Colorado’s Medical Services Board gave final adoption Oct. 9, 2026, to a rule that creates group reimbursement rates when one caregiver delivers certain Community First Choice (HCBS-style attendant) or Long-Term Home Health services to two or more members at the same time, according to HCPF’s MSB 26-04-15-A packet.
Group rates are set at 50% of the current individual rates for the same service. Covered CFC services include Personal Care, Homemaker, and Health Maintenance Activities through In-Home Support Services (agency or IHSS). Consumer-Directed Attendant Support Services are carved out of the Homemaker and Personal Care group-rate sections. For LTHH, the group rate applies to Certified Nurse Aide services.
Billing and compliance
Providers must bill the group rate whenever two or more members receive the listed services from the same caregiver in the same “Time Span” and location. Structuring schedules or agency splits to dodge the group rate is prohibited. Failure to bill group rates when criteria are met is improper billing and can trigger overpayment recovery. HCPF says it may monitor claims, EVV visit data and shared addresses.
HCPF will submit a State Plan Amendment in fall 2026 seeking a Jan. 1, 2027, effective date. The statement of basis says members will not see changes to authorized service levels; agencies may need billing and staffing updates. A proposed rule effective date in the packet is listed as Nov. 30, 2026, with SPA timing controlling federal match.
Why this matters for providers and DSPs
For Colorado provider agencies already absorbing a 2% LTSS rate cut and weekly caregiver-hour caps, shared visits in group homes, host homes or multi-client apartments will pay less per member when one direct care worker serves two people in the same span. Billers should map EVV overlaps now, train schedulers on Time Span rules, and document when one-to-one care is clinically required so audits do not treat every shared address as a group-rate case.