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Colorado MedicaidMedicaid · Prior Auth · Provider Bulletin · CO · Pediatrics, Occupational Therapy, PharmacyHigh impact

Health First Colorado (Colorado's Medicaid Program) News and Updates (B2500526 - 08/2025)

Effective date
Aug 1, 2025
Identified
Jun 20, 2026

Summary

Long-term home health and private duty nursing prior authorization requests require a Skilled Care Acuity Assessment and a Recommendation Letter from the Nurse Assessor, and both must be included with the PAR submission. Wheelchair-mounted robotic arms are not a covered benefit under the Health First Colorado DMEPOS program, effective August 1, 2025. Registered Behavior Technicians must hold an active certification to provide and bill for services, and providers have until August 31, 2025 to come into full compliance.

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What to do

Action · 5 steps
01Already effective August 1, 2025: Before a PAR can be submitted for PDN, LTHH RN or LTHH CNA services, the Home Health Agency or Case Manager must first submit a referral for a Nurse Assessor, and the Skilled Care Acuity Assessment and Recommendation Letter must be included with the PAR submission.
02Already effective July 1, 2025: Providers may supply a breast pump bundle of one manual pump, one single-user electric pump and one set of replacement shields/flanges, billed as HCPCS E0603 with modifier U1 when all three items are provided on the same date of service, and all components of the bundle must be supplied when submitting the claim.
03Already effective August 1, 2025: Wheelchair-mounted robotic arm devices are not a covered benefit under the Health First Colorado DMEPOS program.
04Historical deadline of August 31, 2025 for ABA providers: Verify the active certification status of all RBTs on staff, retain appropriate documentation for audit or program integrity reviews, update staff rosters with Health First Colorado if appropriate, and immediately discontinue billing for services rendered by uncertified individuals after August 31, 2025.
05Check current applicability of these requirements before acting on the dates.

Codes mentioned

E0603

Original notice

Health First Colorado (Colorado's Medicaid Program) News and Updates (B2500526 - 08/2025)
hcpf.colorado.gov · Always check the source before changing claims.
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Related changes

See all Colorado Medicaid changes →
Health First Colorado (Colorado's Medicaid Program) News and Updates (B2200480 - 07/2022)MediumEffective Jun 29, 2022 · Provider BulletinBrowse every Colorado Medicaid change in the policy list

Related policy hubs

Colorado Medicaid policiesCO policy changesPediatricsOccupational TherapyPharmacyCode E0603

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