What the Pediatric Personal Care Benefit Covers
Personal Care services are a benefit for Health First Colorado (Colorado's Medicaid program) members who meet the following criteria:
- 20 years of age and younger.
- Qualify for personal care services as assessed by the Department-defined Personal Care Assessment Tool (PCAT). Do not use the PCAT until you have completed the Department-provided training on this tool.
The 17 Personal Care Tasks are:
- Meal Preparation
- Hygiene - Hair Care/Grooming
- Hygiene - Nail Care
- Hygiene - Shaving
- Hygiene - Mouth Care
- Hygiene - Skin Care
- Mobility - Positioning
- Mobility - Transfer
- Toileting - Bladder Care
- Toileting - Bowel Care
- Toileting - Bowel Program
- Toileting - Catheter Care
- Medication Reminders
The PCAT is used to consistently evaluate an individual's need for Personal Care services. It was created over two years in collaboration with internal and external stakeholders.
How to Start Providing Personal Care Services
All Personal Care services must be pre-approved in a Prior Authorization Request (PAR) process. The personal care provider will need to submit at least these two required documents:
- Personal Care Assessment Tool (PCAT). The PCAT needs to be completed by the personal care provider.
- 485 Home Health Certification and Plan of Care Form (or another form with the same content) (Plan of Care). The Plan of Care Form needs to be completed by the client's doctor.
The Plan of Care Form must order in-home personal care services and describe in detail what services are medically necessary and how often they are needed. The personal care provider will submit the completed forms in an online Prior Authorization Request (PAR).
For more information about this process, see the Pediatric Personal Care Special Provider Bulletin.
Personal Care Providers
Provider List - Pediatric Personal Care Providers listed by county
Part of the Department's goal is to increase the number of personal care providers across the state who accept Health First Colorado to help members receive personal care services. If you are part of a Class A or Class B agency interested in providing personal care services, contact us at PersonalCare@state.co.us.
Additional Documents and Information
- Frequently Asked Questions for Providers
- Special Provider Bulletin
- Personal Care Billing Manual
- Personal Care Rule at 10 CCR 2505-10 8.535
- PCAT Training powerpoint recording
- Billing Presentation
- Case Manager Training