Colorado Class A home care agency license: skilled care, CDPHE rules and Medicare

Class A or Class B: where Colorado draws the skilled line

Colorado has no license called “home health agency.” Instead, C.R.S. 25-27.5 and 6 CCR 1011-1 Chapter 26 create a single Home Care Agency (HCA) license in two classes. A Class A agency provides “any skilled healthcare service” delivered by licensed nurses, certified nurse aides, or licensed therapy and respiratory professionals, and may also provide personal care. A Class B agency provides personal care only and “shall not provide any skilled healthcare service.”⁠¹⁠²

Chapter 26 defines skilled home health services broadly. The list covers wound care; use of prescribed drugs, biologicals and medical supplies; in-home infusion; nursing; certified nurse aide services that need supervision by a licensed or certified professional; occupational, physical and speech therapy; respiratory care; dietetics and nutrition counseling; medication administration; and medical social services. Delivering durable medical equipment or supplies does not count as skilled.⁠² So a company that plans to send out only one RN for medication setups, or a CNA under nurse supervision, still needs Class A.

Some neighbouring situations sort as follows:

• Personal care only. Bathing, dressing, transfers, homemaking, medication reminders and companionship are a Class B license. See the Class B guide.⁠¹
• Medicaid waiver services. An agency providing services regulated by the Department of Health Care Policy and Financing (HCPF) is licensed Class B unless it also provides skilled care or services delivered by a licensed professional. In that case it must be Class A.⁠²
• Upgrading from Class B. A licensed Class B agency that wants to add skilled care files a new initial application and pays the full initial Class A fee. CDPHE does not treat it as an amendment.⁠²
• Residential facilities. A residence that delivers skilled or personal care it is not licensed for must either become a licensed home care agency or use one. It may not provide those services facility-wide under the home care license, and residents must be free to choose another agency.⁠² An assisted living residence is licensed separately; see the Colorado assisted living guide.
• Outside the license entirely. These do not need an HCA license: housekeeping-only organizations, a person working alone with no employees or contractors, HCPF consumer-directed attendant programs, home care placement agencies (which only refer workers for a fee and register separately), licensed dialysis centers doing home dialysis, and certified outpatient rehabilitation agencies.⁠¹

An out-of-state company must keep a physical business office in Colorado that can run day-to-day HCA business.⁠²

The Medicare freeze also closes Colorado Medicaid home health

In Colorado, Medicare and Medicaid home health are linked by rule. Under 10 CCR 2505-10 Section 8.520, Health First Colorado home health services “must be provided by a Medicare and Medicaid-certified Home Health Agency.” The agency must be certified as a Medicare home health provider, enrolled in Colorado Medicaid, insured at the Chapter 26 minimum, and hold a Class A license in good standing.⁠⁸ Section 8.540 sets the same Medicare-plus-Class-A condition for private duty nursing providers.⁠⁸

On May 15, 2026, CMS published a notice imposing a 6-month nationwide moratorium on Medicare enrollment of new home health agencies, effective May 13, 2026. CMS may extend it in 6-month increments. Applications the Medicare contractor received before May 13 are not affected. The notice also covers new HHA branches and practice locations, and it leaves any Medicaid moratorium to each state.⁠⁹ Because Section 8.520 requires Medicare certification first, a new Colorado agency cannot reach Medicaid home health while the federal freeze lasts.⁠⁸⁠⁹

The initial six months end on or about November 13, 2026. The Federal Register notice says CMS decides before that date whether to extend or lift the moratorium, and as of October 12, 2026 no extension or lifting notice had been published. Before you plan around a Medicare start date, ask CDPHE Health Facilities and your Medicare Administrative Contractor whether the freeze is still in force.⁠⁹

The freeze does not stop the state license. You can still get a Class A license and serve private-pay clients, commercial insurance, or Medicaid waiver programs that accept a Class A agency without Medicare certification (covered below).⁠⁹⁠¹¹

CMS delegates Medicare certification surveys in Colorado to CDPHE.⁠¹⁰ CDPHE’s page on initial certification links a 2007 CMS memo (S&C-08-03). It says CMS gives new providers lower survey priority than existing ones and that deemed status through a CMS-approved accrediting organization “is likely to be the fastest route to certification.”⁠¹² That memo predates the moratorium. Accreditation does not get around the moratorium.

Who must run a Class A agency

Chapter 26 Part 6 sets three layers of oversight for skilled agencies.

Governing body. Its members, singly or together, need business and healthcare experience. The body must meet at least once a year and approve the quality management plan every year. It must adopt bylaws or a governing document, set how the administrator’s qualifications are judged, and appoint the administrator in writing. It must also approve an annual operating budget and, where applicable, a capital expenditure plan.⁠²

Administrator. The administrator must:

• be at least 21;
• be a licensed physician, registered nurse or other licensed healthcare professional, or have education and experience in health service administration;
• have at least two years of healthcare or health service administration experience, including one year supervising in home care or a closely related health program.⁠²

The administrator, or a designee, must be available whenever staff are providing services. At minimum that means any 8-hour period between 7 a.m. and 7 p.m., Monday through Friday. A qualified alternate must be named in writing.⁠²

A first-time administrator or alternate needs 8 clock hours of training in the first month: a home care overview, the licensing standards, and state and local law. They need 24 hours in total within 12 months of taking the role. Hours completed in the 12 months before designation count toward the extra 16. After that, the requirement is 12 hours of continuing education every year. If an agency or contractor produces the training itself, CDPHE must approve it or a national organization must recognize it.⁠²

Nursing or healthcare supervisor. Skilled nursing must be supervised by a physician or an RN with at least two years of nursing experience, one of them in home care or a closely related service. Therapy and other services need a supervisor with comparable experience in that field. The supervisor or a similarly qualified alternate must be available at all times during operating hours. A registered nurse or other appropriate health professional must also be reachable after hours, and the agency needs a written on-call policy.⁠²

Insurance, service counties and the office

Three Class A requirements shape the application before anything is filed:

• Liability coverage. At application and renewal, you must show liability insurance, or a surety bond in its place, of at least $500,000 per occurrence and $3,000,000 aggregate. Class B needs only $100,000 / $300,000.⁠² On the certificate of insurance, CDPHE’s Health Facilities and Emergency Medical Services Division at 4300 Cherry Creek Drive South, Denver, must be the certificate holder. The certificate must also list the agency’s physical address and show coverage for the license period. CDPHE accepts a future effective date, but not “TBD.”⁠⁶⁠⁷
• Contiguous counties. You give CDPHE a list of the contiguous counties you plan to serve. You must show you can staff, supervise and deliver care throughout that area. Chapter 26 sets no limit on how many agencies may serve an area.⁠²
• A real office. The initial survey takes place at the physical address on the application, so any lease must be in effect by the survey. If the office is in a rented home or apartment and the lease prohibits running a business, you need written approval from the landlord.⁠⁶⁠⁷ Unlike assisted living, home care agencies are exempt from fire-code (Life Safety Code) and FGI plan review.⁠⁶

Branch offices must offer the same services as the parent, under the same governing body and management, close enough for daily shared supervision. A health professional qualified to oversee the branch’s care must be available during all operating hours.⁠²⁠⁷ Workstations are drop-in spaces for direct care staff only. They may not hold client records, take referrals, do marketing or serve the public.⁠⁷

What goes in the COHFI application

Applications go through COHFI, CDPHE’s online licensing portal. CDPHE’s Home Care Agency checklist, updated July 23, 2026, lists what every initial applicant attaches:⁠⁷

1. Application and fee

   The application must be complete and signed. CDPHE does not process it until the non-refundable fee arrives.

2. Secretary of State registration

   The business entity must be registered with the Colorado Secretary of State, and the name must match the application exactly. If you operate under a different name, including the entity name without “LLC” or “Inc,” you must register that trade name under the entity.

3. Ownership documents

   Articles plus a signed operating agreement, bylaws or partnership agreement, depending on entity type.

4. Certificate of liability insurance

   It must meet the Class A amounts and certificate-holder rules described above.

5. HCA zoning form

   Your local zoning authority must sign it.

6. HCA Form 1

   This form starts the fingerprint background check. The administrator and every owner with 50% or more direct ownership sign it. CDPHE says not to get fingerprinted until it sends instructions, or you may have to repeat the check.

7. Ownership organizational chart

   It must show legal names and percentages for all direct and indirect owners of 5% or more. A staff chart does not satisfy this.

Depending on your situation, you may also need a lease, a management agreement, and separate branch or workstation applications with their fees.⁠⁷ Rule 4.2(D) requires each owner and each manager or administrator to submit fingerprints to the Colorado Bureau of Investigation for a state and national check, at their own cost. CDPHE will not issue a license if an owner has a felony or misdemeanor conviction that could pose a risk to clients. No provisional license is possible until the background check is complete.⁠²

From letter of intent to the zero-deficiency survey

CDPHE’s guidance sets out seven steps for every license type:⁠⁶

1. Letter of intent

   Submit the online letter of intent (LOI). CDPHE replies with COHFI access and names your COHFI account manager.

2. Application and fees

   Submit at least 90 calendar days before your planned start date.⁠³ CDPHE says this is a filing deadline, not a processing estimate.

3. Application and document review

   A licensing technician checks the application against your documents. You must answer any written notice of a defect within 14 calendar days. An application left incomplete for 12 months with no response from you may be closed as abandoned.⁠³⁠⁶

4. Fitness review

   CDPHE reviews your fitness to run the agency under Chapter 2 Part 2.7. Changing the application after this review triggers another one.⁠⁶

5. Final document review

   Outstanding executed documents are collected.

6. Initial survey

   A surveyor schedules a visit, typically on site. Have ready: proof of the administrator’s qualifications and training, background checks in personnel files, all required policies and procedures, the medical malpractice loss reporting information under C.R.S. 13-64-303, and your quality management plan.⁠⁶

7. License issued

   CDPHE issues the license after a survey with zero deficiencies. It is posted in COHFI as a PDF and must be displayed conspicuously at the licensed address.⁠⁶

CDPHE says initial applications typically take 3 to 12 months. It also says home care agencies “are currently taking additional time due to the number of applications coming in.”⁠⁶ If you are making a good-faith effort but are not fully compliant, CDPHE may issue a 90-day provisional license instead, and may issue a second one.⁠³ It may also issue a 90-day provisional license at HCPF’s request to an agency applying for certification.⁠²

Fees on the 2026/2027 schedule

These fees apply to initial applications submitted on or after July 1, 2026.⁠⁵

Two discounts apply only to the base renewal fee. Agencies certified for Medicare or Medicaid deduct $100. Agencies with full accreditation from a CMS-recognized deeming organization get 10% off, if they submit the latest survey and accreditation letter.⁠²⁠⁴ File renewals 60 days before expiration. Late fees are 10% from day 6 after expiration, 50% from day 30 and 75% from day 60. At day 90 the license is invalid and you must stop operating and reapply as a new agency.⁠⁴

Your own background checks, fingerprinting and insurance cost extra and are not on CDPHE’s schedule.⁠⁴⁠⁷

Clinical rules the surveyor will check

Chapter 26 Part 6 is detailed, and the initial survey checks your written policies against it. These rules are specific to skilled care:⁠²

• Assessments. An RN makes the initial assessment visit within 48 hours of referral, within 48 hours of the client’s return home, or on the ordered start-of-care date. If another professional service is the only one ordered, that professional may do it. The comprehensive assessment must be done within 5 calendar days of the start of care and updated at least every 60 days. It must also be updated within 48 hours after a hospital stay of 24 hours or more.
• Plan of care. A physician or licensed independent practitioner establishes it and reviews it at least every 60 days. For clients whose status changed, a summary report goes to the primary care provider every 60 days.
• Nurse delegation and medications. You need a written delegation policy, a medication administration record for clients who receive medications, and a policy on administering and monitoring controlled drugs if the agency administers them, and a written policy on monitoring them if staff transport them from the pharmacy to the client.
• Nurse aides. Aides must be certified by the Department of Regulatory Agencies (DORA) within 4 months of hire. Until then, a supervisor directly observes them weekly for the first month and every two weeks after that. Aides of clients who also receive skilled care get a supervisory visit at least every two weeks, by telehealth if you choose, with an in-person visit at least every 60 days.
• Extended care. Six or more hours of skilled services in 24 hours requires a contingency plan and a communication record kept in the home. Before withdrawing skilled nursing or nurse aide services from an extended-care client, you must give 15 business days’ notice of discharge, unless someone’s safety is at immediate risk.
• Equipment and lab tests. Infusion pumps get an accuracy test between clients, equipment policies must include a back-up system, with emergency services 24 hours a day where a malfunction may threaten the client’s life, and any waived lab test done in the home requires a CLIA certificate of waiver.

The general rules in Part 5 apply too:⁠²

• Within one business day of the start of services, the client gets a signed disclosure notice, a rights notice, advance directive information, and payment information.
• Hiring requires a Colorado criminal history check run no more than 90 days before employment, a check of the Colorado Adult Protective Services database (CAPS), and verification of the employee’s DORA license.
• Direct care staff complete at least 12 training topics a year, including abuse prevention, behavior management, disaster procedures and infection control.
• Records are kept for 5 years after discharge, and the complaint log for 2 years.

If a Class A agency also provides personal care, it must meet the Part 7 personal-care rules as well. Those are covered in the Class B guide.

Adding Medicaid waiver services to the license

Some HCPF waiver services accept either class of license. For Personal Care/Homemaker (specialty 666), In-Home Support Services (656) and Independent Living Skills Training (654), CDPHE states that “either a non-medical class B or a medical class A Home Care Agency license is acceptable.”⁠¹¹ If you submit the waiver application together with your initial license application, CDPHE can do one combined survey. If you add waiver services later, a second initial survey is required.⁠⁷

After a survey with zero deficiencies, CDPHE sends a Certification and Transmittal (C&T). You attach it to a separate Health First Colorado provider enrollment application with HCPF, filed for each physical location. CDPHE certification by itself is not approval to bill.⁠⁷⁠¹¹ Each physical site that provides waiver services must be separately licensed, not run as a branch.⁠⁷

Renewal, inspections and sanctions

Licenses expire one year after issue. Every renewal reports the previous year’s admissions, which sets the volume fee.⁠²⁠³

CDPHE can inspect at any time. Surveyors can ask for administrative records and client files, which you must start producing within 30 minutes. Client documents kept in the home must be produced within 2 hours if the last visit was 14 or more days earlier. Surveyors need the client’s consent to inspect inside the home.⁠² If an agency has been licensed at least three years with no enforcement action or pattern of deficiencies, CDPHE may stretch the survey cycle to up to three years or use a shorter tiered inspection.⁠³

Sanctions short of revocation include a required consultant, monitoring, extra training, a directed plan of correction, and civil fines of up to $10,000 per calendar year.⁠² You must notify CDPHE 30 days before moving. You keep the license only if the new address is in the same service area with the same governing body and administrator; otherwise you apply for a new license.⁠²

Rule dates to watch

• Chapter 26 was last fully rewritten effective February 14, 2022. Its license and fee provisions (Parts 4.4 to 4.10) were amended effective July 1, 2025.⁠²
• Chapter 2 is in effect in its September 14, 2025 version.⁠³
• CDPHE posts the next fee schedule by March 1, 2027, to take effect July 1, 2027.⁠¹
• The federal Medicare moratorium’s first six-month period runs to about November 13, 2026.⁠⁹

Sources

1. 1
   Colorado Department of Public Health and Environment, Home Care Agencies Checked 12 Oct 2026 · Back to text ↑
2. 2
   Colorado Secretary of State, Code of Colorado Regulations, 6 CCR 1011-1, Chapter 26: Home Care Agencies (version effective July 1, 2025) Checked 12 Oct 2026 · Back to text ↑
3. 3
   Colorado Secretary of State, Code of Colorado Regulations, 6 CCR 1011-1, Chapter 2: General Licensure Standards (effective September 14, 2025) Checked 12 Oct 2026 · Back to text ↑
4. 4
   Colorado Department of Public Health and Environment, Home Care Agencies (HCA/HHA) Fee Schedule, 7/1/2026 to 6/30/2027 Checked 12 Oct 2026 · Back to text ↑
5. 5
   Colorado Department of Public Health and Environment, Facility Fees Checked 12 Oct 2026 · Back to text ↑
6. 6
   Colorado Department of Public Health and Environment, Initial Health Facility/Agency Licensing: Guidance and Instructions (All License Types) Checked 12 Oct 2026 · Back to text ↑
7. 7
   Colorado Department of Public Health and Environment, Home Care Agencies (HCA/HHA): Initial Application Checklist (updated July 23, 2026) Checked 12 Oct 2026 · Back to text ↑
8. 8
   Colorado Department of Health Care Policy and Financing, Medical Services Board, 10 CCR 2505-10, Section 8.500: Home Health Services, Hospice, Oxygen, DME Checked 12 Oct 2026 · Back to text ↑
9. 9
   Centers for Medicare & Medicaid Services, Federal Register, Announcement of Nationwide Temporary Moratoria on Enrollment of Home Health Agencies (HHAs), 2026-09717 Checked 12 Oct 2026 · Back to text ↑
10. 10
    Colorado Department of Public Health and Environment, Medicare and Medicaid Certification Checked 12 Oct 2026 · Back to text ↑
11. 11
    Colorado Department of Public Health and Environment, Home and Community Based (HCBS) Waiver Services - Medicaid Certification Guidance Checked 12 Oct 2026 · Back to text ↑
12. 12
    Colorado Department of Public Health and Environment, Guidance Regarding Initial Certification Surveys (CDPHE letter enclosing CMS S&C-08-03) Checked 12 Oct 2026 · Back to text ↑

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