Home health care in Colorado is a complicated business.

To provide the service, agencies must be certified and licensed through the Department of Public Health and Environment, but they are paid by Medicare and Medicaid through the state’s Health First Colorado program, which is in the Department of Health Care Policy and Financing.

There are a variety of services available under the “home health” heading, according to regulations, and they include assistance such as bathing, dressing, or some form of nursing care. It can also include a variety of therapies, such as occupational, physical or even speech-language services.

Critical, though, is that whatever the service, it must be assessed as either medically necessary or needed. Depending on the program within Medicare/Medicaid, home health services can be short-term or long-term, but the focus is on keeping the patient out of the typical hospital setting, which can become extremely expensive.

“It’s to provide services to those who have that need and to keep them out of a more intense setting, and, frankly, to keep them alive,” said a HCPF medical professional who agreed to offer their assessment without being named, because they were not authorized to speak publicly.

Typically, the assessment for care will come from a home health agency, but that can’t happen without a doctor signing off on what’s known as a plan of care. That plan, which nearly always requires a doctor’s signature, names the home health agency that will be providing the care.

Ordinarily, that agency is chosen by the patient, but sometimes it comes from the recommendation of a hospital worker or caseworker assigned to help the patient find an agency near their home or specializes in whatever need they might have.

Generally, the services are not without limit, so agencies need to provide additional documentation any time timelines are exceeded, according to regulations.

There were more than 200 certified home health agencies in Colorado in 2023, according to the most recent federal data available. On Going HHC, while listed, did not show any information regarding the work it billed Medicare/Medicaid. Other records, however, show it was paid nearly $3.6 million that year.