Upcoming Policy Update:LRP Homemaker Service Hour Limits

Initiative:

Cap on Weekly LRP Homemaker

The Department of Health Care Policy & Financing (HCPF) is providing advance notice of an upcoming policy update related to Homemaker services provided by Legally Responsible Persons (LRPs).

What is changing?

HCPF intends to revise the current policy, which allows up to 5 hours per LRP (with a limit of two LRPs), to allow up to a maximum of 7 hours per week of Homemaker services per member when delivered by an LRP. This is a per member cap (not per LRP), and the total weekly hours may be delivered by one or more LRPs within the household. This is not a change to a member’s overall authorized hours of Homemaker services. Should a member need additional Homemaker services, they can receive these from alternative caregivers who are not LRPs.

Why this change?

The current policy, which allows up to 5 hours per LRP (with a limit of two LRPs), was approved by the Joint Budget Committee (JBC) and by the Medical Services Board (MSB) in early Spring 2026. When the rule was brought back to MSB for final reading, MSB did not approve it and asked HCPF to determine options to revise the policy to better ensure that the impact of the cap would be consistent across members. While HCPF has some flexibility in what the policy should be, we are also required to achieve the savings associated with the original policy voted on by the JBC.

The revised approach, allowing a maximum of 7 hours per week of Homemaker services per member provided by an LRP, is both allowed federally and will achieve the cost savings required of the legislature. It also meets the intent of the request from the MSB to ensure consistency of impact across Members.

Current policy remains in effect

At this time, the existing 5-hour weekly limit per LRP (up to two LRPs) remains in effect under the current emergency rule authority through June 12, 2026. No immediate action is required.

What to expect next

In the coming weeks as we gather feedback, HCPF will work with Case Management Agencies on how to best operationalize this revised policy. HCPF plans to bring this updated policy forward to the Medical Services Board on June 12, 2026 through an emergency rule.

If approved:

• The 7-hour per member limit would become effective following MSB approval
• Additional guidance and operational details will be provided at that time

Providing feedback

HCPF welcomes stakeholder feedback on this proposed approach. Stakeholders will have the opportunity to review and provide feedback on the new draft rules going to MSB on June 12, 2026 when they are posted shortly. More information will be shared via this OCL Newsletter.

HCPF will continue to communicate updates as more information becomes available.

Updated Rule Draft:Weekly Limit of 56 Hours Per Caregiver

Initiative:

Cap on Weekly Caregiving Hours

HCPF would like to thank everyone who submitted written comments or provided verbal feedback during recent meetings on the first draft of this rule.

We are now seeking feedback on our second rule revision draft based on stakeholder feedback for a weekly limit of 56 hours per caregiver for a single member across Personal Care, Homemaker, Health Maintenance Activities (HMA), Long-Term Home Health (LTHH)-Home Health Aide, and LTHH-Nursing Services. Members will not experience cuts to their authorized service hours or budgets as a result of new caregiver limits.

The weekly limit of 56 hours per caregiver for a single member will be implemented between July 1, 2026 and July 1, 2027. By July 1, 2027, all caregivers must not provide more than 56 hours of care for a single member per week for the services listed above unless an exception based on allowable criteria has been granted.

Caregiver hours will be reduced in stages over a one-year period - reduction to 84 hours on July 1, 2026, 70 hours on January 1, 2027, and 56 hours on July 1, 2027.

There will be an exceptions process for individuals who meet allowable exception criteria.

The 16 hour per day limit for caregivers across personal care, homemaker, HMA, LTHH, and Private Duty Nursing will remain.

We are seeking a second round of stakeholder feedback on the revised rule language. A form to provide feedback includes specific questions pertaining to the exception process language, enforceability language, roles and responsibilities for Case Managers and provider agencies, and the structure of the changes.

Please provide feedback by Wednesday, May 20th so we can ensure edits are incorporated prior to our presentation at the Medical Services Board.

New Rule Revision Draft:Private Duty Nursing (PDN)

Initiatives:

Establish Private Duty Nursing (PDN) 60-Day Acute Benefit

Establish Private Duty Nursing (PDN) Per Diem Rate

HCPF is pleased to share a draft of proposed updates to the Private Duty Nursing (PDN) rule, effective January 1, 2027, pending federal approval.

These proposed changes aim to enhance access to care, promote flexibility in service delivery, and modernize reimbursement approaches while maintaining program integrity.

A high-level summary of key changes and new additions to the rule 10 CCR 2505-10 8.540 are provided below.

Key Updates:

• New Acute PDN Benefit

A new Acute PDN benefit has been added to support members experiencing a short-term change in medical condition or transitioning from an institutional setting.

• Allows for immediate access to increased skilled nursing services without prior authorization in acute situations
• Limited to short-term use (up to 60 days)
• Designed to help prevent hospitalization or re-institutionalization and support safe and more timely transitions to home
• New PDN Per Diem Reimbursement Methodology

The rule introduces a per diem reimbursement option that allows for a blended daily rate covering RN, LPN, and CNA services when specific criteria are met.

• Supports flexible staffing based on member needs
• Replaces hourly billing for applicable days of service
• Requires documentation of both nursing and CNA services provided on the same day
• Does not change medical necessity or authorized levels of care
• Per Diem Rate Structure
• A standardized per diem rate has been established to streamline billing and align reimbursement with mixed-service delivery models. This is intended to reduce administrative burden while maintaining appropriate oversight and accountability.
• Current proposed thresholds are as follows:
• PDN hours: minimum 4 hours per day
• CNA hours: minimum 6 hours per day
• General Rule Cleanup and Clarifications

The rule includes technical edits and clarifications to improve readability, align definitions, and ensure consistency across sections. For example, references to the no longer operational Nurse Assessor Program have been removed. These changes are not intended to alter existing policy but to make requirements clearer for providers and stakeholders.

This is intended as an initial draft, and we welcome your feedback.

Stakeholder input is critical to ensuring the rule is clear, effective, and operationally feasible.

Please share any comments or questions by Monday, June 8, 2026 through this form or by emailing [email protected].

New Rule Revision Draft:Group Rates For Certain Community First Choice (CFC) and Long-Term Home Health (LTHH) Services

Initiative:

Create Group Rates for Certain Community First Choice (CFC) and Long-Term Home Health (LTHH) Services

HCPF is pleased to share proposed updates to regulation regarding reimbursement for certain CFC and LTHH services, effective January 1, 2027, pending federal approval.

For CFC services, HCPF is proposing the introduction of group rates when services are delivered to multiple members in the same setting at the same time. These group rates would apply to Personal Care and Homemaker services, as well as to the delivery of Health Maintenance Activities (HMA) through In-Home Support Services (IHSS). Because CFC does not currently include a rate for shared service delivery, this change will allow a single Direct Care Worker to support multiple members simultaneously—improving flexibility, reducing duplicative billing, and better aligning reimbursement with service delivery.

For LTHH services, HCPF is proposing group rates for Certified Nurse Aide (CNA) services under the same conditions. This approach supports more efficient service delivery and workforce flexibility while maintaining person-centered care. Individual rates will remain when services are provided to a single member. These changes aim to reduce duplicative billing, improve payment accuracy, and support long-term program sustainability. Members will not see changes to authorized services, but providers may adjust billing and scheduling practices.

Implementation will occur throughout the calendar year 2027. Providers will begin billing group rates, where applicable, on January 1, 2027, with members transitioning at their Continued Stay Review (CSR) or new authorization period.

HCPF welcomes stakeholder feedback on these regulations to ensure the changes are clear, effective, and operationally feasible. Please use this Google Form to provide feedback, or email any questions or comments to [email protected].