Home Health Program

What are Home Health (HH) Services?

The Home Health benefit for Health First Colorado members provides services from a licensed and certified Home Health Agency (HHA) for members who need Intermittent home health services. Home health services include:

  • 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)

There are two types of home health services:

  1. Acute Home Health: Skilled Home Health services 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 Managed Care Program, prior authorization for acute home health may be required by the Managed Care Organization.)
  2. Long-term Home Health: 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.

Who is Eligible?

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/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; and
  • The services meet medical necessity criteria and are provided in a manner consistent with professional practice.

Pediatric Assessment Tool

The Pediatric Assessment Tool (PAT) was developed in response to stakeholder feedback that objective criteria were needed to assess pediatric home health service needs. The tool is based on the OASIS home health assessment tool, was crafted with expert input from a team of developmental pediatricians, and is tailored to capture pediatric-specific service needs. It determines which service needs meet medical necessity. The PAT was revised in late 2013 by a team including provider and member representatives to refine its assessment of complex and unique medical needs. All materials on this page relate to the Revised PAT.

Community First Choice

Community First Choice is an important initiative being explored by Health First Colorado. Community First Choice (1915k) is a new option available that allows states to provide some Home and Community Based Services on a consumer-directed basis within their Medicaid state plan. Here is the link to more information about Community First Choice.

Questions, Concerns, or Feedback?

Please contact us at 303-866-3447 or homehealth@state.co.us.