Colorado tightens home health billing while approvals are pending

Colorado has told home health agencies they may not bill Acute Home Health as a stopgap while they wait for a Long-Term Home Health approval. The rule took effect October 1, 2026. It is about how agencies bill. It does not change what home health services members can get.

What's changing

The Colorado Department of Health Care Policy and Financing (HCPF) put out Operational Memo OM 26-065 on October 26, 2026. It reminds home health agencies that these are two separate benefits:

• Acute Home Health (AHH): no prior authorization needed.
• Long-Term Home Health (LTHH): prior authorization needed.

While an agency is waiting on an LTHH Prior Authorization Request (PAR), it may not use AHH as a temporary way to get paid. That includes billing under AHH, then reversing those claims and billing again under LTHH once the PAR is approved.

Agencies that keep doing this may be referred to HCPF's Provider Integrity team, have claims taken back, or face other corrective action. The memo tells agencies to raise PAR delays with HCPF through HCPF's set channels.

Who it affects (and who it doesn't)

This affects enrolled home health agencies and how they bill.

It does not change members' eligibility or their covered home health services. The memo notes how important it is that members can get medically necessary home health services.

Key dates

• October 1, 2026: The memo took effect.

What you can do

1. If your family member gets home health care, this memo does not change the services they can receive.
2. If you are waiting on a Long-Term Home Health approval, ask your home health agency or case manager where it stands. The memo tells agencies to raise PAR delays with HCPF.
3. Keep a copy of any notice you get about home health services.

For questions about Acute Home Health policy, email Devinne Parsons at HCPF: devinne.parsons@state.co.us.

For questions about Long-Term Home Health or PARs, email HCPF's Home Health inbox: hcpf_homehealth@state.co.us.