Medicaid Nursing Home Rates by State

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Colorado

Medicaid nursing facility payment · Cost-based · researched October 2026

Colorado’s Medicaid agency and its state plan are the official source for these rules. This page summarizes them as researched in October 2026; check the state’s own documents, listed under Sources, before relying on them.

At a glance

Rate method

Cost-based

Case-mix level

Facility average

Classification

PDPM

Rate updates

Once a year

Managed care (LTC)

No

Quality program

Pay-for-Performance (P4P)

Paid outside the rate

Moderate

Bed hold

Leave only

Published rates

Rates only

Assisted living

Covered

Personal needs allowance

$110.36 / month

Overview

• Colorado (Health First Colorado, run by HCPF) builds a cost-based 'Core Component' rate for each Class I nursing home from its own audited MED-13 cost report.
• The rate has three parts: (1) health care (direct nursing + indirect care + raw food), paid at actual cost up to 125% of the statewide median (130% for state veterans homes), with direct nursing adjusted for the home's Medicaid case mix;
• (2) administrative and general (A&G), paid at a price of 105% of the median (110% for homes with 60 or fewer beds; 120% for all-private-room homes);
• (3) fair rental allowance for capital.
• Claims are NOT paid at that cost-based rate.
• They are paid at an 'MMIS rate' = Core Component x a statewide percent factor, set so that the statewide average posted rate grows only by the amount the legislature allows (the 'growth cap').
• Most of the gap between cost and the capped rate comes back later as a provider-fee-funded supplemental payment.
• The FY2026-27 posted file (7/1/2026) lists 189 homes: statewide average $283.00/day (down 2.0% from $288.78 after the 7/1/2026 2% across-the-board cut), median about $282.40, range $205.03-$355.99.

What matters in Colorado

• Roughly 15-20% of base is paid outside the posted rate, mostly provider-fee-funded supplemental payments; about 10% net of the fee.
• Claims pay a capped rate; about $70M of the gap to cost-based rates returns later as a supplemental payment.
• $283.00 statewide average rate for FY2026-27, down 2.0% after the 7/1/2026 across-the-board cut.
• Case mix is per home: direct nursing cost scales with the home's average Medicaid acuity, using PDPM nursing since 7/1/2023.
• $10 per Medicaid day extra for homes at least 85% Medicaid; $5 for 75-84.99% or a county's only Medicaid home.
• Medicare coinsurance on days 21-100 usually yields $0, since Medicaid pays only its rate minus Medicare's payment.

Frequently asked

What explains the gap between a Colorado home's posted and cost-based Medicaid rates?

Claims are paid at the cost-based rate multiplied by a statewide percent factor that holds average growth to the legislature's cap. About $70M of the gap returns later as a supplemental payment.

How does Colorado pay for ventilator and bariatric residents?

Residents in the 6 approved Hospital Back Up facilities are paid the federal Medicare PDPM case-mix-adjusted rate for their class, before the wage index, with no link to the home's cost-based rate.

What does Colorado's nursing home pay-for-performance payment reward?

It pays $0 to $7.28 per Medicaid day by points tier, funded by at least 15% of provider-fee supplementals. Measures include resident-directed care practices scored from applications and documentation.

How much is paid outside the posted rate in Colorado?

Moderate: roughly 15-20% of base, or about 10% net of the provider fee homes pay in.

What does Colorado Medicaid pay on Medicare coinsurance days?

Medicaid pays only its rate minus Medicare's payment, so homes usually receive $0 of day 21-100 coinsurance.

Does Colorado require a minimum share of spending on care?

No; because health care is paid at cost up to a limit, homes that spend less simply get a lower rate.

How is the Colorado nursing home provider tax charged?

$18.81 per non-Medicare day in SFY2026-27; small, CCRC, public and hospital-based homes are exempt; returned through supplemental payments.

How the rate is set

How the method got here

Verified October 11, 2026

Cost basis

Uses cost reports

Yes

Cost report

Colorado MED-13 (state-specific Financial and Statistical Report for nursing facilities), filed annually and audited by HCPF's contractor Myers and Stauffer. Since 7/1/2024, Medicare and other third-party (non-Medicaid) ancillary costs are excluded from allowable Medicaid costs (10 CCR 2505-10 8.441.5.L; SPA TN 24-0006). Since the SFY2024-25 filings, audited consolidated financial statements for the facility, its management company and related parties are also required (HB 23-1228; 8.450).

Base year and rebasing

Health care: re-based every year from the most recent MED-13 filed by December 31 of the prior year, with the median and limit reset each July 1. A&G: the median is re-set every fourth year and inflated by the SNF market basket in the three years between. FRV: facilities are re-appraised every 4 years. The latest appraisals (National Valuation Consultants) were done Jul-Oct 2025 and set FRV for the next 4 years. A facility's Core Component rate is set on July 1 and re-set again at 23 months and 6 months after its cost-report year end (8.443.13), but mid-year changes are settled through a supplemental payment, not the claim rate.

Components

Component	Method	Notes
health care (direct nursing + indirect care + raw food)	Cost-based, up to a ceiling. Each home is paid its allowable cost, up to a facility-specific limit derived from 125% of the statewide median (130% for state veterans homes). Direct nursing cost is case-mix neutralized for the median, and the home's share is then re-scaled by its Medicaid case-mix ratio. Indirect care is paid at the lesser of cost or its share of the limit. Each facility's growth in health care cost is also capped at 8% per year (indexed from 7/1/2009 audited costs).	C.R.S. 25.5-6-202(1)-(2); 10 CCR 2505-10 8.443.7.B-D. 8.443.7.D.2 still says 'resource utilization groups... nursing weights'. The state plan (TN 23-0015) replaced this with PDPM nursing from 7/1/2023 (see case_mix).
administrative and general (A&G)	Price, not each home's own cost: 105% of the statewide median A&G per diem for homes with 61+ licensed beds, 110% for 60 or fewer beds, and 120% for homes offering private rooms to all residents. The median is re-based every 4th year and inflated by the SNF market basket in between. Uses actual days, not occupancy-imputed days.	8.443.8.E. The HB 23-1228 rule revision (MSB May 2026) moved some staff (nursing scheduler, admissions/transitions) from A&G to health care, and added the private-room A&G and FRV provisions, effective for cost reports setting July 1, 2028 rates.
fair rental allowance (capital)	Fair rental value; see capital field.	8.443.9.B
percent factor (growth cap)	The MMIS per diem paid on claims = the July 1 Core Component rate x one statewide percent factor. The factor is set so the statewide average MMIS rate, net of patient payment, equals last year's average plus the allowed growth. Allowed growth: 3% (statute through FY2022-23, cap on the General Fund share), 2% in FY2020-21 and FY2021-22, 10% in FY2023-24, 3% in FY2024-25, 1.5% in FY2025-26 (HB 23-1228). From FY2026-27, HCPF sets the average itself; it was cut 2% for FY2026-27. A further 1.5% reduction to each home's calculated MMIS rate has applied every year since FY2013-14.	8.443.1.B; state plan 4.19-D p.15 and p.39c; C.R.S. 25.5-6-202(9)(b). The amount by which Core Component rates exceed the MMIS rates is paid back as the 'Core Component supplemental payment', last in the provider-fee priority order (about $70M in SFY2026-27).

Inflation

Skilled Nursing Facility Market Basket without capital (IHS Global Insight / S&P), applied from the midpoint of each cost-report period to the midpoint of the rate year for health care and A&G. The latest publication before July 1 is used. Under the growth cap, inflation raises the Core Component but not necessarily the paid MMIS rate.

Verified October 11, 2026

Case mix

System

PDPM

Applied at

Facility average

How it works

Each home's direct nursing cost (and its share of the health care limit) is scaled by the home's average Medicaid case-mix index, so every Medicaid resident in a home is billed at the same posted per diem regardless of their own acuity (8.443.6, 8.443.7.D; state plan 4.19-D p.34).

Classification

PDPM nursing component classification and CMS weights, effective 7/1/2023 (state plan 4.19-D p.34, TN 23-0015, approved 10/30/2023). For SFY2023-24 only, homes made worse off by the change could keep RUG-III 34-group (v5.20) indexes. Before that: RUG-III 34-group index maximizer v5.12b, with Colorado-specific nursing weights (time studies x Colorado nursing salary ratios).

Applies to

Direct health care (nursing) cost and the direct-care share of the health care limit only. Indirect care, raw food, A&G and FRV are not case-mix adjusted. The separate CPS supplemental uses the MDS Cognitive Performance Scale.

Acuity measured from

Picture dates are the 1st day of each quarter: each resident's most recent non-delinquent MDS assessment. Facilities review rosters and can correct them until the last day of the quarter's 2nd month. Two averages are computed. (1) Facility-wide CMI, a simple average of all residents, averaged over the quarters matching the cost-report period and used to normalize costs. (2) Medicaid CMI, a simple average of residents with Medicaid as payer in the 30 days before their assessment, taken as a two-quarter average. The rate uses the Medicaid acuity ratio (Medicaid CMI / facility cost-report CMI). Assessments older than 122 days or incomplete are counted at the 'case mix index established in these rules' (value not found).

Updated

CMI is computed quarterly. The claim rate changes only on July 1. Acuity changes during the year re-set the Core Component at the 23-month and 6-month dates, and are paid the following year as the 'Acuity Adjusted Core Component' supplemental payment (8.443.11.B).

Move to PDPM

Moved from RUG-III 34 to the PDPM nursing component on 7/1/2023 (TN 23-0015), before CMS ended RUG support. SFY2023-24 had a hold-harmless option to keep RUG-III indexes. HCPF says the change is cost neutral because of the cost-based UPL and the cap on statewide average rate growth. Note: the regulation text (8.443.7.D.2) has not been updated and still refers to RUG nursing weights.

Verified October 11, 2026

Low-acuity residents

None. Colorado pays one posted per diem per home to every Medicaid resident. There is no reduced or flat rate for low case-mix groups. Low-acuity residents only lower the home's average Medicaid CMI and so its direct nursing component at the next rate setting. People who don't meet nursing facility level of care (ULTC 100.2 / LOC screen) are not covered at all. Checked: 10 CCR 2505-10 8.443 (rule eff. 8/14/2026), state plan 4.19-D (compiled 9/15/2026), NF billing manual.

Verified October 11, 2026

Capital

Fair rental allowance (8.443.9; C.R.S. 25.5-6-202(4)). Base value = depreciated replacement cost appraisal, re-done every 4 years (last round Jul-Oct 2025, by NVC), plus improvements, indexed between appraisals by 50% of the change in the RSMeans nursing home construction index. Capped at a per-bed limit: $25,000 in 1985, indexed by RSMeans. For cost reports setting July 1, 2028 rates, the cap doubles for homes offering private rooms to all residents. Rental rate = average 10+ year Treasury bond rate + 2%, with an 8.25% floor and 10.75% ceiling. The annual fair rental payment is divided by the greater of audited patient days or 90% of licensed bed capacity.

Verified October 11, 2026

Budget adjustment factor

(1) Statewide percent factor (growth cap): every home's Core Component is scaled by one factor so the statewide average posted rate grows only by the allowed amount: 3%/yr standard through FY2022-23 (2% in FY2020-21 and FY2021-22), then +10% FY2023-24, +3% FY2024-25, +1.5% FY2025-26 (HB 23-1228). Posted statewide averages: $251.07 (FY23) -> $276.16 (FY24) -> $284.42 (FY25) -> $288.78 (FY26) -> $283.00 (FY27). (2) An additional 1.5% reduction to each home's calculated MMIS rate has applied every year since FY2013-14 (state plan 4.19-D p.39c; C.R.S. 25.5-6-202(9)(b)(VI)). (3) 7/1/2026: a 2% across-the-board Medicaid provider rate cut applied to NFs ($288.78 x 0.98 = $283.00). NFs had been exempted from the 10/1/2025 repeal of the 1.6% ATB increase. (4) General Fund share is computed at a 50% federal match even when FMAP is higher (C.R.S. 25.5-6-202(9)(b.5)).

Verified October 11, 2026

Add-ons and money outside the rate

Paid outside the posted rate

Level

moderate

Estimate

Roughly 15-20% of base. Derived: provider-fee-funded supplementals about $130M (SFY2026-27, $65M fee + $65M federal match; about $70M of this is the Core Component true-up of rates above the cap) + High Medicaid Utilization about $23.5M + Denver complex-patient pool $1.4M, about $155M. The base is assumed at about $0.85-0.95B (an assumed 3.0-3.3M Medicaid days x $283; Medicaid days not directly sourced). Net of the roughly $65M fee homes pay in, the gain is about $90M, about 10%. Public-NF CPE payments (size not found) come on top for government-owned homes.

Components

Medicaid Utilization (fee return), Acuity Adjusted Core Component, P4P (at least 15%, about $19-20M), CPS, PASRR II resident and facility: about $60M combined. Core Component supplemental: about $70M. High Medicaid Utilization (GF): about $23.5M. Public NF CPE/UPL: unknown. Denver complex patients: $1.4M. DOC parolee add-on: small (about 10 beds). Wage enhancement: ended 2025.

Source

https://hcpf.colorado.gov/sites/hcpf/files/Facility%20Provide…

Verified October 11, 2026

Payments by owner type

Applies

yes

Detail

(1) Public NF supplemental (CPE): state-owned and non-state government-owned homes (county, special-district hospital LTC units, state veterans homes) can certify uncompensated Medicaid cost and draw federal match up to the UPL for their class (4.19-D p.50-58). Private homes cannot. Size and number of homes not found. (2) State-owned homes (e.g. Colorado State Veterans Homes at Rifle, Florence, Fitzsimons) are exempt from the provider fee yet receive the fee-funded supplementals, and get a 130% (vs 125%) health care limit for state veterans homes. (3) The opposite direction: the $1.4M Denver complex-patient pool is limited to privately owned Denver homes with >= 90% Medicaid.

Funding

CPE: the government owner certifies its own uncompensated cost as the non-federal share; no IGT from a sponsoring hospital and no private-operator lease arrangement found.

Source

https://hcpf.colorado.gov/sites/hcpf/files/Colorado%20Medicai…

Verified October 11, 2026

Quality program

Program

Nursing Facility Pay-for-Performance Supplemental Payment (10 CCR 2505-10 8.443.12; C.R.S. 25.5-6-202(5); state plan 4.19-D p.38). Running since 7/1/2009; scored by Myers and Stauffer.

Funding

Provider fee plus federal match. It is third in the provider-fee payment hierarchy and no General Fund is used. Under HB 23-1228, P4P must be at least 12% of all provider-fee supplemental payments in SFY2024-25 and 2025-26, and at least 15% from SFY2026-27.

Size

Not published as a dollar figure. Derived: at least 15% of provider-fee supplementals, which total about $130M in SFY2026-27 (about $65M fee + $65M federal match, Sept 2026 board slides), gives roughly $19-20M. Per diems for SFY2026-27 (PY2026): $0 / $1.82 / $3.64 / $5.46 / $7.28 per Medicaid day, up from $0 / $1.48 / $2.96 / $4.44 / $5.92 in SFY2025-26. From 2009 to 2023 the per diems were $0-$4.00.

Paid as

Per Medicaid day add-on computed annually (prior calendar year Medicaid days x tier per diem), paid as a supplemental payment in 12 monthly installments (quarterly for state-run homes). It is not in the claim rate.

Measures

Measure	Source	Weight	How points are earned
Quality of Life domain: resident-directed care (enhanced dining 3, enhanced personal care 3, end-of-life program 2, connection and meaning 5, person-directed care training 4, trauma-informed care 5, daily schedules/care planning 3)	state (application + documentation, verified by Myers and Stauffer)	25 points	Meet all minimum criteria for the measure; no partial points
Quality of Life domain: environment, relationships and staff empowerment (appearance 2, noise 3, consistent assignments 4, volunteer program 3, staff engagement 3, transitions of care/discharge rights 4, equity initiatives 4, accessibility 2, isolation protocols 2)	state (application)	27 points	Meet measure criteria
Nationally reported MDS quality measures (17.2-17.9, e.g. weight loss, falls with major injury) + narrative on the 3 lowest QMs (17.1)	MDS QM (CASPER reports)	20 points + 1	Up to 4 points per QM based on the home's score; thresholds are in the application (not captured)
Vaccine education 2, reducing avoidable hospitalizations 3, best practices 5, antibiotic stewardship/infection control 5	state (application)	15 points	Meet measure criteria
Staff retention rate (excl. NHA/DON)	facility payroll (calculator + roster)	3 points	>= 60% retention or improvement vs prior year
DON or NHA retention	facility records	2 points	>= 3 years in position
Nursing staff turnover	facility (HCPF turnover tool)	3 points	< 60% turnover or improvement vs prior year
Behavioral health care training	state (COE-NF training completion)	about 4 points (remainder to 100)	Complete Mental Health 101 + 2 of 3 foundational trainings

Scoring period

The application covers the prior calendar year (PY2026 = CY2025 performance), is due Feb 28 (portal opens Jan 1), and results are released May 1 with appeals by May 15. Payment runs over the next SFY (PY2026 pays SFY2026-27, Jul 2026-Jun 2027), so the lag is about 6-18 months after the performance year.

Payment formula

Five tiers by points: 0-20 = 0x, 21-45 = 1x, 46-60 = 2x, 61-79 = 3x, 80-100 = 4x. The base multiplier x is set so total P4P equals at least 15% (SFY2026-27+) of provider-fee supplemental payments. Payment = tier per diem x Medicaid days. Homes with a substandard quality of care deficiency (42 CFR 483.12/.24/.25 at IJ, pattern/widespread harm, or widespread potential harm) get half (21 homes for PY2026).

Eligibility

Class I NFs that apply and conduct an externally standardized resident/family satisfaction survey during the year. Participation is voluntary: in PY2026, 175 of 182 homes applied (96.2%). Applications with recycled prior-year documentation scored zero (4 homes).

Cadence

Scored annually; paid monthly over the state fiscal year.

Scores published

Yes. Myers and Stauffer's annual 'Pay-for-Performance Application Review' (Data Report) lists every home's self-score and final score, plus measure-level results. Posted on https://hcpf.colorado.gov/nursing-facilities-topics#P4P (2026 report: https://drive.google.com/file/d/1eLhWYGpjbqr7J9aZJ-SGgHgSDYmM…).

Notes

This is mostly a process/attestation program (documentation-based), not a pure outcomes program. MDS QMs are only about 21 of 100 points. Average reviewer score was 69 in PY2026, against 85 self-scored. Payment tier distribution in PY2026: 4x 66 homes, 3x 61, 2x 29, 1x 13, 0x 6. Because the pool is a fixed share of the fee, more applicants dilute the per diem (SFY2025-26 per diems fell from 2024).

Verified October 11, 2026

Provider tax

Charged

per non-Medicare day

Standard amount

$18.81 per non-Medicare resident day, SFY2026-27 (from $18.21 in SFY2025-26; 3.29% SNF market basket inflation). Assessed on prior calendar-year non-Medicare days (total minus Medicare-paid days, including Medicare Advantage days), billed monthly. Statutory cap: $12.00 + SNF market basket inflation since FY2011-12.

Tiers

Who	Test	Amount
Homes with >= 55,000 total resident days	volume	Reduced fee. HCPF's page says these homes pay 18.71% of the standard fee (year not stated; likely SFY2024-25 or 2025-26)
Homes with <= 45 licensed beds	size	exempt
Continuing care retirement communities (IL + AL + SNF on one campus, one operator)	ccrc	exempt
State-owned and operated NFs (e.g. state veterans homes)	public	exempt
Distinct-part NFs of a licensed general acute hospital	hospital_based	exempt

Lower for high-Medicaid homes

no

Returned in the rate

Not in the claim rate. It comes back as the Medicaid Utilization supplemental payment (home's Medicaid days / total days x the fee it paid), first in the provider-fee hierarchy, plus the other fee-funded supplementals (acuity, P4P, CPS, PASRR II, Core Component). Paid monthly, due no more than 15 days after the fee payment.

Source

https://hcpf.colorado.gov/nursing-facilities-topics#Provider ; https://drive.google.com/file/d/1QlxD3f_Uvxl2h53-T7M_o5EiPJGe… ; https://www.sos.state.co.us/CCR/GenerateRulePdf.do?ruleVersio…

Verified October 11, 2026

Provider tax notes

Nursing Facility Provider Fee (C.R.S. 25.5-6-203; 8.443.17): $18.81 per non-Medicare resident day for SFY2026-27 (up 3.29% from $18.21), on 4,836,863 non-Medicare days. Exempt: CCRCs, state-owned, hospital-based distinct parts, and homes with <= 45 beds. Homes with >= 55,000 total days pay a reduced fee. About $65M is collected and fully recycled with federal match into the supplemental payments listed above. Since SB 25-270 the fee is set within the CHASE enterprise (outside the TABOR cap), with a new Facility Provider Fee Enterprise Support Board (first met 7/21/2026). H.R. 1 freezes the fee-to-net-patient-revenue ratio at the SFY2025-26 baseline.

Verified October 11, 2026

Supplemental payments

Provider-fee-funded (Class I), paid in this priority order, reduced from the bottom if the fee falls short: (1) Medicaid Utilization (home's Medicaid share of days x the provider fee it paid; returns the Medicaid share of the tax); (2) Acuity Adjusted Core Component (prior-year mid-year rate changes for acuity/cost); (3) P4P; (4) Cognitive Performance Scale (homes 1+ SD above the statewide share of Medicaid residents with CPS 4-6; pool = 2% of the statewide average Core Component per CPS day); (5) PASRR Level II resident (4% of the statewide July 1 Core Component per Level II resident day); (6) PASRR II facility (duplicate add-on for approved Supplemental Behavioral Services programs; 84 applications in 2026); (7) Core Component supplemental (gap between the Core Component and the capped MMIS rate; first to be cut). SFY2026-27 totals (Sept 2026 board slides): fee about $65M; about $60M to items 1-6 and $70M to item 7, half fee and half federal. Outside the fee: High Medicaid Utilization ('Essential Access', General Fund + federal under UPL): $10/Medicaid day for >= 85% Medicaid, $5 for 75-84.99% or the sole Medicaid NF in a county. SFY2026-27 about $23.5M (66 Tier 1, 37 Tier 2, 18 sole-provider homes), up from $20.8M. Public NF CPE/UPL payments: government-owned homes (state and non-state) certify uncompensated Medicaid cost and receive federal match up to the UPL by class (4.19-D p.50-58; size not found). Denver complex-patient pool: $1.4M/yr for privately owned Denver homes with >= 90% Medicaid that take Denver Health complex/uninsured discharges (4.19-D p.65-66). DOC parolee add-on (Tier I/II, at most 50% of the statewide average rate, about 10 beds, quarterly). Wage Enhancement ($15 minimum wage) payment: $8.7M pool, ended after SFY2024-25 (eliminated 8/28/2025, -$4.4M GF).

Verified October 11, 2026

Other add-ons

All are paid as separate supplemental payments, not in the posted rate. (1) Cognitive Performance Scale (CPS) payment for high-dementia/brain-injury homes. (2) PASRR Level II resident payment (4% of the statewide Core Component) and Supplemental Behavioral Services facility payment. (3) High Medicaid Utilization $5/$10 per Medicaid day. (4) DOC compassionate-release parolee add-on, Tier I/II (at most 50% of the statewide average MMIS rate). (5) SB 26-149 (2026): about +$275/day add-on for up to 10 NF placements of people under civil commitment/protective placement with extraordinary needs; RFP by CDHS, state plan submission underway, payment frequency (quarterly?) under discussion in Aug 2026. (6) Hospice room and board in a NF = 95% of the facility's NF rate (paid via hospice). There is no Alzheimer's-unit, ventilator or bariatric add-on on the regular rate; those needs go to the Hospital Back Up program.

Verified October 11, 2026

Units paid separately

(1) Hospital Back Up (HBU) level of care (8.470): ventilator-dependent, complex wound, medically complex, and (2025 expansion) bariatric, disorders of consciousness and severe neurological residents in 6 approved SNFs. Paid per resident at the federal Medicare PDPM case-mix-adjusted rate for the resident's PDPM class, before the wage index, with no link to the home's cost-based rate. A 60-day interim rate is used until the MDS is accepted. The ceiling is 90% of the Medicaid payment to the discharging hospital. Drugs and oxygen are billed separately. The contractor validates MDS/PDPM classes each June and December, and claims are reprocessed if the class is wrong. (2) Swing beds: paid the statewide average Class I rate. (3) Class II and privately owned Class IV ICF/IID: separate cost-based system with 85% imputed occupancy; state-run Class IV is retrospective cost. (4) State veterans homes: health care limit 130% of median (vs 125%), fee-exempt, quarterly supplemental payments. (5) Homes with five or fewer Medicaid beds may be paid the statewide average rate (C.R.S. 25.5-6-202(12)). (6) New facilities are paid the most recent average weighted Class I rate until their first cost report (9 homes are at exactly $283.00 in the FY2026-27 file).

Verified October 11, 2026

Payment rules

Managed care for long-term care

Status

no

Detail

Health First Colorado's managed care entities do not pay for long-stay nursing home care. The Accountable Care Collaborative's Regional Accountable Entities (RAEs) run primary-care networks, care coordination and the capitated behavioral health benefit, and two physical-health MCOs operate in parts of the state. Nursing facility per diems are paid fee-for-service through interChange: HCPF's Sept 2026 provider fee board slides describe the base per diem as 'Medicaid nursing facility claims billed through interChange... funded by the state General Fund and federal matching funds'. The only exception is PACE (capitated, all-inclusive). Sources: https://hcpf.colorado.gov/sites/hcpf/files/ACC%20Phase%20III%… ; https://hcpf.colorado.gov/sites/hcpf/files/Facility%20Provide…

Verified October 11, 2026

Who pays

fee_for_service. Nursing facility per diems are billed fee-for-service to HCPF's claims system (interChange/MMIS). PACE is the only capitated program that covers nursing home stays (PACE days count toward the Medicaid Utilization supplemental payment).

Verified October 11, 2026

Managed care rate floor

Not applicable. Nursing facility care is fee-for-service, and no MLTSS program pays NF per diems. No MCO rate floor for NFs was found. PACE pays nursing homes under its own contracts.

Verified October 11, 2026

Included in the daily rate

All-inclusive per diem (8.440.1): room and board, nursing, therapies, aide services, medically related social services, dietary, activities, routine personal hygiene, CLIA lab services, ordinary supplies and equipment, and listed OTC drugs (analgesics, artificial tears, etc.). Not included / billed separately (8.440.2.A): prescription drugs (pharmacy), oxygen, ambulance and all medical transport, physician fees, DME and supplies for imminent discharge, repairs of resident-owned DME, and non-Medicaid ancillaries (Medicare-covered lab/radiology/PT/OT/ST/RT). PETI/IME (post-eligibility income deductions) can pay for hearing aids, eyeglasses, dental and non-covered drugs from the resident's income, with prior authorization. Private rooms are paid at the semi-private rate.

Verified October 11, 2026

Bed hold

Hospital stays

Not paid. 'Nursing facility medical leave days are not a Health First Colorado benefit.' The facility may charge the resident or family a room reservation for medical leave (8.482.43).

Leave days

Paid. Non-medical/programmatic leave (home visits, therapeutic or rehab absences), approved by a physician and in the plan of care, up to 42 days per calendar year at the regular per diem (billed as leave days, rev codes 0182/0183). Beyond 42 days the resident may pay a room reservation.

Occupancy rule

None.

Notes

The resident's specific bed must be held regardless of payer (4.19-C).

Source

https://hcpf.colorado.gov/nf-billing

Verified October 11, 2026

Personal needs allowance

Per month

110.36

Effective

2026-01-01

Notes

HCPF Operational Memo OM 25-073 (2026 Social Security COLA), nursing and intermediate care facility PNA table: 2025 base $108.73 x 3% = $110.36, effective Jan. 1, 2026. Indexed every year to the Social Security COLA. (The earlier note's 2025 figure of $107.35 was wrong; the memo shows $108.73.)

Confidence

confirmed

Source

https://hcpf.colorado.gov/sites/hcpf/files/HCPF%20OM%2025-073…

Verified October 11, 2026

Medicare coinsurance days

Method

lesser_of

Rule

Part A SNF coinsurance days 21-100: Health First Colorado uses the 'lower of' pricing formula. The claim carries the home's Medicaid per diem as the rate, plus the coinsurance and Medicare paid amounts, and Medicaid pays only up to the Medicaid per diem minus what Medicare paid, capped at the coinsurance. Medicare Advantage cost-sharing: no NF-specific rule found.

Effect

Because the Medicare per diem is usually well above the Medicaid rate (about $283 average), the home usually receives $0 of the day 21-100 coinsurance for dual eligibles.

Source

https://hcpf.colorado.gov/nf-billing

Verified October 11, 2026

Required care spending

Applies

no

Rule

No requirement to spend a share of revenue on care, with recoupment. Related rules, not counted: the health care component is paid at actual cost up to the limit, so homes that spend less simply get a lower rate. The 8% per-year cap on health care cost growth. Audited financial statements, related-party and ownership disclosure (HB 23-1228, 8.450), with penalties for non-filing. The ended Wage Enhancement payment required a $15/hr minimum wage attestation. P4P is cut in half for substandard quality of care citations.

Source

https://www.sos.state.co.us/CCR/GenerateRulePdf.do?ruleVersio…

Verified October 11, 2026

Occupancy rules

Applies

yes

Rule

Capital only. The fair rental payment is divided by the greater of audited patient days or 90% of licensed bed capacity, rural and urban alike, so homes below 90% occupancy get less capital per day (8.443.9.B.1.h). Health care and A&G use actual days. The 85% imputed occupancy rule (8.443.3) applies only to Class II (ICF/IID).

Source

https://www.sos.state.co.us/CCR/GenerateRulePdf.do?ruleVersio…

Verified October 11, 2026

MDS accuracy penalties

None found for the regular Class I rate. The case-mix effect is facility-average. Homes review quarterly MDS rosters and correct them by the end of the quarter's 2nd month. Late or missing assessments older than 122 days are counted at a rule-set default CMI (value not found). Late MDS corrections are accepted only if errors affect at least 25% of residents (state plan 4.19-D p.14). For HBU residents, the contractor audits MDS/PDPM classes twice a year and claims are reprocessed to the validated class (8.470.7.C).

Verified October 11, 2026

Published rates and changes

How often rates change

A home's rate changes

annual

When

Jul 1: the posted MMIS claim rate (Core Component x statewide percent factor) changes once a year. Core Component rates are also re-set at 23 and 6 months after each home's cost-report year end, but those mid-year changes do not change the claim rate. They are settled the following year through the Acuity Adjusted Core Component supplemental payment. Supplemental payments are recalculated each July 1 and paid monthly.

Verified October 11, 2026

When rates change

July 1 state fiscal year for the MMIS claim rate and all annual supplemental payments (rate letters plus supplemental payment rate letters; data validation letters sent about June 12, protests due about June 26). Core Component re-sets fall at facility-specific 23-month/6-month dates tied to the cost-report fiscal year end (8.443.13 table). CHOW/new-facility rates start on the provider agreement date.

Verified October 11, 2026

Posted rates

Home-level rates published

Yes

Where

https://hcpf.colorado.gov/provider-rates-fee-schedule (section 'Skilled Nursing Facility': 'Skilled Nursing Facility Rates FY 26-27', plus a 'Skilled Nursing Facility Statewide Average Rates' table back to 2017-18)

Format

pdf (text-extractable table: NPI, name, address, SNF rate, hospice room-and-board rate (95%), rate begin date)

Cadence

Annual (July 1)

History

Facility files FY2021-22 through FY2026-27 on the page. Statewide average rates FY2017-18 ($220.87) through FY2026-27 ($283.00).

Home identifier

NPI plus facility name and address. The FY2025-26 file also has HCPF's PFID (provider facility ID, the same ID used in the P4P report); the FY2026-27 file has NPI only. No CCN.

Verified October 11, 2026

Rate build-ups

Published

No

Where

Not posted. HCPF sends each home an individual rate letter (contact HCPF_LTC_Facilities@state.co.us) and annual supplemental payment rate letters, and Myers and Stauffer's COLTCO portal (https://colorado-nf.mslc.com) is login-only. Public inputs: P4P per diem table and per-home P4P scores (P4P data report), High Medicaid Utilization tier counts, and provider fee per diem (stakeholder/board slides).

What they show

The posted file shows only the final MMIS per diem and the hospice R&B rate. Not shown: Core Component build-up (health care, A&G, FRV), limits/medians, CMI, percent factor or supplemental amounts.

Format

pdf

Example file

https://hcpf.colorado.gov/sites/hcpf/files/Skilled%20Nursing%…

Verified October 11, 2026

Recent changes

Verified October 11, 2026

Assisted living

Medicaid assisted living

Covered

yes

Program

Alternative Care Facility (ACF) service: Medicaid-certified assisted living residences, under the HCBS Elderly, Blind, and Disabled (EBD) 1915(c) waiver, also available on the Community Mental Health Supports (CMHS) waiver and the Medicaid Buy-In. Rules: 10 CCR 2505-10 8.7505; CDPHE assisted living rules 6 CCR 1011-1 Ch. VII.

What is paid

Services only: 24-hour protective oversight, personal care, homemaker and daily living skills assistance. Room and board is paid by the resident (typically from SSI/state supplement income). A state room-and-board cap or supplement was not verified here.

Rate

EBD ACF per diem (T2031 U1), effective 7/1/2026: $101.65/day outside Denver County, $107.13/day Denver County (was $103.72/$109.32 from 4/1/2026; the drop reflects the 7/1/2026 2% ATB cut). ACF respite (S5151): $131.38 / $138.94 per day.

Limits

Needs nursing facility level of care and income under 300% of SSI. No EBD waitlist was noted on HCPF's page (not confirmed).

Source

https://hcpf.colorado.gov/sites/hcpf/files/EBD%20CMHS%20BI%20…

Verified October 11, 2026

Sources

1. 10 CCR 2505-10 Section 8.400 (incl. 8.440-8.443, 8.450, 8.470, 8.482), version effective 8/14/2026 · regulation
2. Colorado Medicaid State Plan (compiled 9/15/2026), Attachment 4.19-C and 4.19-D · state plan
3. C.R.S. 25.5-6-202 Nursing facility provider reimbursement (2024 CRS, via colorado.public.law) · statute
4. C.R.S. 25.5-6-203 Nursing facility provider fees · statute
5. C.R.S. 25.5-6-210 Additional supplemental payments (high Medicaid / DOC parolees) · statute
6. C.R.S. 25.5-6-208 Wage enhancement supplemental payment · statute
7. HCPF Nursing Facilities Topics (Provider Fee and Supplemental Payments, P4P, SBS, HBU) · agency page
8. HCPF Provider Rates and Fee Schedule page (SNF rates FY21-22 to FY26-27; statewide average rates) · agency page
9. Skilled Nursing Facility and Hospice Room and Board Fee Schedule, July 1, 2026-June 30, 2027 · rate file
10. SFY 2025-26 SNF Fee Schedule · rate file
11. HCPF Nursing Facility Billing Manual · agency page
12. Facility Provider Fee Enterprise Support Board slides, July 21, 2026 (and minutes) · agency page
13. Facility Provider Fee Enterprise Support Board slides, September 15, 2026 (fee and payment calculations; H.R. 1 impacts) · agency page
14. Nursing Facility Stakeholder Meeting presentations, Jul 2025-Aug 2026 · agency page
15. NF Stakeholder Meeting, August 2026 (FY2027 provider fee model: $18.21 -> $18.81; High Medicaid Utilization $23.5M) · agency page
16. 2026 Nursing Facility Pay-for-Performance Application Review (Myers and Stauffer, June 2026) · agency page
17. Medicaid Provider Rate Reductions Q&A (June 2026) · agency page
18. Medicaid Provider Rate Reductions Fact Sheet (June 2026) · agency page
19. FY 2025-26 HCPF Budget Reduction Items Fact Sheet (Oct 2025) · agency page
20. FY 2026-27 R-06 Executive Order and Other Spending Reductions · agency page
21. HB 23-1228 Nursing Facility Reimbursement Rate Setting · statute
22. SB 25-270 (provider fees into CHASE enterprise) · statute
23. HB 08-1114 (nursing facility provider fee), enrolled · statute
24. The Accountable Care Collaborative fact sheet (July 2026) · agency page
25. HCPF Alternative Care Facilities page · agency page
26. HCPF Elderly, Blind, and Disabled Waiver page · agency page
27. EBD/CMHS/BI/CIH HCBS Rate Schedules effective July 1, 2026 (v1.1) · rate file
28. Personal needs allowance · secondary

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