6 Colo. Code Regs. § 1011-1 Chapter 26, pt. 4

Current through Register Vol. 47, No. 16, August 25, 2024

Part 4 - [Effective 7/1/2024] DEPARTMENT OVERSIGHT

4.1 License Classification

(A) An HCA shall be issued a license consistent with the type and extent of services provided. Unless otherwise specified, each licensed HCA shall meet the requirements in Part 5 of this chapter as well as Parts 6 and/or 7 depending upon the services provided.

(1) Class A - a home care agency that provides any skilled healthcare service. Agencies with a Class A license may also provide personal care services.

(2) Class B - a home care agency that provides only personal care services. An agency with a Class B license shall not provide any skilled healthcare service.

(B) An HCA providing home care services that are regulated by the Colorado Department of Health Care Policy and Financing (HCPF), excluding certified agencies defined in Part 2.4 of this chapter, shall be licensed as a Class B agency unless otherwise specified below.

(1) Any HCA providing services regulated by HCPF that also provides skilled care or services delivered by a licensed professional shall be licensed as a Class A HCA.

(a) In reviewing compliance with the requirements of this chapter by the Program of All-Inclusive Care for the Elderly (PACE) established in Section 25.5-5-412, C.R.S., the Department shall coordinate with HCPF in regulatory interpretation of both license and certification requirements to ensure the intent of similar regulations is congruently met.

(b) Any HCA participating in the In-Home Support Service program may be licensed as a Class A or B HCA and shall comply with both HCPF's regulations concerning those programs and the applicable portions of this chapter. The Department shall coordinate with HCPF in regulatory interpretation of both license and certification requirements to ensure the intent of similar regulations is congruently met.

(C) Residential facilities

(1) Any residential facility that delivers skilled home health or personal care services that the facility is not otherwise licensed or certified to provide, shall either become 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.

(a) Consumer services shall be provided only upon individual service contracts. The resident or consumer requiring services not covered under the primary license shall be given the opportunity to contract with the home care agency of choice and shall not be restricted to the use of the residential facility home care agency.

(b) A residential facility may not contract for nor provide skilled home health or personal care services on a facility-wide basis under this license. Each residential facility providing facility-wide services shall be licensed according to the appropriate provider type.

(c) The home care records shall be easily identifiable and separated in the consumer record from the residential care records.

(2) The requirements contained in Parts 5 through 7 of this chapter shall apply only to processes, policies, and procedures that address those consumers receiving skilled home health or personal care services in their temporary or permanent home or place of residence.

(a) The requirements apply to all residential facilities providing skilled home health services not covered under the primary residential care license or certification.

(b) The requirements for governing body, professional advisory committee, complaints, occurrences, and quality assurance activities may be met, in whole or in part, in conjunction with like activities of the primary license. However, there shall be documented oversight of the home care portion of the services provided distinct from that of the primary license.

(D) Pursuant to Section 25.5-10-202(22), C.R.S., Independent Residential Support Services do not require licensure by the Department.

(E) Nothing in this section relieves an entity that contracts or arranges with a community centered board or service agency, and that meets the definition of a "home care agency" under Section 25-27.5-102, C.R.S., from the entity's obligation to apply for, and operate under, a license in accordance with these regulations.

4.2 License Procedure

(A) The HCA shall comply with the requirements of 6 CCR 1011-1, Chapter 2, regarding license application procedures, the process for change of ownership, and the continuing obligations of a licensee.

(B) When submitting an application for an initial or renewal license, the HCA shall include evidence of either liability insurance coverage or a surety bond in lieu of liability insurance coverage. Such coverage shall be maintained for the duration of the license period. The minimum amount of coverage is:

(1) Class A - $500,000 per occurrence and $3,000,000 aggregate.

(2) Class B - $100,000 per occurrence and $300,000 aggregate.

(C) The agency shall submit to the Department a list of the contiguous counties that it plans to serve and assure adequate staffing, supervision, consumer care, and services are provided within the declared geographical area.

(D) With the submission of an application for licensure or within ten (10) calendar days after a change in the owner, manager, or administrator, each owner and each manager or administrator of a home care agency shall submit a complete set of their fingerprints to the Colorado Bureau of Investigation for the purpose of conducting a state and national fingerprint-based criminal history record check. Each owner, manager, or administrator is responsible for paying the fee established by the Colorado Bureau of Investigation for conducting the criminal history record check.

(1) The Department may acquire a name-based criminal history record check for an applicant who has twice submitted to a finger-print based criminal history record check and whose fingerprints are unclassifiable.

(2) When the results of a finger-print based criminal history record check of an applicant reveal a record of arrest without a disposition, the Department shall require that person to submit to a name-based criminal history record check.

(3) No license shall be issued or renewed by the Department if the owner, applicant, or licensee of the home care agency has been convicted of a felony or a misdemeanor, which felony or misdemeanor involves conduct that the Department determines could pose a risk to the health, safety, or welfare of HCA consumers.

(4) Each HCA owner, applicant, or licensee is under an affirmative obligation to inform the Department if they are convicted of a felony or of a misdemeanor that involves moral turpitude or conduct that the Department determines could pose a risk to the health, safety, or welfare of HCA consumers. Failure to advise the Department of a conviction may result in non-renewal or other appropriate sanctions, as set forth in Parts 4.7 and 4.8 of this chapter.

(E) No license shall be transferred from one location to another without prior notice to the Department as provided in this subsection. If an agency is considering moving or changing the licensed physical address, the agency shall notify the Department thirty (30) days prior to the intended relocation.

(1) To retain the current license, the new physical location shall be relocated within the existing geographic service area and retain the same governing body and administrator.

(2) If the change in physical address does not meet the requirements listed above, the HCA shall submit an application for a new license.

(F) An HCA shall notify the Department thirty (30) days prior to making any changes to the branch office physical address or organization.

(G) An HCA seeking a waiver of these regulations, or any other Department regulations, shall comply with the requirements of 6 CCR 1011-1, Chapter 2, Part 5.

4.3 Provisional Licenses

(A) The HCA shall comply with the requirements of 6 CCR 1011-1, Chapter 2, Part 2.4 regarding provisional licenses, with the following additions:

(1) If requested by HCPF, the Department may issue a provisional license for a period of ninety (90) days to an agency that has applied to be a certified home care agency.

(2) No provisional license shall be granted before completion of a criminal background check and finding in accordance with Part 4.2 of this chapter.

4.4 License Fees

(A) Unless otherwise specified in this chapter, all license fees paid to the Department shall be deemed non-refundable.

(B) The appropriate fee total shall accompany an HCA's initial or renewal license application. The fee total shall include any applicable branch and workstation fees as set forth in this section.

(C) Initial licensure

(1) Each HCA license applicant shall specify the type and extent of services to be provided and request the appropriate license category based upon the criteria set forth in Part 4.1 of this chapter. The initial license fee shall be:

(a) Class A - $3,240.30

(b) Class B - $2,376.22

(2) Any currently licensed Class B HCA that desires to change its license category to a Class A HCA shall submit an initial license application and initial license fee for a Class A license.

(D) Provisional licensure

(1) Any HCA approved by the Department for a provisional license shall submit a fee equal to fifteen percent (15%) of the applicable initial license fee for each provisional license term.

(2) The appropriate fee shall be submitted before issuance of the provisional license.

(3) If the Department finds reasonable compliance by an applicant holding a provisional license, it shall issue an initial license upon receipt of the license application and total fee for initial licensure and any additional appropriate fees specified in Part 4.4.

(E) Renewal licensure

(1) Base Fee. There shall be a base fee that is determined by the license category as defined in Part 4.1 of this chapter. The renewal license base fee shall be:

(a) Class A - $1,674.15

(b) Class B - $1,431.13

(2) Additional volume fee. Each HCA shall report its annual admissions for the previous year on its license renewal application. If the number of annual admissions is fifty (50) or more, the HCA shall add the following amount to its base fee:

(a) 50 to 99 admissions - $108.01

(b) 100 or more admissions - $216.02

(3) Medicare or Medicaid service discount. Each HCA that is currently certified to provide Medicaid or Medicare services shall deduct $100 from its base fee.

(4) Deeming discount. A license applicant that is accredited by an accrediting organization recognized by CMS as having deeming authority may be eligible for a ten percent (10%) discount off the base renewal license fee. In order to be eligible for this discount, the license applicant shall submit copies of its most recent recertification survey(s), and any plan(s) of correction with the most recent letter of accreditation showing the license applicant has full accreditation status in addition to a completed renewal application.

(F) Branch and workstation fees

(1) In addition to any other licensure fees, the following fees shall apply to the circumstances described. The fees shall be submitted with the license application or as otherwise specified.

(a) An HCA shall submit a $216.02 fee for each branch office as defined in Part 2.2 of this chapter.

(i) For existing branches, the fee shall be submitted with the license application.

(ii) For new branches, the fee shall accompany the notice of the HCA's intent to open a branch office pursuant to Part 5.2 of this chapter.

(b) An HCA that operates one or more work stations solely for the convenience of direct care staff shall pay a fee of $54.01 per workstation.

(G) Revisit fee

(1) An HCA's annual license fee may be increased as the result of a licensure inspection or substantiated complaint investigation where a deficient practice is cited that has either caused harm or has the potential to cause harm to a consumer and which the HCA has failed to demonstrate appropriate correction of the cited deficiencies at the first on-site revisit.

(2) The fee shall be one hundred percent (100%) of the HCA's initial or renewal license fee and shall be assessed for the second on-site inspection and each subsequent on-site inspection pertaining to the same deficiency.

(H) Change of ownership fee

(1) Any HCA meeting the criteria set forth in 6 CCR 1011-1, Chapter 2, Part 2.6 shall pay a change of ownership fee. The fee shall be determined according to the license classifications set forth in Part 4.1 of this chapter and submitted with the change of ownership notice. The fee shall be:

(a) Class A - $3,240.30

(b) Class B - $2,376.22

(I) Change of name and change of address fees

(1) A licensed HCA shall conform with the notification requirements of 6 CCR 1011-1, Chapter 2, Part 2.9.6 regarding any change in the HCA name or business address.

(2) A fee of $81.01 shall accompany each notice of a change in HCA name or business address.

4.5 Inspections

(A) The HCA shall comply with the requirements of 6 CCR 1011-1, Chapter 2, Parts 2.9.4, 2.10.1, and 2.10.2 regarding inspections, with the following additions:

(1) The Department shall make such inspections as it deems necessary to ensure that the health, safety, and welfare of home care consumers are protected. In addition to licensure inspections, the Department may conduct supplemental inspections at any time in response to complaints alleging noncompliance with the regulations contained in this chapter.

(a) Consumer records kept in the home or individual consumer documents not included in the HCA's permanent record shall be made available to the Department within two (2) hours of request if the last visit occurred fourteen (14) or more days prior to the request. The time for production may be extended at the Department's discretion.

(b) The consumer file and administrative records, including but not limited to, census and demographic information, complaint and incident reports, meeting minutes, quality assurance, and annual program review documents shall be provided to the inspector commencing within thirty (30) minutes of request. The time for production may be extended at the Department's discretion.

(2) Inspections shall not be conducted in a home care consumer's home without the consumer's consent.

4.6 Plan of Correction

The HCA shall comply with the requirements of 6 CCR 1011-1, Chapter 2, Part 2.10.4(B) regarding a plan of correction.

4.7 Intermediate Restrictions or Conditions

(A) The Department may impose intermediate restrictions or conditions on a license, which may include at least one of the following:

(1) Retaining a consultant to address corrective measures;

(2) Monitoring by the Department for a specific period;

(3) Providing additional training to personnel, owners, or operators of the home care agency;

(4) Complying with a directed written plan to correct the violation; or

(5) Paying a civil fine not to exceed $10,000 per calendar year for all violations.

(B) If the Department imposes an intermediate restriction or condition that is not the result of a serious and immediate threat to health or welfare, the Department shall provide the agency with written notice of the restriction or condition. No later than ten (10) days after receipt of the notice, the agency shall submit a written plan that includes the time frame for completing the directed plan that addresses the restriction or condition specified.

(C) If the Department imposes an intermediate restriction or condition that is the result of a serious and immediate threat to health, safety, or welfare, the Department shall notify the agency in writing, by telephone, or in person during an on-site visit.

(1) The agency shall remedy the circumstances creating the harm or potential harm immediately upon receiving notice of the restriction or condition.

(2) If the Department provides notice of a restriction or condition by telephone or in person, the Department shall send written confirmation of the restriction or condition to the agency within two (2) business days.

(D) After submission of an approved written plan, the agency may appeal any intermediate restriction or condition to the Department through an informal review process as specified by the Department.

(E) If the Department imposes an intermediate restriction or condition that requires payment of a civil fine, the agency may request, and the Department shall grant, a stay in payment of the fine until final disposition of the restriction or condition.

(F) If an agency is not satisfied with the result of the informal review, or chooses not to seek informal review, no intermediate restriction or condition shall be imposed until after the opportunity for a hearing has been afforded the licensee pursuant to Section 24-4-105, C.R.S.

4.8 Enforcement and Disciplinary Sanctions

The provisions of 6 CCR 1011-1, Chapter 2, Part 2.11 regarding enforcement and disciplinary sanctions shall apply to all HCAs and home care placement agencies.

4.9 Civil Fines

If the Department assesses a civil fine pursuant to Part 4.7 of this chapter, the money received by the Department shall be transmitted to the state treasurer who shall credit the same to the general fund.

6 CCR 1011-1 Chapter 26, pt. 4

47 CR 10, May 25, 2024, effective 7/1/2024