1. General Context
What are PARs?
PARs (Prior Authorization Requests) are formal approvals required by Colorado Medicaid before certain services can be provided or paid for.
Why is this change happening in Colorado?
The state is introducing a single assessment process to determine eligibility for multiple programs at once. This reduces the need to work with multiple agencies and ensures a more streamlined experience for families.
What is a State Nurse Assessor Referral?
The referral is the first step in the prior authorization process. Abby Care submits this referral on your behalf. It triggers an independent evaluation conducted by the state’s contracted vendor, Telligen.
What is the State Nurse Assessment?
A nurse assessor, hired by the state, will conduct a holistic evaluation of your child (or loved one) to determine which Medicaid programs they are eligible for. This includes reviewing medical records, speaking with the member/family, and using a standardized tool to evaluate medical and functional needs.
Previously: Abby Care completed a Pediatric Assessment Tool (PAT) via Zoom to determine CNA program eligibility. Moving forward, the state nurse assessor will complete this assessment.
2. Impact on Families
How will this impact existing families?
- Families currently receiving payment for caregiving must submit a prior authorization starting August 1, 2025.
- Approval from Colorado Medicaid is required before your annual recertification date.
- Abby Care will help gather and submit all required documents.
- Families with annual recertifications from September 1, 2025, onward will receive additional instructions.
How will this impact new families?
- New families will meet with the state nurse assessor for a holistic needs evaluation.
- Abby Care will help prepare by gathering documents and identifying needed supports.
- After the nurse assessor’s recommendation, Abby Care will submit the prior authorization request.
3. Timing
When do PARs begin?
August 1, 2025.
When will I need prior authorization approval?
Approval is needed before your annual recertification. Abby Care will guide you through the process and ensure all required documents are collected.
When will I meet with the Nurse Assessor?
When starting new services or during your annual recertification. This visit is in addition to your Abby Care start visit and annual recertification visit.
4. Qualification & Pay
Will my CNA program qualification change?
Possibly. The state nurse’s assessment and prior authorization process will determine ongoing eligibility. Abby Care will assist throughout.
Will my hours change?
Possibly. The nurse assessor will recommend hours across all programs. The prior authorization outcome confirms approved service hours.
How will my pay be impacted?
Pay depends on approved hours and programs. Abby Care will help review the nurse assessor’s recommendations and explore programs (IHSS, CNA, PASA) to maximize pay.
5. Process Details
How does the Nurse Assessor evaluation work?
Similar to the PAT assessment done previously with Abby Care. Evaluates your child’s needs and recommends suitable programs.
Is the assessment in-person or virtual?
It can be either. You’ll coordinate directly with the state nurse assessor. They will call to schedule once a referral has been submitted.
Will my process with Abby Care change?
- You will continue working with your Family Associate.
- Abby Care RN visits every 60 days continue.
- Charting and payment processes remain the same.
- Only the annual assessment will be conducted by the state nurse.
6. Scheduling with Telligen
Who is Telligen?
Third-party vendor contracted by Colorado to conduct nurse assessments.
What does the scheduling process look like?
- Within 24 hours of referral submission, Telligen will call to confirm your availability.
- A scheduling team member will follow up to set the appointment.
- Appointments take 1–3 hours and require both caregiver and member presence.
- As of 8/15/25, calls are being made within one week of referral submission due to high demand.
What phone number will they call from?
Calls come directly from the assigned nurse. Abby Care does not receive the number in advance.
What if I miss their call?
The nurse will leave a voicemail with a callback number. Ensure your voicemail is clear.
If I’m having difficulty scheduling, who do I contact?
- Reach out to the nurse who called you.
- Or contact Telligen directly: 844-650-0560, CO_SNA@telligen.com
7. Receiving the Recommendation Letter
What happens when I receive my recommendation letter?
- The letter outlines which program(s) you are eligible for.
- Abby Care also receives a copy and will contact you to guide the next steps.
How do I receive my recommendation letter?
- You will receive an email that has the service hours detailed. Please check your email and spam folder to ensure you have received it. If you cannot find it please contact Abby Care and we can send this to you!
8. Language Assistance
What if I need an interpreter?
Abby Care is committed to accommodating all families' language needs by providing interpreters and multilingual support throughout the assessment and prior authorization process. Telligen provides interpreters and offers the option to select your preferred language when scheduling assessments. This ensures families can fully participate in the assessment process.
9. Additional Clarifications for Families
- Can my Abby Care nurse attend my yearly visit? No, the state nurse will conduct the assessment. Abby Care nurses will conduct their assessments.
- Can hours change after the state assessment? Yes, hours may change based on the state’s recommendation.
- Do I need to submit paperwork now to prevent hours from decreasing? No. Abby Care will prepare documents before your annual visit.
- Are these changes political? No. These changes were planned by Colorado Medicaid before the current administration.
- Can I appeal? Yes. Families can submit additional documentation (care assessments, therapy notes, PCP documentation) with Abby Care’s help.
- Who schedules my assessment? The state nurse assessor will contact you directly.
- If I’m found ineligible, is there a grace period? No, the state says families may be redetermined the following year.
- If doctors are unavailable, what happens? Mandatory documents (485 draft, order, letter of recommendation) must be received before submission, which may delay processing.
- Can I request an early assessment? Yes, but the patient's hours may decrease or be deemed non-qualified for services; therefore, there is a potential risk of an early evaluation.
- Does the Letter of Recommendation specify tasks? No, the letter of recommendation only identifies the hours per service.
- If receiving IHSS from another agency, must I switch? No. You may keep services with different agencies.
- Medication Authority- AbbyCare does not provide the Med Authority certification for CNAs to give medication.
You can contact us by either calling our office directly or completing our interest form online by clicking the provided link. Once we receive your submission, a member of our dedicated team will promptly review your information and contact you Monday- Friday from 8:00 am to 6:00 pm to discuss your needs, answer any questions, and guide you through the next steps.
Key Contacts
Telligen – State Nurse Assessments
- Phone: 844-650-0560
- Email: CO_SNA@telligen.com
AbbyCare – Colorado
- Phone: (720) 734-4348
- Or email: care@abbycare.org
