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Unless otherwise noted below, each service location must be enrolled separately by submitting a separate application, and paying an additional application fee (if applicable). In instances where services are provided in a Health First Colorado or Child Health Plan Plus (CHP+) member’s residence or other non-provider owned setting, providers will need to use their main office location as the service address. Additional office locations, where no services are provided to members, do not need to be enrolled.
Please also be sure to review each of the specialties/services below for all requirements, including whether you are required to contact the Colorado Department of Public Health and Environment for additional requirements or approvals. To contact CDPHE to submit a Letter of Intent go to www.healthfacilities.info, then click "get licensed or certified", then "submit letter of intent.
When selecting multiple specialties, select all appropriate specialties/services on the same application.
You should only submit one application for the HCBS provider type that includes all of your specialties or the services you provide. You do not need to submit a separate application for each type of waiver (DD/SLS/CES, EBD/BI, etc).
You only need to submit additional applications if you have additional service locations or if you are applying for an additional provider type outside of HCBS.
Copy of IRS 147c EIN Verification Letter (For EIN enrollments only)
Copy of IRS 147c EIN Verification Letter
For each individual providing services, must submit license and a resume showing individual/family grief, loss, or bereavement counseling with pediatric/adolescent experience of one year.
For businesses other than sole-proprietors, the provider must submit a statement on letterhead attesting that the provider is the only person who will be providing services, and that he/she will not be hiring others to provide these services. If the provider will have employees providing services, the provider must submit a list of staff and attach a copy of the current license for each employee. The provider must sign either attestation.
Provider must also be approved for specialty 666 - Personal Care/Homemaker Services
As of January 1, 2020, IRSS providers must pass the Colorado Division of Housing (DOH) IRSS Inspection Protocol every two years. All Host Homes and IRSS settings that are owned or leased by a PASA must pass the inspection. Please note that Family Caregiver Settings are excluded from this requirement. To request an inspection, please email the Division of Housing at IRSS.email@example.com for inspection information. This does not need to be done prior to enrollment but should be done as soon as possible to ensure your agency meets timeline requirements.
REQUIRED CERTIFICATIONS AND/OR LICENSES: