) digits for the month, two (2) digits for the date and two (2) digits for the year. Example: 010116 for January 1, 2016.

FromTo
010119   

or

FromTo
010119010119

Span dates of service

FromTo
010119013119

Practitioner claims must be consecutive days.
Single Date of Service: Enter the six (6)-digit date of service in the "From" field. Completion of the "To field is not required. Do not spread the date entry across the two (2) fields.

Span billing: permissible if the same service (same procedure code) is provided on consecutive dates.

24B. Place of ServiceRequired

Enter the Place of Service (POS) code that describes the location where services were rendered. Health First Colorado accepts the CMS place of service codes.

11Office
12Home

Note: Use POS Code 12 (Home) for Alternative Care Facility, Adult Day Program, or Respite in the Facility

24C. EMGNot Required 
24D. Procedures, Services, or SuppliesRequired

Enter the CIH procedure code that specifically describes the service for which payment is requested.

CIH

Refer to the Procedure Code Table section.

24D. ModifierRequiredEnter the appropriate procedure-related modifier that applies to the billed service. Up to four modifiers may be entered when using the paper claim form.
24E. Diagnosis PointerRequiredEnter the diagnosis code reference letter (A-L) that relates the date of service and the procedures performed to the primary diagnosis.

At least one (1) diagnosis code reference letter must be entered.

When multiple services are performed, the primary reference letter for each service should be listed first, other applicable services should follow.

This field allows for the entry of four (4) characters in the unshaded area.
24F. $ ChargesRequiredEnter the usual and customary charge for the service represented by the procedure code on the detail line. Do not use commas when reporting dollar amounts. Enter 00 in the cents area if the amount is a whole number.

Some CPT procedure codes are grouped with other related CPT procedure codes. When more than one (1) procedure from the same group is billed, special multiple pricing rules apply.

The base procedure is the procedure with the highest allowable amount. The base code is used to determine the allowable amounts for additional CPT surgical procedures when more than one (1) procedure from the same grouping is performed.

Submitted charges cannot be more than charges made to non-Health First Colorado covered individuals for the same service.

Do not deduct Health First Colorado co-pay or commercial insurance payments from the usual and customary charges.
24G. Days or UnitsRequiredEnter the number of services provided for each procedure code.

Enter whole numbers only- do not enter fractions or decimals.
24G. Days or UnitsGeneral InstructionsA unit represents the number of times the described procedure or service was rendered.

Except as instructed in this manual or in Health First Colorado bulletins, the billed unit must correspond to procedure code descriptions. The following examples show the relationship between the procedure description and the entry of units.

Home and Community-Based Services
Combine units of services for a single procedure code for the billed time period on one (1) detail line. Dates of service do not have to be reported separately. Example: If 40 units of personal care services were provided on various days throughout the month of January, bill the personal care procedure code with a From Date of 01/03/XX and a To Date of 01/31/XX and 40 units.
24H. EPSDT/Family PlanNot Required 
24I. ID QualifierNot Required 
24J. Rendering Provider ID #RequiredIn the shaded portion of the field, enter the NPI of the Health First Colorado provider number assigned to the individual who actually performed or rendered the billed service. This number cannot be assigned to a group or clinic.
25. Federal Tax ID NumberNot Required 
26. Patient's Account NumberOptionalEnter information that identifies the Member or claim in the Provider Agency's billing system. Submitted information appears on the Remittance Advice (RA).
27. Accept Assignment?RequiredThe accept assignment indicates that the Provider Agency agrees to accept assignment under the terms of the payer's program.
28. Total ChargeRequiredEnter the sum of all charges listed in field 24F. Do not use commas when reporting dollar amounts. Enter 00 in the cents area if the amount is a whole number.
29. Amount PaidNot Required 
30. Rsvd for NUCC Use  
31. Signature of Physician or Supplier Including Degrees or CredentialsRequiredEach claim must bear the signature of the enrolled Provider Agency or the signature of a registered authorized agent.

Each claim must have the date the enrolled Provider Agency or registered authorized agent signed the claim form. Enter the date the claim was signed using two (2) digits for the month, two (2) digits for the date and two (2) digits for the year. Example: 070116 for July 1, 2016.
32. 32- Service Facility Location Information
32a- NPI Number
32b- Other ID #
ConditionalEnter the name, address and ZIP code of the individual or business where the Member was seen or service was performed in the following format:
1st Line Name
2nd Line Address
3rd Line City, State and ZIP Code
If the Provider Type is not able to obtain an NPI, enter the eight (8)-digit Health First Colorado provider number of the individual or organization.
33. Billing Provider
Info & Ph #
RequiredEnter the name of the individual or organization that will receive payment for the billed services in the following format:
1st Line Name
2nd Line Address
3rd Line City, State and ZIP Code
33a- NPI NumberRequired 
33b- Other ID # If the Provider Type is not able to obtain an NPI, enter the eight (8)-digit Health First Colorado Provider Agency number of the individual or organization.

Back to Top

 

Complementary and Integrative (CIH) Waiver Services

The HCBS-CIH waiver program provides a variety of services to eligible Members with a spinal cord injury, brain injury, spina bifida, multiple sclerosis, muscular dystrophy, and cerebral palsy with the inability for independent ambulation as an alternative to inpatient hospital and nursing facility placement. Members meeting program eligibility requirements are certified by the case management agency/single entry point as medically eligible for this HCBS waiver program. This waiver offers all of the following services:

  • Adult Day Services (Basic) - Services delivered on a tiered basis.
    • Tier I - Services provided virtually or in-person in an outpatient setting to include parks or other community-based locations. Meal provision not required if services are not provided in person or over the lunch hour. Service can be provided up to three (3) hours per day.
    • Tier II - Services provided between three (3) - five (5) or more hours per day as approved by the Case Manager and in the context of the Member's health, for one (1) or more days per week. Services provided in an outpatient setting, encompassing both health and social services needed to assure the optimal functioning of the individual. Meals provided as part of these services shall not constitute a full nutritional regimen" (3 meals per day). Physical, occupational and speech therapies indicated in the individual's plan of care would be provided as component parts of this service if such services are not being provided in the Member's home..
    • Tier III - Services provided over a full day as approved by the Case Manager and in the context of the Member's health, for one (1) or more days per week. Services provided in an outpatient setting, encompassing both health and social services needed to assure the optimal functioning of the individual. Meals provided as part of these services shall not constitute a full nutritional regimen" (3 meals per day). Physical, occupational and speech therapies indicated in the individual's plan of care would be provided as component parts of this service if such services are not being provided in the Member's home. Tier I Adult Day Services cannot be provided in conjunction with this service.
  • Adult Day Services (Specialized) - Services provided between three (3) - five (5) or more hours per day as approved by the Case Manager and in the context of the Member's health, for one (1) or more days per week. Services provided in an outpatient setting, encompassing both health and social services needed to assure the optimal functioning of the individual. Meals provided as part of these services shall not constitute a full nutritional regimen" (3 meals per day). Physical, occupational and speech therapies indicated in the individual's plan of care would be provided as component parts of this service if such services are not being provided in the Member's home. Tier I Adult Day Services cannot be provided in conjunction with this service.
  • Complementary and Integrative Health Services - Services are limited to Acupuncture, Chiropractic Care, and Massage Therapy. Services are to be delivered under direction of a care plan approved by a Complementary and Integrative Health Service Provider. There is a yearly cap that allows for no more than 408 total units of any combination of services.
  • Electronic Monitoring* (Personal Emergency Response Systems) - An electronic device, which enables certain individuals at high risk of institutionalization to secure help in an emergency. The individual may also wear a portable help" button to allow for mobility. The system is connected to the person's phone and programmed to signal a response center once a help" button is activated. Monitoring of the device is included in the PERS service. The response center is staffed by trained professionals.
  • Electronic Monitoring* (Medication Reminder) - 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 (meal preparation and routine household care) 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.
  • Home Modification - Specific modifications, adaptations or improvements in an eligible Member's existing home setting which, based on the Member's medical condition are necessary to ensure the health, welfare and safety of the Member, enable the member to function with greater independence in the home, are required because of the Member's illness, impairment or disability, as documented on the ULTC-100.2 form and the care plan and prevents institutionalization of the Member. There is a lifetime cap of $14,000 per Member.
  • Personal Care* - Assistance with eating, bathing, dressing, personal hygiene, activities of daily living. These services may include assistance with preparation of meals but does not include the cost of the meals themselves. When specified in the service plan, this service may also include such housekeeping chores as bed making, dusting and vacuuming. 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.
  • Relative Personal Care - Personal Care providers may be members of the individual's family. The number of Health First Colorado personal care units for provided by any single member of the Member's family shall not exceed the equivalent of 444 personal care units per annual certification. Payment will not be made for services provided to an individual by an individual's spouse employed by a Personal Care agency.
  • Remote Supports* - Remote Supports service provides live, two (2)-way virtual coaching, supervision and cues from a virtual attendant for everyday activities of daily living that do not require hands-on assistance to be completed safely. These supports can help a Member live more independently in their home and community. Services may include prompts and reminders for such needs as dressing, cooking support, overnight support and fall detection. Remote Supports Technology is included to purchase and install devices that support the delivery of Remote Supports.
  • Respite - Services provided to an eligible Member on a short-term basis because of the absence or need for relief of those persons normally providing the care. The unit of reimbursement shall be a unit of one (1) day for care provided in an Alternative Care Facility. Individual respite providers shall bill according to an hourly rate or daily institutional rate, whichever is less.
  • Non-Medical Transportation - Service offered in order to enable individuals served on the waiver to gain access to waiver and other community services, activities and resources, specified by the service plan. This service is offered in addition to medical transportation required under 42 CFR 431.53 and transportation services under the State Plan, defined at 42 CFR 440.170 (a) (if applicable), and shall not replace them. Non-Medical Transportation is limited to two (2) roundtrips per week. Trips to and from Adult Day programs are not subject to this cap.
  • Home Delivered Meals** - Includes nutritional counseling, planning, preparation, and delivery of meals. Must demonstrate need for the service in Service Plan: demonstrated need for nutritional counseling, meal planning, and preparation, dietary restrictions or specific nutritional needs, unable to prepare their own meals, limited or no outside assistance, inability to access and prepare nutritious meals demonstrates a need-related risk to health, safety or institutionalization. Home Delivered Meals are limited to two (2) meals per day up to 14 meals per week, up to 365 days post-transition.
  • Home Delivered Meals** - Post Hospitalization – expands the availability of home delivered meals following a 24 hr hospitalization providing up to 30 days of meals post discharge two (2) times within a certification period. Members have up to 30 days post discharge to opt in to receive this benefit.
  • Life Skills Training - Individualized training, provided in Member's residence, the community, or group living situations, that is designed and directed with Member to develop and maintain the ability to independently sustain himself/herself in the community. Must demonstrate need for the service in Service Plan: need for training to sustain self in the community, skills for which training is needed and that without poses a risk to the health, safety, or ability to live in the community, without training individual could not develop the skills needed, with training ability to acquire these skills within 365 days. Life Skills Training is limited to up to 24 units per day with no more than 160 units per week, up to 365 days post-transition.
  • Peer Mentorship - Provided by peers to promote self-advocacy and encourage community living by instructing and advising on issues and topics related to community living, describing real-world experiences as examples, and modeling successful community living and problem-solving. Must demonstrate the need for the service in Service Plan: need for soft skills, insight, or guidance from a peer, without service may experience a health, safety, or institutional risk, no other services or resources available to meet the need. Peer Mentorship is limited to 24 units per day for 365 days post-transition.
  • Transition Setup** - Coordination and coverage of one (1)-time, non-recurring expenses to establish a basic household upon transition from nursing facility, Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID), 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., ACF, Host Home, Group Home, or SLP. This is not available in a community-to-community transition.] Units limited to 40, up to 30 days post-transition.
  • Wellness Education Benefit (WEB) - The WEB is designed to reduce the need for a higher level of care by offering educational materials that provide Members and their families with actionable tools that can be used to prevent the progression of a disability, increase community engagement, combat isolation and improve awareness of Health First Colorado services.

The HCBS-CIH program also offers the following participant-directed service delivery options:

  • Consumer Directed Attendant Support Services (CDASS)* - CDASS is a service delivery option that offers HCBS-CIH Members the opportunity to direct services that assist an individual in accomplishing activities of daily living including personal care, homemaker and health maintenance tasks. Members may also designate an authorized representative to direct these activities on their behalf. The Member, or the authorized representative, is responsible for hiring, training, recruiting, setting wages, scheduling, and in other ways managing the attendant.
  • 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. Such services are provided under the direction of the Member, or an authorized representative who is designated by the Member. Additionally, IHSS providers are required to provide the core independent living skills.

Back to Top

 

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.

Back to Top

*Denotes a Service transitioning to Community First Choice (CFC) at each Member’s Continued Stay Review (CSR) from July 1, 2025-June 30, 2026; service will be unavailable across the waiver from July 1, 2026, forward.

**Denotes a Service leaving the waiver as of June 30, 2026, due to CFC implementation.

HCBS CIH Manual Revisions Log

Revision DateAddition/ChangesMade by
12/1/2016Manual revised for interChange implementation. For manual revisions prior to 12/01/2016 Please refer to Archive.HPE (now DXC)
12/27/2016Updates based on Colorado iC Stage II Provider Billing Manual Comment Log v0_2.xlsxHPE (now DXC)
1/10/2017Updates based on Colorado iC Stage Provider Billing Manual Comment Log v0_3.xlsxHPE (now DXC)
1/19/2017Updates based on Colorado iC Stage Provider Billing Manual Comment Log v0_4.xlsxHPE (now DXC)
1/26/2017Updates based on Department 1/20/2017 approval emailHPE (now DXC)
5/22/2017Updates based on Fiscal Agent name change from HPE to DXCDXC
6/26/2018Updated billing (claims submission) and timely filingHCPF
6/28/2018Updated claim submissionHCPF
12/21/2018Clarification to signature requirementsHCPF
3/19/2019Clarification to signature requirementsHCPF
7/2/2019Updated Appendices' links and verbiageDXC
3/2/2020Converted to web pageHCPF
3/4/2020Updated to include (4) Transition Services and updated NMTHCPF
8/31/2020Updated to include Tiered Adult Day Services.HCPF
9/14/2020Added Line to Box 32 under the Paper Claim Reference TableHCPF
11/24/2021Added Remote Supports Services effective 1/1/2022HCPF
1/27/2022Removed Remote Supports Services effective 1/1/2022HCPF
3/7/2022Added Remote Supports effective 3/7/2022HCPF
8/3/2022Updated Transportation description and moved to align with other similar servicesHCPF
8/16/2022Updated Waiver Name Change and expanded eligibility criteria effective 7/1/2022; removed CDASS FMS vendor, updated CDASS units. HCPF
10/31/2022Added in Specialty numbers and rearranged services as appropriate.HCPF
4/3/2023Updated AWS URL LinksHCPF
4/13/2023Adding Home Delivered Meals benefit effective 4/1/2023HCPF
9/8/2023Corrected outdated operational references, updated acupuncture procedure code to 97810. HCPF
2/27/2024Added Denver County codes for Transportation and updated the limit for CIH servicesHCPF
4/25/2024Added new Denver County codes and completed correctionsHCPF
7/19/2024Added duplicative claims language to Claim Submissions section. Updated Remote Supports codes.HCPF
12/12/2024Updated codes, added reference to Denver Regional Pricing Appendix, updated references to Case Management Agencies that reflect the outcome of Case Management Redesign.HCPF
04/18/2025Added the Wellness Education Benefit.HCPF
06/27/2025Updated manual to indicate services transitioning to CFC in July 2026, services leaving the waiver to align with CFC.HCPF

Back to Top