Private Duty Nursing and Pediatric Long-Term Home Health Services Pre-Approval Project

The Department of Health Care Policy & Financing identified that letters we sent to Health First Colorado (Colorado’s Medicaid program) members about Private Duty Nursing (PDN) and Pediatric Long-term Home Health (PLTHH) services were missing important, legally-required information. 

We notified members that we would not require prior authorization requests (PARs) for these services while we worked to correct the letters. 

In order to ensure our members and providers have adequate time to review their plans of care and submit new PARs, we have begun notifying providers and members that PARs will once again be required  at some point in the future. When the Department is confident that our process for PAR submission is ready to implement, we will provide advance notice to both providers and members so that there is adequate time to review plans of care.  This will not happen before November 1, 2020.  While the responsibility for PAR submission lies with providers, members will need to cooperate with provider requests for information.

Please use this page to stay current on updates on this project and important resources to ensure a smooth transition.

For Members:
Action Needed: None Currently 
If you currently have private duty nursing services, pediatric long-term home health services, or both, you will receive a letter with more information.

For Providers: 
Action Needed: Providers need to ensure their User Administrator is set up with eQSuites, so they receive timely communication regarding PDN/PLTHH PAR submission in progress when those updates start coming out.
If you currently treat members who receive private duty nursing services, pediatric long-term home health services, or both, you will need to submit an updated plan of care and supporting documentation in the new request. Details on this process can be found here

Trainings:

Frequently Asked Questions