AbbyCare FAQ on Prior Authorization Requests (PARs) and State Nurse Assessments
You may have many questions about the AbbyCare process, from how to schedule your state nurse assessor appointment to when you can officially begin as an employee. We know the steps can feel overwhelming at first, so we have put together everything you need in one place. Below, you will find helpful information and resources to guide you through each stage of the process and ensure you feel supported and prepared along the way.
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.
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.
