Pediatric Personal Care Benefit

What the Pediatric Personal Care Benefit Covers

Personal Care services are a benefit for Colorado Medicaid clients who meet the following criteria:

  1. 20 years of age and younger.
  2. 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 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:

1. Personal Care Assessment Tool (PCAT). The PCAT needs to be completed by the personal care provider.

2. 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 Medicaid to help Medicaid 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 303-866-3447 or 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 Webinar

Billing Presentation

Case Manager Training

Program Contact

Elizabeth Freudenthal
303-866-6814