HCBS Waiver Services

  • EIN or SSN as indicated below
  • Billing/direct pay entity with IRS reporting

The provider type you have selected indicates you should complete the Standard Provider Application.

Download the Standard Provider Application by clicking this link

Standard Provider Application enrollment most often requires the use of an EIN, with a few exceptions for enrollment using a SSN. This is a direct pay, or billing entity, where reimbursements are reported to the IRS as enrolled using EIN or SSN as indicated below.
Please find the applicable provider type and access all documentation needed in the following table:

Provider Type


Additional Documentation

Adult Day Services (EIN) Insurance Requirements
Alternative Care Facility (ACF) (EIN or SSN)
Behavioral Programming (EIN)  
Behavioral Therapies (Autism) (EIN or SSN)  
Brain Injury (BI) Assistive Technology (EIN)  
Children with Life Limiting Illness (CLLI)
  • Home Health, Hospice, Personal Care/Homemaker Services (EIN)
  • Therapy and Counseling (EIN or SSN)
Children’s Case Management (EIN)  
Colorado Choice Transitions (CCT)
  • Assistive Technology, Care Giver Education,
    Community Transition Services, Enhanced Nursing Services,
    Home Delivered Meals, Independent Living Skills Training,
    Intensive Case Management, Peer Mentorship,
    Transitional Specialized Day Rehabilitation Services (EIN)
  • Dental and Vision (SSN)
  • Home Modifications, Transitional Behavioral Health Supports,
    Transitional Substance Abuse Counseling (EIN or SSN)
New HCBS Providers:
  1. Review CCT Services and Supports Desk Reference
  2. Review CCT Reference Manual
  3. Complete Standard Application (see above)
  4. Complete Letter of Intent (see below)
Existing HCBS Providers
  1. Review CCT Services and Supports Desk Reference
  2. Complete Letter of Intent (see below)
Community Mental Health Services (BI only) (EIN or SSN)  
Community Transition Services (EIN)  
Day Treatment (EIN)  
Developmental Disabilities (EIN or SSN)
  • Children’s Extensive Support
  • Day Habilitation Services
  • Individual Residential Services & Supports, and/or
  • Supported Living Services
Developmental Disabilities -
Children's Habilitative Residential Program (CHRP) (EIN or SSN)
Developmental Disabilities -
Colorado Choice Transitions (CCT) DD/SLS (EIN or SSN)
→ Letter of Intent for DD, SLS
Developmental Disabilities -
Group Home Services (EIN or SSN)
Electronic Monitoring (EIN or SSN)
Home Modification (EIN or SSN)
In-Home Support Services (IHSS) (EIN)  
Independent Living Skills Training (EIN)  
Non-Medical Transportation (NMT) (EIN or SSN) Non-Medical Transportation Letter
Personal Care/Homemaker (EIN)
Substance Abuse Counseling (BI only) (EIN or SSN)  
Supported Living Program (EIN)  
Transitional Living Program (EIN)  
For further assistance please contact: Xerox State Healthcare Provider Services Call Center 1-800-237-0757