CO · guidance
CO HCPF Pediatric Personal Care Benefit Billing Manual — Personal Care Benefit Overview
PersonalCareBenefitOverview
ThePediatricPersonalCarebenefitisavailabletoHealthFirstColoradomembers20yearsoldandyoungerwhorequirePersonalCare(PC)services.
PCservicesaremedicallynecessaryservicesthatdonotrequireaprovidertohaveamedicalcertificationoraprofessionallicensetosafelyprovideservices.Underthisbenefit,aPCproviderassiststheHealthFirstColoradomemberwithPCtasksinordertomeethisorherphysical,maintenance,andsupportiveneeds.Thisassistancemaytaketheformofhands-onassistance(actuallyperformingataskfortheperson),supervision(ensuringataskisperformedsafely,includingactiveintervention),orpromptingorcueingthemembertocompletethetask.
Ifamemberrequiressupportofamedicallyskilledcaregivertocompleteatask,suchasbathingorhygiene,theassociatedtaskshallbeconsideredskilledinnatureandcoveredunderotherHealthFirstColoradostateplanbenefitsand/orColoradoHCBSwaiverprograms.
WaiverCaseManagersmustcollaboratewithPediatricPCproviderstoensurethatPriorAuthorizationRequests(PARs)aresubmittedcorrectlyandontimetopreventoverlaporomissionofauthorizedPCunitsbetweentheMedicalPARandWaiverPAR.
PCprovidersmustworkwiththemember'scasemanagertoensurethatanycurrentPARSfortheseservicesarecancelledormodifiedpriortostartingservicesundertheHealthFirstColoradofeeforserviceprogram.
RefertothePersonalCareBenefitCoverageStandardforadditionalinformationaboutthisbenefit,includingeligibilityrulesforproviders,detailsaboutwhattasksarecoveredandinteractionwithotherHealthFirstColoradoprograms.
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Provenance
- Source
- hcpf.colorado.gov
- Retrieved
- 2026-07-26
- Edition
- 2026-07-26
- Content hash
9f73b51a41cea91aeecd4a26ce5e271ad6d53de663d432297f56b30daa7f67d6
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