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Nursing Facilities Topics

Nursing Facility Operations     Provider Fee and Supplemental Payments     Hospital Back Up (HBU)     Billing and CHOW          

Compliance Oversight     Stakeholder Meetings and Communication
 

Nursing Facility Operations

Billing Manuals 

Billing Training

View Beginning Billing Workshop: Nursing Facility - PETI on the Provider Training Webpage 
​

Nursing Facility Post-Eligibility Treatment of Income / Incurred Medical Expense (PETI/IME) 

Personal Needs Account (PNA) Surety Bond 

Private Pay Survey 

Rules and Regulations

​Other Resources

View General Nursing Facility FAQs

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​Provider Fee and Supplemental Payments

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Questions about Provider Fees and Supplemental Payments - email Jeff.Wittreich@state.co.us 

Provider Fee

The Nursing Facility Provider Fee was implemented in accordance with the provisions of Colorado House Bill 08-1114, which was signed into law by the Governor of Colorado in 2008. This law enacts a Health First Colorado (Colorado's Medicaid Program) reimbursement system for Health First Colorado recipients who reside in Class I Nursing Facilities. The Health First Colorado reimbursement system is funded by a provider fee assessed to all nursing facilities which meet state licensing requirements, with certain exceptions as defined in 10 CCR 2502-10 Section 8.443.17.​

​The nursing facility’s provider fee is calculated as total resident days minus Medicare resident days (non-Medicare resident days) for the calendar year (for example CY 2023), multiplied by the next state fiscal year's per-diem fee. (For example, SFY 2024-25 per-diem fee is the SFY 2023-24 per-diem fee inflated by 3.01%.) Nursing facilities with greater than 55,000 total resident days pay 18.71% of the fee.​

The Nursing Facility Provider Fee is used for making supplemental payments for the state fiscal year to Class I Nursing Facilities for:​

  • Medicaid Utilization Supplemental Medicaid Payment​
  • Acuity Adjusted Core Component Supplemental Medicaid Payment​
  • Pay-for-Performance Supplemental Medicaid Payment​
  • Cognitive Performance Scale Supplemental Medicaid Payment​
  • Pre-Admission Screening and Resident Review (PASRR) II Resident Supplemental Payment​
  • PASRR II Facility Supplemental Payment ​
  • Core Component Supplemental Medicaid Payment​
     

 

Pay for Performance (P4P)

10 CCR 2505-10 Section 8.443.12 contains the regulations regarding the Pay-for-Performance Supplemental Payment.​

​The Department of Health Care Policy and Financing (HCPF) pays a supplemental payment to Class I nursing facilities that provide services resulting in better care and higher quality of life for their residents. Annually, the Class I nursing facility applications submitted to the HCPF contractor are scored to determine the amount of supplemental payment that will be distributed to each nursing facility with a completed a verified/audited application. The nursing facility's P4P supplemental payment is calculated as Medicaid resident days multiplied by a per-diem add-on based on the score of the application.​

​The application includes performance measures that the nursing facility must meet or exceed to qualify for points. The nursing facility must also perform a resident and family satisfaction survey, in a manner determined by HCPF. The nursing facility must maintain documentation supporting its representations for each performance measure and submit the documentation with the application. The current and past applications are provided in the links below.​

​Per HB 23-1228, in State Fiscal Year (SFY) 2024-25 and 2025-26, the per diem rates will equal no less than 12% of the total of all of the annual Provider Fee supplemental payments. For SFY 2026-27 and all subsequent years, the P4P per diem rates will equal no less than 15% of the total of all annual Provider Fee supplement payments.​

 

Supplemental Behavior Services (SBS)

Supplemental Behavioral Services (SBS) is an elective nursing facility service that recognizes and reimburses nursing facilities for serving individuals with moderate to severe mental illnesses, cognitive dementia, and brain injuries. Nursing Facilities that wish to participate must submit an application for approval to HCPF. HCPF evaluates the supplemental services applications and authorizes whether the facility has met participation requirements. HCPF audits the facilities on program participation, and if the facility meets programmatic requirements, the facility receives a supplemental payment for each resident served by the program. On-site visits and desk reviews are conducted to evaluate and validate whether nursing facilities that applied for additional reimbursement under the SBS model have implemented and comply with programmatic measures as established by a previous SBS workgroup.

10 CCR 2505-10 Section 8.443.10.B.4. and 5 contains the regulations regarding the Supplemental Behavior Services (SBS) payment.

The facilities must apply to participate and must meet the following program criteria:

  • Appropriate staff credentialing and experience with targeted clientele
  • Enhanced staffing model
  • Specialized training that includes behavior management, crisis intervention, mental illness, and psychotropic medication
  • Therapeutic groups must be provided based on clientele served (i.e. conflict resolution, communication skills, art therapy, stress/relaxation groups, etc.)
  • Therapeutic work programming must be offered
  • Life skills training is offered
  • Groups and training for clientele focus on community reintegration efforts
  • Memo of Understanding (MOU) with the mental health providers is required
     

Application

Applications can be submitted in the following ways:

By Portal

By Email

  • Email Christine.Bates1@state.co.us
    • Provide a separate email, requesting confirmation of receipt, if applications are submitted electronically.

By Mail (if providing hard copy or flash drive)

  • Department of Health Care Policy and Financing
    ATTN: Christine Bates
    303 E. 17th Avenue, Suite 1100
    Denver, CO 80203
     

Acuity Adjustment Supplemental Payment

HCPF pays a supplemental payment to nursing facilities for the difference between the Core Component per diem rate and the adjusted Core Component per diem rate for the prior year. This Acuity Adjustment supplemental payment is based on acuity. The Acuity Adjustment supplemental payment is calculated as the difference between the July 1 (for example 7/1/2023) Core Components reimbursement rate and the state fiscal year's (for example SFY 2023-24) acuity adjusted Core Components reimbursement rate(s), multiplied by the Medicaid resident days in which the acuity adjusted Core Components rate was effective.​
 

Medicaid Utilization Supplemental Payment

The Medicaid Utilization Supplemental Payment is reimbursement for a nursing facility’s proportion of Medicaid resident days to total resident days. The nursing facility’s Medicaid Utilization supplemental payment is calculated as the percentage of Medicaid resident days to total resident days for the calendar year (for example CY 2023) multiplied by the next state fiscal year's (for example SFY 2024-25) provider fee. The Medicaid resident days are the sum of Medicaid fee-for-service resident days plus hospice room and board resident days plus the Program of All-inclusive Care for the Elderly (PACE) resident days.
 

High Medicaid Utilization Supplemental Payment

The High Medicaid Utilization supplemental payment is reimbursement to nursing facilities with greater Medicaid utilization rates or that are geographically critical to ensuring access to care for Colorado residents.​

The nursing facility’s High Medicaid Utilization supplemental payment is calculated as Medicaid resident days multiplied by a per-diem add-on. A nursing facility with a Medicaid utilization rate between 75.00% and 84.99% receives a $5.00 per-diem add-on while a nursing facility with a Medicaid utilization rate greater than or equal to 85.00% receives a $10.00 per-diem add-on. A geographically critical nursing facility receives at minimum a $5.00 per-diem add-on, even if its Medicaid utilization rate is less than 75.00%.​

​Total resident days used in the High Medicaid Utilization Supplemental payment removes Medicaid pending, Veterans Affairs, and other uncompensated resident days as reported by the nursing facility.​
 

Wage Enhancement Supplemental Payment

On May 28, 2019, Governor Jared Polis signed into law House Bill (HB) 19-1210, allowing local governments within the State of Colorado to increase their minimum wage higher than the statewide minimum wage. This bill allowed eligible nursing facilities to receive a supplemental payment that covered the difference between the local minimum wage and the statewide minimum wage. Supplemental payments were made for calendar year (CY) 2020 and 2021. The last minimum wage supplemental payment made pursuant to HB 19-1210 was for CY 2021, disbursed in late June 2022. ​

​That particular piece of legislation has been revised to include the entire state instead of facilities that reside in local governments that increase the minimum wage above the statewide minimum wage. The revised legislation can be found under HB 22-1333 which "changes the definition of 'eligible nursing facility provider' and makes other conforming changes to allow any Colorado nursing facility that meets the defined criteria to be eligible to receive wage enhancement supplemental payments, as defined in the act, to increase the minimum wage for nursing facility employees to at least $15 per hour." ​

​All Medicaid nursing facilities will be asked to attest that the minimum wage for all employees has been increased to at least $15 per hour effective January 1, 2023. The attestation will be due December 31, 2022.​
 

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Hospital Back Up (HBU) Program

The Hospital Back Up (HBU) Program is a long-term care program that provides hospital-level care in a skilled nursing facility (SNF) setting. Members who no longer need acute care in a hospital but require 24-hour monitoring and life-sustaining technology for complex medical conditions may apply to receive long-term care in an HBU certified facility.​

HBU supports qualified skilled nursing facilities in providing hospital-level care to members who are ventilator dependent, have complex wounds, or have medically complex needs, as defined in rule 10 CCR 2505-10 8.470.1. Patients must be approved for LTC Medicaid and have a ULTC 100.2 certification with start and end dates to be approved for HBU. 

Contacts:

Approved HBU Facilities

View HBU Program FAQs

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Nursing Facility Billing and Change of Ownership

Providers are required to maintain their Medicaid billing account(s) information to ensure the provider receives HCPF communications and HCPF outreach. The Provider Billing Account Maintenance page contains helpful information and provider web portal quick guides. ​

HCPF must be notified when:

  • Change in Doing Business As Name - Complete the Doing Business As (DBA) Name Change Form (Provider Enrollment Forms) and submit a copy to HCPF_LTC_Facilities​@state.co.us 
     
  • Change of Ownership (CHOW) - Complete the Change of Ownership (CHOW) Form (Provider Enrollment Forms) and submit a copy to HCPF_LTC_Facilities@state.co.us at least 45 days before the expected CHOW effective date. 
    • A CHOW is:
      • The purchase of an existing Medicaid nursing facility or intermediate care facility​
      • The change in the tax identification number of an existing Medicaid nursing facility or intermediate care facility​
      • An existing Medicaid nursing facility or intermediate care facility's withdrawal from Medicaid
         
    • When a CHOW involves only the current owner, the following actions must be taken:
      • Current owner must notify the FCU Team at least 45 days before the expected CHOW effective date for a tax id change or for the facility withdrawal from Medicaid ​
      • Current owner must disenroll from the HCPF billing system
      • Current owner must complete a final MED-13 report
      • If withdrawing from Medicaid, current owner must complete a personal needs account final accounting
      • Current owner must complete CHOW compliance reviews (closing review)
         
    • When a CHOW involves a seller and a buyer, the following actions must be taken: 
      • Buyer or Seller must notify the FCU Team at least 45 days before the expected CHOW effective date
      • Buyer must obtain a new license from the Colorado Department of Public Health and Environment (CDPHE) and enroll in the HCPF billing system before billing Medicaid for rendered services
      • Buyer must obtain a new surety bond for the personal needs account
      • Seller must disenroll from the HCPF billing system​
      • Seller must complete a final MED-13 report
      • Seller must complete a personal needs account final accounting
      • Seller must complete CHOW compliance reviews
         
    • Common CHOW processing delays or issues:
      • Mandatory CHOW reviews are delayed if notification is not received by HCPF as required by rule 10 CCR 2025-10, Section 8.424​
      • Required facility documentation for the final compliance reviews is not maintained at the facility. Documentation includes at least the 5615 Forms, COLA reports, monthly census reports, account receivable reports, credit aging reports, and all documentation related to the personal needs accounts (reconciliations and all supporting documentation for each resident account).​
      • Buyer enrollment application not submitted, is missing information, or submitted after the CHOW effective date. (Buyer must enroll separately for nursing facility room and board, hospice, and respite)​.
      • Seller continues to bill after the CHOW effective date or delays disenrollment from the billing system. ​
         

View Change of Ownership FAQ
 

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Compliance Oversight

Nursing Facility and ICF Compliance Oversight

HCPF is responsible for ensuring Nursing Facilities (NF) and Intermediate Care Facilities (ICF) comply with rules and regulations 10 CCR 2025-10, Section 8.400​

HCPF performs compliance reviews on the following:

  • NF and ICF billing activity for room and board (census report, patient liability, accounts receivable, and aging credits)​
  • NF resident personal needs account reconciliation, account activity, eligibility limit, and surety bond
  • NF PETI/IME activity logs for prior authorized PETI/IME services
  • NF PASRR level of care approval date for admission to a facility
  • NF Denial of Payment on New Admissions (DPNA) impositions from the Centers for Medicare and Medicaid Services (CMS) or CDPHE surveys

Providers are required to maintain all documentation at the facility for seven years. HCPF reviews are conducted on a rotating basis every three to five years. Change of Ownership (CHOW) or closing reviews are performed when HCPF is notified of the change or closure.

Resources

Provider Enrollment and Update Forms:

  • CHOW Notification Form (look under Provider Enrollment forms)​
  • 5615 Form (look under PETI forms)​

Other:

View Compliance Related FAQs

Resources

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Stakeholder Meetings and Communication

Nursing Facility Stakeholders Meeting (NFSM)

The purpose of this meeting is to identify challenges in providing Medicaid services in nursing facilities. This meeting provides an opportunity for HCPF staff, members, and providers to discuss issues unique to nursing facilities and their residents. Meetings are held virtually. This meeting replaced the NFAC and PFAB meetings. Contact: Richard.Clark@state.co.us for more information. ​

Visit Nursing Facility Stakeholders Meeting website
 

Nursing Home Innovations Grant Board

The function of the Nursing Home Innovations Grant Board (NHIGB) is to promote improved quality of life and quality of care for nursing home residents through grants that support nursing facilities.  This board is managed by the Colorado Department of Public Health and Environment (CDPHE), in cooperation with HCPF. 

Visit the CDPHE Nursing Home Innovations Grant Board website

Email: cdphe_nhib_grants@state.co.us 

View NHIGB FAQs
 

Communication Resources

Nursing Facilities Team Contacts

Memo Series - a library of memos that provide guidance and information from HCPF

Provider Bulletin

OCL Stakeholder Engagement page - Provides a calendar of public meetings and links to information related to the Office of Community Living (OCL) and Long-Term Services and Supports

Sign up to receive HCPF communications on a variety of topics

 

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