Nursing Facilities

Hospital Back-Up Program (HBU)

Questions? Email HospitalBackUp@hcpf.state.co.us (encrypt if sending Personal Health Information)

Nursing Facility Application Review

Nursing Facility Billing Training

Please see "Beginning Billing Workshop: Nursing Facility - PETI" in the Billing Training and Workshops section of the Provider Training Webpage on the Department website.

Nursing Facilities Pay for Performance

2020 Nursing Facility Pay for Performance Application - Updated November 19, 2019
- 2019 Nursing Facility Pay for Performance System User Guide - December 2018
- 2020 Application Changes Overview - September 2019

Nursing Facility Pay for Performance Recommendations Report - June 2019
Nursing Facility Pay for Performance Data Report - June 2019
Nursing Facility Pay for Performance Recommendations Report - July 2018
Nursing Facility Pay for Performance Data Report - July 2018
Nursing Facility Pay for Performance Data Report - August 2017
Nursing Facility Pay for Performance Recommendations Report - June 2017
Nursing Facility Pay for Performance Recommendations Report - September 2016
Nursing Facilities Pay for Performance Final Report - 2016
Nursing Facilities Pay for Performance Final Report - 2015
Nursing Facilities Pay for Performance Final Report - 2014
Nursing Facilities Pay for Performance Final Report - 2013
Nursing Facilities Pay for Performance Final Report - 2012

Nursing Facility PETI

Nursing Facility 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 new Health First Colorado (Colorado's Medicaid Program) reimbursement system for Health First Colorado recipients who reside in nursing homes classified as Class 1 nursing facilities by statute. Class 1 nursing facilities provide for general skilled nursing care to residents who require 24-hour care. The new Health First Colorado reimbursement system is funded by a provider fee assessed to all nursing facility providers which meet state licensing requirements, with certain exceptions as defined in the law. The law assesses the fee retroactively to July 1, 2008.

Questions about the nursing facility provider fee, invoicing process, due dates and late penalties?

Contact the Department's Nursing Facility Provider Fee Accountant at 303-866-3820

Nursing Facility Provider Fee - Documents and Descriptions

House Bill 08-1114 Text
Provider Fee Invoicing Document - 2009
Provider Fee Invoicing Webinar Document Presentation - April 2009
Provider Fee Timelines Flow Chart - 2009
Period 1 Mass Adjustment Guidance
Senate Bill 09-263 Text - including changes to Nursing Facility reimbursement methodology for FY 09-10

Nursing Facility Supplemental Behavioral Services

Application for Supplemental Behavioral Services
- Applications for calendar year 2018 must be submitted by March 31, 2019

Applications can be submitted to:
Health Care Policy and Financing
ATTN: Richard Clark
1570 Grant Street
Denver, CO 80203

Or electronically to:
Richard.Clark@state.co.us
Please provide a separate email, requesting confirmation of receipt, if applications are submitted electronically.

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 submit an application for approval to the Department. The Department evaluates the supplemental services applications submitted by participating facilities and authorizes whether the facility has met participation requirements. The Department 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 are in compliance with programmatic measures as established by a previous SBS workgroup.

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 focuses on community reintegration efforts
MOU with the mental health providers is required

Legislation and Studies prior to HB 08-1114

Resources

Other Long-Term Services and Supports Programs