Adult Day Care Regulations in Colorado

Who regulates adult day care in Colorado

In Colorado, the main rules for adult day programs come from Medicaid. The Department of Health Care Policy and Financing (HCPF), which runs Health First Colorado, sets the standards for Adult Day Services (ADS) in 10 CCR 2505-10, Section 8.7505. ADS is a benefit in four home and community-based services (HCBS) waivers, including the Elderly, Blind, and Disabled (EBD) Waiver.

ADS provider agencies must be Medicaid-certified by HCPF. Under the rule, proof of certification is an approved provider agreement plus a recommendation for certification from the Colorado Department of Public Health and Environment (CDPHE). The sources reviewed for this guide do not describe a separate state license for adult day centers, so confirm with CDPHE before opening a program that will not bill Medicaid.

Types of adult day programs in Colorado

• Basic ADS center: A community-based entity that provides regularly scheduled services, set out in the member's care plan, that support social, recreational, physical and emotional well-being.
• Specialized ADS (SADS) center: A center serving members with a primary diagnosis such as a dementia-related disease, multiple sclerosis, brain injury, chronic mental illness, an intellectual or developmental disability, Huntington's disease, Parkinson's disease or post-stroke conditions who need extensive rehabilitative therapies. At least two-thirds of the center's population must have one of these diagnoses.
• Non-center-based and telehealth ADS: The rule also allows ADS outside a center, including virtual group or individual services.

How to get certified in Colorado

1. Request certification from HCPF or its agent, which sends certification information and application forms (10 CCR 2505-10, Section 8.7403).
2. Submit the completed application. HCPF or its agent reviews it and completes an on-site review of the agency.
3. Obtain a recommendation for certification from CDPHE and an approved provider agreement, which together serve as proof of ADS certification (Section 8.7505).
4. Receive HCPF's decision to approve, provisionally approve or deny certification. Provider agencies must be certified before rendering or billing for services.

Key requirements

• Staffing ratio: One staff member for every eight members in center-based and in-person non-center-based ADS, with continuous supervision. Telehealth ADS requires one staff member for every 15 virtual members.
• Nursing: An RN or LPN must be available at least two hours daily during center-based ADS. CNAs may assist under an RN or LPN's direction, with at least weekly documented oversight. SADS centers must have nursing staff available during all hours of operation.
• Environment: At least 40 square feet per member, a temperature range of 68 to 76 degrees Fahrenheit, an on-site private shower or bathing area, and a restraint-free environment.
• Hours: The rule sets no minimum operating hours, but centers must publish their hours and availability in written policies.
• Diagnosis verification: SADS diagnoses must be verified by a licensed medical professional or case management agency documentation at admission and when the member's condition changes significantly.
• Same-day limits: ADS is not covered on the same date as HCBS residential services unless HCPF has approved both through a prior authorization request.

Section 8.7505 took effect March 16, 2024, and was amended effective November 30, 2024.

Medicaid funding for adult day in Colorado

Section 8.7505 covers ADS for members of the Brain Injury, Community Mental Health Supports, Complementary and Integrative Health, and Elderly, Blind, and Disabled waivers. HCPF describes the EBD waiver as serving people 65 and older who have a functional impairment, along with certain people ages 18 to 64.

Under HCPF's billing manual, all HCBS services require prior approval before Health First Colorado will reimburse them, unless otherwise noted. Case management agency case managers submit prior authorization requests electronically through the Bridge, which interfaces with the Colorado interChange system.

Billing basics

HCPF's HCBS billing manual for the BI, CMHS and EBD waivers (last revised July 17, 2026) lists these ADS codes. Its revision log notes separate Denver County codes and a Denver Regional Pricing Appendix, so check those before billing for Denver County services.

• EBD (outside Denver County): S5100 with modifier U1 for basic Tier 1 (15-minute units, up to three hours per day), S5105 U1 for basic Tier 2 (one unit equals three to five hours), and S5105 U1 TF for specialized ADS.
• CMHS: S5100 UA for basic Tier 1 (15-minute units, up to three hours per day), S5105 UA (three to five hours), and S5105 UA TF for specialized ADS.
• Brain Injury: S5100 U6 for Tier 1 (15-minute units, up to two hours per day) and S5102 U6 for Tier 2 (one unit equals two or more hours).

The manual describes paper claims on the CMS-1500 form and refers providers to HCPF's General Provider Information Manual for claim submission. HCPF's EVV Program Manual lists the services that require electronic visit verification, and Adult Day Services is not among them.

Other ways centers are paid

Enrolled veterans who meet VA eligibility and clinical criteria can get Adult Day Health Care through the VA, which may be provided at VA medical centers, State Veterans Homes or community organizations.

Official resources

• HCPF: Elderly, Blind, and Disabled Waiver
• 10 CCR 2505-10, Section 8.7505: Adult Day Services
• 10 CCR 2505-10, Section 8.7403: Provider Agency Certification
• 10 CCR 2505-10, Section 8.7000: Home and Community-Based Services
• HCPF: HCBS Billing Manual (BI, CMHS, EBD)
• HCPF: EVV Program Manual
• VA Adult Day Health Care

Frequently asked questions

Do I need a license to open an adult day center in Colorado?

The sources reviewed for this guide describe Medicaid certification rather than a state license. To serve Medicaid waiver members, an ADS provider must be certified by HCPF, which requires an approved provider agreement and a CDPHE recommendation for certification. Confirm with CDPHE whether any other license applies to your model.

Does Colorado Medicaid pay for adult day care?

Yes. Adult Day Services is covered in the Brain Injury, Community Mental Health Supports, Complementary and Integrative Health, and Elderly, Blind, and Disabled waivers, with prior authorization through the member's case management agency.

What is specialized adult day services?

SADS centers serve members with specific diagnoses, such as dementia or brain injury, who need extensive rehabilitative therapies. At least two-thirds of a SADS center's members must have a qualifying diagnosis, and nursing staff must be available during all hours of operation.