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Long-Term Home Health Program

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Announcement

December 17, 2024

Prior Authorization Request (PAR) submission information has been announced for Pediatric Long-Term Home Health (LTHH) services.

Physical Therapy (PT), Occupational Therapy (OT), and Speech Therapy/Speech-Language Pathology (ST/SLP) soft launch begins February 3, 2025. PAR submissions for Registered Nursing (RN) and Certified Nursing Assistant (CNA) services will Go-Live on July 1, 2025.

Additional information is available in Operational Memo HCPF OM 24-060. HCPF will communicate changes via the Memo Series and stakeholders may submit questions to the homehealth@state.co.us inbox. Training opportunities with Acentra Health and HCPF are forthcoming, but providers can begin the process of familiarizing themselves with the PAR submission process through the Atrezzo Portal by visiting the ColoradoPAR Training webpage. 

The Home Health benefit for Health First Colorado (Colorado's Medicaid program) members 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.

View Home Health FAQ page

Who Qualifies?

Health First Colorado Members 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 Updates

✴️ This is a Priority Project for the Office of Community Living

Effective February 3, 2025, HCPF will begin a Soft Launch period for the submission of Pediatric LTHH therapy PARs. This includes Physical Therapy (PT), Occupational Therapy (OT), and Speech Therapy (ST). The Soft Launch is a voluntary period for providers to submit PARs for medical necessity review by Acentra Health, the current Colorado UM vendor. A PAR will be approved for up to one year. A determination that would typically result in a denial or reduction in hours will not trigger a formal denial but rather allow the member's services to continue uninterrupted while allowing the home health agency (HHA) to gain valuable feedback and education regarding the PAR process. 

The Soft Launch will remain available until the Maintenance of Effort (MOE) requirement for Colorado is lifted by the Centers for Medicare and Medicaid Services (CMS), but not before May 1, 2025.

  • February 3, 2025 - Pediatric LTHH PARs Soft Launch - PT/OT/ST
  • July 1, 2025 - Pediatric LTHH PARs Go Live - RN/CNA
  • April 6, 2026 - Full implementation of Pediatric LTHH PARs - All Disciplines

While the Soft Launch is voluntary, providers, especially those with a large caseload, are highly encouraged to submit a minimum of 10% of their PARs per month during this time. Note: submission trends will be monitored and support to providers will be provided as needed. 

Please refer to the following resources for additional information:

HCPF will continue to communicate changes via the Long-Term Home Health website and Memo Series. Stakeholders may submit questions to the homehealth@state.co.us inbox. Information and upcoming training about the PAR submission process through the Atrezzo Portal can be found by visiting the ColoradoPAR Training webpage.

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
    • An 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

LTHH Office Hours Question and Answer Log

  • Join us on the second Tuesday of each month from 1 to 1:30 p.m.
    Join via Google Meet
    Join via Phone: 1-321-430-0021‬  PIN: ‪928 613 877‬#

LTHH and PDN Newsletter  

PAR Restart Workgroup (Concluded)

PLTHH PAR Restart Workgroup Feedback Form

Meeting Materials: 

Rule Revision Workgroup (Concluded)

LTHH Rule Revision Workgroup Feedback Form

LTHH Listening Log - February 2025

8.520 Home Health Services Rule Revision-Draft - February 2025

Meetings have concluded; the rule is in the formal clearance process.

Meeting Materials: 

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 primary 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.

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Additional Resources and Information

Contact Us

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

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