How to start a hospice in Colorado

Colorado requires a Hospice license (provisional, then regular; inpatient hospice facility rules included) from Colorado Department of Public Health and Environment, Health Facilities and Emergency Medical Services Division to operate a hospice. Fee: Fees (initial, renewal, provisional, conditional, change of ownership, workstation, late) follow the Department's published fee schedule (cdphe.colorado.gov/facility-fees), updated each July 1. Default provisional license fee in rule is $1,128.76 unless the schedule says otherwise. Fees can vary by location, Medicare-cost-report patient days, multi-site ownership and CMS-recognized accreditation; accredited hospices may get a discount on the annual renewal base fee. Fees are non-refundable.

License required

Yes

License

Hospice license (provisional, then regular; inpatient hospice facility rules included)

Issuing agency

Colorado Department of Public Health and Environment, Health Facilities and Emergency Medical Services Division

Fee

Fees (initial, renewal, provisional, conditional, change of ownership, workstation, late) follow the Department's published fee schedule (cdphe.colorado.gov/facility-fees), updated each July 1. Default provisional license fee in rule is $1,128.76 unless the schedule says otherwise. Fees can vary by location, Medicare-cost-report patient days, multi-site ownership and CMS-recognized accreditation; accredited hospices may get a discount on the annual renewal base fee. Fees are non-refundable.

Renewal

Every year · Renewal application and fee due at least 60 days before license expiration; late fees apply.

Accreditation

Accreditation by a CMS-recognized organization is optional; accredited hospices in good standing may receive a renewal fee discount if the accreditor sends surveys and plans of correction to the Department.

Medicare certification

Medicare certification is separate from the state license (state survey or CMS-approved accreditor). CMS imposed a nationwide 6-month moratorium on new Medicare hospice enrollments (including new practice locations) effective 2026-05-13, extendable in 6-month increments; applications received by the Medicare contractor before that date are still processed, accreditation cannot be used for deemed-status entry during the moratorium, and a hospice undergoing a non-exempt ownership change within 36 months of enrollment must re-enroll as new and is therefore blocked. The federal notice leaves Medicaid/CHIP hospice moratoria to each state.

Regulation

6 CCR 1011-1, Chapter 21 (Hospices, eff. 2026-01-14) and Chapter 2 (General Licensure Standards, Part 2.12 fees); C.R.S. 25-3-105

1. Submit a complete license application with attachments and the non-refundable fee at least 90 days before the planned start date
2. Operate under a provisional license while the Department reviews compliance
3. Receive a regular one-year license once reasonable compliance is shown and the license fee is paid
4. Renew yearly, filing at least 60 days before expiration

Staffing

• Governing body
• Administrator responsible for day-to-day management, qualified by education, knowledge and experience; a qualified administrator designee
• Medical director (governing body may appoint one person to both administrator and medical director roles)
• Interdisciplinary group

Program

Health First Colorado (Colorado Medicaid)

Enrollment portal

Colorado interChange Provider Web Portal (Gainwell)

Fiscal agent

Gainwell Technologies (Colorado interChange MMIS)

Application fee

HCPF lists the CY2026 fee as $750 for institutional providers, charged on new enrollments, revalidations and new locations. HCPF also has a process for paying a previously waived fee. Federal rule (42 CFR 455.460): the state must collect the CMS application fee from institutional providers that are newly enrolling or re-enrolling; individual physicians and non-physician practitioners are exempt, as are providers already enrolled in (or that already paid the fee to) Medicare or another state's Medicaid/CHIP. CMS set the fee at $750 for calendar year 2026.

Fingerprinting

HCPF names its high-risk types, all for new enrollments: doulas, DME suppliers, home health agencies, hospices, lactation providers, skilled nursing facilities, personal care agencies under the state plan, certain opioid treatment providers, and some HCBS providers. Those providers and their 5%+ owners must be fingerprinted within 30 days of a request. Federal rule (42 CFR 455.434, 455.450(c)): providers the state places in the 'high' categorical risk level, and anyone owning 5% or more of such a provider, must submit fingerprints for a criminal background check.

Site visit

HCPF says site visits are required for all high-risk providers, including all non-emergent medical transportation providers, and that site visits are recorded. Federal rule (42 CFR 455.432, 455.450(b)-(c)): the state must do site visits before and after enrollment for providers in the 'moderate' or 'high' risk levels, and any enrolled provider must allow unannounced on-site inspections.

Revalidation

Health First Colorado and CHP+ providers must revalidate at least every five years. HCPF emails providers about six months before their deadline and posts a revalidation-dates spreadsheet; claims are denied for providers that miss the date. Federal rule (42 CFR 455.414): every enrolled provider must be revalidated at least once every 5 years.

Full Colorado Medicaid enrollment guide →

CON program

No

Colorado certificate of need details →

State minimum wage

$15.16 an hour

Effective

2026-01-01

Scheduled increases

Rises to $15.71 in 2027 ($12.69 tipped), per the state labor department.

Direct-care wage floor

HCBS base wage: Medicaid HCBS providers must pay direct care workers at least $17.00/hour statewide in 2026 ($19.29 in Denver, $18.17 in Edgewater); if a local minimum wage is higher, the higher rate applies.

Rate pass-through

Providers attest annually to paying the base wage; non-compliance can lead to audits, corrective action, claim suspension or recoupment.

HCBS 80/20 rule

Federal baseline: 42 CFR 441.302(k) requires the state to show that each provider spends at least 80% of Medicaid payments for homemaker, home health aide and personal care services under 1915(c) waivers on direct care worker pay and benefits. Compliance starts 2030-07-09 (for managed care, the first rating period starting on or after that date); annual payment-adequacy reporting under 441.311(e) starts 2028-07-09. A state may set a lower share for state-defined small providers and exempt providers facing hardship, each only through a public notice-and-comment process. The eCFR text has not changed since 2024-07-09. No state-published 80/20 implementation step (small-provider criteria, hardship exemption or reporting guidance) was found for this state in the official sources reviewed.

Hospice agencies (community based) — active organization NPIs (NPPES)

227 (as of Sep 13, 2026)

Medicare-certified hospices (CMS Care Compare)

88 (as of Aug 19, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

1,188,599 (as of Jun 1, 2026)

All Colorado Hospice Medicaid rates, ranked →