Colorado State Regulations.

        History of Regulation In 2008, the General Assembly passed Senate Bill 08-153 (SB 153), which required home care agencies to be licensed by the Health Facilities and Emergency Medical Services Division (Division) in the Colorado Department of Public Health and Environment (CDPHE) and charged the Colorado State Board of Health (Board of Health) with adopting rules for the licensing program. The purpose of regulation was to address a growing concern regarding the provision of care by home care agencies, specifically improper patient care and criminal activity.

        Although individuals could be prosecuted for fraud or abuse of patients, privately funded home health agencies could not be removed from the marketplace since they were not regulated, and serious problems were found in home care agencies that were certified as Medicare and Medicaid providers.

        The bill required home care agencies to ensure that their employees were adequately trained and vetted. Senate Bill 153 also required home care placement agencies1 (placement agencies) to register with the Division. It required placement agencies to perform criminal history record checks in order to refer individuals to provide skilled health and personal care services2 in the home, and they were also required to provide a disclosure to consumers concerning the duties and employment status of the individual providing services.

        In 2010, the General Assembly passed Senate Bill 10-194 (SB 194), which placed a moratorium on the licensure requirement for Community Centered Boards (CCBs) and agencies that provide services to persons with developmental disabilities. This moratorium expired in March 2011. Senate Bill 194 also exempted qualified early intervention service providers for children with developmental disabilities. In 2012, the General Assembly passed House Bill 12-1294, which impacted the regulation of all health facilities in Colorado. Specifically, it required the Board of Health to establish different requirements appropriate to the various types of home care agencies, such as those that are substantially funded through Medicare or Medicaid and Providers of All-Inclusive Care for the Elderly.

            a)    Home care placement agencies provide referrals for home care attendants, for a fee, and do not employ or contract with home care attendants.

            b)    Personal care services include, but are not limited to, getting in and out of bed, walking or mobility, bathing, using the toilet, and dressing.

Summary of Current Laws

        Licensing Home care agencies are required to be licensed by the Division in order to provide skilled home health services and personal care services to consumers in their homes.

        The Board of Health housed in CDPHE is charged with adopting rules for licensing home care agencies.

A home care agency is defined as

        Any sole proprietorship, partnership, association, corporation, government or governmental subdivision or agency […], not-for-profit agency, or any other legal or commercial entity that manages and offers, directly or by contract, skilled home health services or personal care services to a home care consumer in the home care consumer’s temporary or permanent home or place of residence. A residential facility that delivers skilled home health or personal care services which the facility is not licensed to provide shall either be licensed as a home care agency or require the skilled home health or personal care services to be delivered by a licensed home care agency.

Skilled home health services are defined as

        Health and medical services furnished to a home care consumer in the home care consumer’s temporary or permanent home or place of residence that include wound care services; use of medical supplies including drugs and biologicals prescribed by a physician; in-home infusion services; nursing services; home health aide or certified nurse aide services that require the supervision of a licensed or certified healthcare professional acting within the scope of his or her license or certificate; occupational therapy; physical therapy; respiratory care services; dietetics and nutrition counseling services; medication administration; medical social services; and speech-language pathology services. “Skilled home health services” does not include the delivery of either durable medical equipment or medical supplies.

Personal care services are defined as

        Assistance with activities of daily living, including but not limited to bathing, dressing, eating, transferring, walking or mobility, toileting, and continence care. It also includes housekeeping, personal laundry, medication reminders, and companionship services furnished to a home care consumer in the home care consumer’s temporary or permanent home or place of residence, and those normal daily routines that the home care consumer could perform for himself or herself were he or she physically capable, which are intended to enable that individual to remain safely and comfortably in the home care consumer’s temporary or permanent home or place of residence.5

1.  § 25-27.5-103(1), C.R.S
2.  § 25-27.5-104(1), C.R.S.
3.  § 25-27.5-102(3) (a), C.R.S.
4.  § 25-27.5-102(7), C.R.S.
5.  § 25-27.5-102(6), C.R.S

        The Colorado State Board of Health (Board of Health) is vested with the authority to adopt rules for home care agencies and placement agencies. The Board of Health sets the minimum standards for the operation of home care agencies. The Division licenses two types of home care agencies:

• Class A agencies provide skilled healthcare services (e.g., medication administration, injections, intravenous therapy, and wound care), personal care services (e.g., getting in and out of bed, walking or mobility, bathing, using the toilet, and dressing), and other services such as homemaker and companion services.
• Class B agencies provide personal care services and other services such as homemaker and companion services. However, they are not licensed to provide skilled healthcare services.

        References: DORA (Department of Regulatory Agencies).

When is Skilled Care required?

        1. General prohibitions:

            a)    Broken skin or inactive skin problems, wound care.

            b)    Use of prescription ointments, stocking, exercise.

            c)    When client is not independent with eating, chewing, swallowing, or at risk of chocking and aspiration.

            d)    Medications, suppositories.

            e)    Catheters, enemas.

            f)     Respiratory care, except to move mask to shave client.

            g)    When client’s condition: Requires reports to nurse. Involves circulatory problems, loss of sensation.

        2. When is personal Care appropriate?

            a)    As a medical condition improves and less assistance is required for functional mobility.

            b)    Companionship needs.

            c)    When client fully trained with adaptive equipment.

            d)    When client fully trained, only needs stand by assist.

            e)    Client does not required skilled transfer.

            f)     Medication reminding, assistance OK when pre-poured /prepared, well labeled and complete instructions re time.

         (Use list 6CCR1011-1 section7, section 8).