How to start a skilled nursing facility in Colorado

Colorado requires a Nursing care facility license from Colorado Department of Public Health and Environment (CDPHE), Health Facilities and Emergency Medical Services Division to operate a skilled nursing facility. Fee: Set by the CDPHE facility fee schedule (updated each July 1); amounts not restated here.

License required

Yes

License

Nursing care facility license

Issuing agency

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

Fee

Set by the CDPHE facility fee schedule (updated each July 1); amounts not restated here.

Medicare certification

Separate from the state license. The state survey agency runs an unannounced standard health survey, a Life Safety Code survey and an emergency-preparedness survey against 42 CFR Part 483 Subpart B. For a Medicare SNF the state certifies and the CMS Location decides Medicare participation; for a Medicaid-only NF the state's certification is final and the state Medicaid agency decides participation.

Regulation

6 CCR 1011-1, Chapter 2 (general licensure standards) and Chapter 5 (nursing care facilities)

1. Review CDPHE's licensure process and requirements for nursing care facilities
2. Apply through CDPHE's license/certification application process and pay the scheduled fee
3. Pass the CDPHE licensing inspection under 6 CCR 1011-1 Chapters 2 and 5
4. For Medicare/Medicaid, complete the federal certification survey (CDPHE is the state survey agency) and enroll with Health First Colorado

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.

Skilled nursing facilities — active organization NPIs (NPPES)

604 (as of Sep 13, 2026)

Medicare/Medicaid-certified nursing homes (CMS Care Compare)

210 (as of Aug 1, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

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

All Colorado Skilled nursing Medicaid rates, ranked →