Adult Day Care in Colorado
All states: adult day services map
In short: No state adult day license; Medicaid-certified Basic and Specialized centers need 1 staff per 8 Members and at least 2 nursing hours daily.
Colorado adult day services at a glance
| License or certification | No state license. Centers that bill Medicaid need HCPF certification after a CDPHE survey. |
|---|---|
| Who licenses or certifies | No licensing agency. CDPHE surveys centers and HCPF certifies them for Medicaid. |
| Adult day care vs adult day health | No split. Medicaid certifies Basic ADS and Specialized ADS (SADS) centers. |
| Strictest staffing ratio | 1 staff per 8 Members in person (HCPF Medicaid rule); 1 per 15 for telehealth |
| Dementia ratio | No ratio specified. SADS centers need nursing staff for all hours open. |
| Medicaid programs | EBD, CMHS, CIH and Brain Injury waivers; PACE |
| Medicaid billing unit | 15-minute (S5100) or 3 to 5 hour half-day (S5105) units; Brain Injury waiver uses 15-minute or per-day (S5102) units |
| Licensed centers | Not confirmed. There is no license, and we did not find a count of certified centers. |
Last verified against state sources: 2026-10-21.
How is adult day care regulated in Colorado?
Colorado does not license adult day centers. The Colorado Department of Public Health and Environment (CDPHE) says no license is required for adult day services. The rules that shape how a center runs come from Medicaid instead: a center that wants to bill Health First Colorado (the state Medicaid program) must be certified by the Department of Health Care Policy and Financing (HCPF) after CDPHE surveys it.
Colorado also does not split adult day care from adult day health care. Its Medicaid rule, 10 CCR 2505-10 section 8.7505, calls the service Adult Day Services (ADS) and recognizes two kinds of certified center:
- Basic ADS centers, which serve adults on Medicaid home and community based services (HCBS) waivers.
- Specialized ADS (SADS) centers, which serve people whose primary diagnosis is a dementia-related disease, Multiple Sclerosis, brain injury, chronic mental illness, an intellectual or developmental disability, Huntington's disease, Parkinson's disease, or a post-stroke condition needing extensive rehabilitative therapy. At least two-thirds of a SADS center's participants must have one of these verified diagnoses, and the center must have nursing staff for all hours it is open.
ADS can be delivered at a center, in person outside a center (non-center-based), or by telehealth. Colorado's rules call participants Members.
Three layers can apply to a Colorado center, and each comes from a different agency:
- Licensing (CDPHE). No adult day license exists. CDPHE's role is to take the application and survey centers that want Medicaid certification, as described in its Medicaid Certification Guidance Document for HCBS Waiver Services (adult day is specialty code 601).
- Medicaid (HCPF). Section 8.7505 sets the adult day standards, and the general HCBS provider agency rules in sections 8.7400 to 8.7418 add requirements for every certified provider. The older adult day rule at section 8.491 is listed as repealed.
- Other funding. The U.S. Department of Veterans Affairs pays for adult day health care for some veterans.
Because there is no license, the Medicaid certification rules are the only state standards we found for adult day. They apply to certified centers, not to private-pay programs that never seek certification.
Do you need a license to open an adult day center in Colorado?
No. CDPHE states that no license is required for adult day services. If you want to bill Medicaid, though, you must be certified first: you send CDPHE a Letter of Intent and an application, pass an initial survey with zero deficiencies, and then enroll with HCPF using the certification document CDPHE issues.
How Medicaid certification works. The steps come from the CDPHE guidance document and 10 CCR 2505-10 section 8.7403:
- Submit a Letter of Intent and an Adult Day Services application to CDPHE's Health Facilities and Emergency Medical Services Division. Include Colorado Adult Protective Services (CAPS) check results with the initial application (section 8.7409).
- After CDPHE accepts the application, it conducts an initial on-site survey.
- After a zero-deficiency survey, CDPHE creates a certification document in its COHFI system.
- Attach that document to your Medicaid Provider Enrollment Application with HCPF. HCPF makes the final decision: approval, provisional approval with a corrective action plan, or denial.
- You may not provide or bill Medicaid services until you are certified and have an approved Provider Agreement (section 8.7505.E.1).
One enrollment per site. HCPF requires a separate Medicaid Provider Enrollment Application for each physical location where waiver services are provided. A center cannot operate inside a licensed health facility or agency unless it has its own separate space and entrance, and participants do not pass through the licensed space to reach it.
Buying a center. Changes in ownership, tax ID, address and similar material changes must be reported through the Provider Portal within 35 calendar days. On a change of ownership, the CDPHE and HCPF processes run at the same time. If the employer identification number (EIN) changes, the old provider agreement ends and the new owner must enroll from scratch, which cannot be approved until the prior owner voluntarily disenrolls (section 8.7404). Plan the timing of any purchase with both agencies early.
What we did not find. We did not find a published application or survey fee, a certificate of need or moratorium, how often centers are resurveyed or recertified after the first survey, or which local health, fire and occupancy permits CDPHE expects first. Ask CDPHE's Health Facilities and Emergency Medical Services Division about fees and survey frequency, and ask your city or county about local permits.
What are the staffing rules for adult day centers in Colorado?
Medicaid-certified Colorado centers need at least 1 staff member for every 8 Members, with continuous supervision, for center-based and in-person services, and 1 for every 15 Members in telehealth sessions. Basic centers must also provide at least 2 hours of RN or LPN nursing each day. We did not find a separate ratio for people with dementia, but SADS centers must have nursing staff for all hours they are open.
These rules are in 10 CCR 2505-10 section 8.7505.E.7, set by HCPF.
- Medicaid (HCPF): 1:8 center-based and in-person; 1:15 telehealth. Staffing must also be adjusted to Members' needs and be enough to carry out each Provider Care Plan.
- Licensing (CDPHE): no ratio specified, because there is no license.
- Other funding: the VA program page sets no ratio.
Who counts toward the ratio. Only staff trained and able to provide direct services count. Staff may do more than one job as long as it fits the rule's definition of a Direct Care Worker. We did not find a minimum number of staff who must be on site regardless of how many Members attend.
Nursing. Nursing for medical monitoring and medication supervision must be provided by an RN or LPN at least 2 hours a day at center-based ADS, and as needed for non-center-based ADS. Certified nursing assistants (CNAs) may provide nursing tasks under RN or LPN direction, with that supervision documented at least weekly. SADS centers must have nursing staff for all hours of operation.
Director. The director needs one of three combinations: a bachelor's degree plus two years of social or health services experience; a Colorado RN or LPN license plus two years of health or social service experience including supervision; or a high school diploma or GED plus four years of experience and supervisory skills.
Medications. Staff who assist with or monitor medications must pass a Qualified Medication Administration Person (QMAP) competency evaluation, unless the law otherwise authorizes them (section 8.7409).
Training. Direct Care Workers must be trained before they provide services, and all staff and volunteers need training in universal precautions and infection control. Topics include person-centered practices, each Member's needs and protocols, and agency policies. Direct Care Workers must also complete at least 4 hours of competency-based dementia training within 120 days of starting, at no cost to them, and at least 2 hours of dementia continuing education every two years.
Background checks. Criminal background checks, reference checks and a federal OIG exclusion check are required before staff serve Members and every five years after. CAPS checks are also required, and certain substantiated abuse findings bar a worker.
What we did not find. We did not find qualifications for social work or activity staff, a staff TB test or vaccination requirement, or a yearly training hour minimum beyond the dementia continuing education. Ask HCPF or CDPHE if you need an answer on these.
What does an adult day center in Colorado have to provide?
A Medicaid-certified Colorado center must provide help with daily living activities, health monitoring, medication assistance, nutrition and social and recreational activities. It needs at least 40 square feet per Member in eating and activity areas and an on-site private shower or bathing area. Transportation is not a required center service; Medicaid pays for it separately.
Required services. Under section 8.7505.C, ADS must include at minimum:
- In-person help with activities of daily living, such as eating, toileting and mobility.
- Monitoring of health and hygiene, medication assistance and management, and carrying out physician orders.
- Activities that support self-care and social support.
- Nutrition services, including therapeutic diets and snacks at center-based ADS as the care plan requires.
- Age-appropriate social and recreational activities.
Dropping off a meal, workbook or activity packet by itself is not a covered service unless in-person ADS is also provided.
Space and building. Eating and activity areas must provide at least 40 square feet per Member. Centers need an on-site private shower or bathing area for emergency hygiene, recreation space suited to the number of Members, and indoor temperatures kept between 68 and 76 degrees F. We did not find how certified capacity is calculated, a restroom ratio, or a separate space rule for dementia care.
Food. Centers must follow local food safety rules, including handwashing facilities, holding cold food at or below 41 F and hot food at or above 135 F, and date labeling opened food.
Hours. The rule does not set minimum days or hours. Instead, a center must have a written policy stating its hours and days, its non-center availability and when nursing is available.
Written policies. Section 8.7505.E.11 requires written policies on admission criteria, intake (including with guardians or representatives), meals and snacks, hours and nursing availability, personal items Members may bring, and telehealth if offered, plus a signed agreement with each Member. Every HCBS provider agency must also keep the policies listed in section 8.7408:
- Staffing and employment, including background, CAPS and reference checks, job duties, training, supervision, and keeping impaired staff from working.
- Medication administration, handling, storage and disposal.
- Protected health information.
- Preventing, investigating and reporting mistreatment, abuse, neglect and exploitation (MANE) within 24 hours.
- Individual rights and non-discrimination.
- Dispute resolution, with 15 days advance notice of any change or end of services.
- Grievances and complaints, including anonymous ones.
- Independent contractors, if used.
- Contingency plans for staff absences and emergency plans, including loss of staff.
What rules protect participants in Colorado adult day centers?
Certified centers may admit only Members whose needs fit their certification, must keep a signed care plan reviewed at least twice a year, and must give 15 days notice before changing or ending services. Incidents go to the Member's Case Manager within 24 hours for critical incidents and two business days for others. Records are kept seven years.
Who can enroll. A center may admit only Members whose needs fall within its certification category and the populations it serves. For Medicaid Members, the provider must confirm waiver eligibility and an approved Prior Authorization Request before services start. SADS centers must verify each Medicaid Member's qualifying diagnosis with the Professional Medical Information Page (PMIP) at admission and after any significant change; for Members with other payers, a physician or licensed medical professional must verify it.
Care plan. A Provider Care Plan documents medications, diet, the services delivered during ADS and any modifications to the Member's rights, and is signed by the Member or a representative. It must be reviewed at least twice a year (section 8.7410). We did not find a deadline for writing the first care plan.
Discharge. Members must get 15 days advance notice of any change or end of services, and a provider may not stop agreed services without documented efforts to resolve the problem. We did not find a list of permitted discharge reasons.
Records. Each ADS record must include the primary physician's contact details, supervision documentation, the Member's orientation, a signed service agreement, the PMIP for SADS Members, and documentation of any telehealth services. Medicaid providers keep records for seven years, or longer if another rule or the provider agreement requires it (section 8.130.2).
Incidents. Under section 8.7411, providers report deaths, hospitalizations, medical emergencies, MANE allegations, injuries, property theft, medication errors, missing Members, criminal activity and unusual Member actions to the Member's Case Manager. Critical incidents are due within 24 hours and others within two business days.
What we did not find. We did not find a required physician order or physical exam for Basic ADS, or TB screening of participants. Families should ask a center for its written admission criteria and Member agreement, and operators should ask HCPF what it expects.
How does Medicaid pay for adult day in Colorado?
HCPF pays for adult day through four HCBS waivers: Elderly, Blind, and Disabled (EBD); Community Mental Health Supports (CMHS); Complementary and Integrative Health (CIH); and Brain Injury (BI). Centers bill in 15-minute units or a half-day or day unit, depending on the waiver and how long the Member attends. PACE organizations also run day centers for their enrollees.
Important: The rates below come from HCPF's waiver rate schedule effective October 1, 2025. HCPF posts newer rate schedules on its provider rates page, and we were not able to check their adult day rates. Confirm the current rate before you budget or bill.
EBD, CMHS and CIH waivers. All three use the same codes and rates, with a different modifier for each waiver (U1 for EBD, UA for CMHS, U1 SC for CIH). From the October 1, 2025 rate schedule:
- Basic, 15 minutes (S5100): $3.99 outside Denver County, $4.32 in Denver County, up to 12 units (3 hours) a day.
- Basic, half day of 3 to 5 hours (S5105): $48.77 outside Denver, $52.73 in Denver.
- Specialized (SADS), half day (S5105 with TF modifier): $61.43 outside Denver, $65.39 in Denver. SADS centers are paid the Specialized rate for every Member.
- Denver County claims add the HX modifier.
Brain Injury waiver. BI Adult Day Services bills S5100 at $7.59 per 15 minutes, up to 8 units (2 hours) a day, or S5102 at $84.85 per day for 2 or more hours of attendance. The 15-minute units cannot be billed on the same day as the day unit. The schedule lists no separate Specialized or Denver rate for BI.
Rules for every claim. Providers must confirm the Member's eligibility and an approved Prior Authorization Request before services and claims, and payment cannot exceed the Health First Colorado fee schedule rate in effect on the date of service (section 8.7407). Certified providers may not charge Medicaid Members a copayment for covered services.
Transportation. Trips to and from adult day are a separate waiver service with their own codes, billed per one-way trip by taxi (A0100) or by mileage-band van trip, or as an RTD or Access-A-Ride pass (A0110), with the HB modifier.
Attendance documentation. For services billed in 15-minute units, records must show the location, date, start and end times, the staff person, the tasks done and the units provided. Services billed per day need a daily attendance tracker and activity notes (section 8.7405). Attendance time decides which unit you can bill. We did not find a rule requiring an electronic sign-in and sign-out system for adult day.
PACE. Colorado's PACE rule defines a PACE center with recreation, therapy, socialization, personal care and dining areas, although it does not use the term adult day. PACE is paid a set amount per enrollee, and the care team decides how often a person attends, so day center care is not billed by the unit.
Can a private-pay adult day center operate in Colorado without Medicaid?
Yes. Colorado has no adult day license, and CDPHE ties its application and survey to Medicaid certification. We did not find any state standard for a private-pay program that never seeks certification, so ask CDPHE before you open whether any other rules apply to your plans.
What still applies at a certified center. The ADS rule governs certified Medicaid providers. A certified SADS center must document and verify the diagnosis of its non-Medicaid Members too, through a physician or licensed medical professional. We did not find limits on what a private-pay-only program may do, such as nursing or giving medications, outside other professional practice laws, and we did not find state fee disclosure or contract rules for private-pay participants.
Veterans. The U.S. Department of Veterans Affairs offers Adult Day Health Care to enrolled veterans who meet clinical criteria, through VA medical centers, State Veterans Homes or community organizations, as half or full days. A copay may apply.
Other federal funds. Certified centers may use other federal funds, such as the Child and Adult Care Food Program, alongside Medicaid, but must disclose every funding source and show that services are not paid for twice (section 8.7505.F.3). We did not find Older Americans Act or state-funded adult day standards from Colorado's State Unit on Aging. Your local Area Agency on Aging can tell you what is available in your region.
The market. We did not find a state count of certified adult day centers or a Colorado adult day association with a website. CDPHE or HCPF may be able to tell you how many ADS and SADS centers are certified.
What is changing next for adult day in Colorado?
As of our last check on October 21, 2026, we did not find an announced upcoming change to Colorado's adult day rules or Medicaid adult day payment. Two recent changes are already in effect, and newer rate schedules are posted that we could not check.
- New rule location, 2024. HCPF moved its adult day rule from section 8.491, now repealed, into section 8.7505 of the new 8.7000 HCBS rule series, with effective dates of March 16, 2024 and November 30, 2024. Older HCPF documents that cite section 8.491 are out of date.
- Rate reduction, October 1, 2025. HCPF lowered adult day rates on the EBD, CMHS, CIH and BI waivers. For example, the Basic half-day rate outside Denver fell from $49.55 to $48.77, and the BI day rate fell from $86.21 to $84.85.
- Later rate schedules. HCPF lists newer waiver rate schedules on its provider rates page. We could not confirm their adult day rates, so check that page for the rate in effect on your dates of service.
The 8.7000 rule series was amended several times in 2026. The proposed rule filings we checked did not mention adult day, but watch HCPF rulemaking for changes to section 8.7505.
Get notified when Colorado adult day rules change
Leave your email and we will let you know when Colorado changes its adult day licensing, staffing or Medicaid rules. No newsletter, only changes for this state.
Who to ask about adult day rules in Colorado
Questions about Colorado adult day rules are best put to the state. Start with CDPHE Medicaid Certification Guidance Document for HCBS Waiver Services.
Colorado adult day sources
- CDPHE: Medicaid Certification Guidance Document for HCBS Waiver Services
- 10 CCR 2505-10 section 8.7505: Adult Day Services
- 10 CCR 2505-10 section 8.7403: HCBS provider certification
- 10 CCR 2505-10 section 8.7405: documentation for billing
- 10 CCR 2505-10 section 8.7409: staff qualifications, training and background checks
- 10 CCR 2505-10 section 8.7411: incident reporting
- HCPF: EBD, CMHS, BI and CIH waiver rate schedules effective October 1, 2025
- HCPF: Provider rates and fee schedules
- 10 CCR 2505-10 section 8.497: PACE
- U.S. Department of Veterans Affairs: Adult Day Health Care
Related reading
- The Compliance Curve: Why Adult Day Services Should Learn from Home Care Before They Have To
- Simplifying Payments with Electronic Billing for Adult Day Care
- Effective Transportation Tracking for Elder Day Centers
- How to Differentiate Your Adult Day Care Center: A Guide for Operators
- Adult day services in every state (map)
- Adult Day Care Services and Reference Guide
Other states with no state adult day license
Alabama, Alaska, Connecticut, District of Columbia, Idaho, Illinois, Indiana, Kentucky, Maryland, Massachusetts, Michigan, Mississippi, New Jersey, New York, North Dakota, Ohio, Oregon, South Dakota, Vermont, Washington, West Virginia, Wisconsin. See every state on the adult day services map.
Page history
- October 21, 2026: Page rewritten and checked against state sources.
This page is a reference, not legal advice. State rules change, so confirm details with the state before you act on them.
Ankota provides software for adult day centers, covering attendance, care plans, transportation and billing. If you would like to talk about running your center, contact Ankota or read more about Ankota's adult day care software.
