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Welcome to the Home and Community-Based Services State Review and Exceptions request page. This page is designed to serve as a one-stop resource for case managers to access request forms for various Home and Community-Based Services and Community First Choice services for exceptions to service limits and state review. These forms should be used when a member’s assessed needs cannot be fully met within standard Medicaid service limits, thresholds, or program requirements.
Each request must be supported by member-specific documentation, including assessment findings and service plan details, that demonstrate service appropriateness and compliance with applicable policy. Case managers are responsible for ensuring requests clearly describe the member’s needs, the reason standard limits are insufficient, and how the requested exception supports the member’s health, safety, and community-based living. Any supporting documentation must be uploaded into the Care and Case Management (CCM) System.
Please review the instructions and criteria included with each form prior to submission to support a complete and timely review process.
Select the exception you would like to request
Select the exception you would like to request
Exception requests are for services where there is a service limit in place and the case manager is requesting to exceed the established limit.
SLS Exceptions
SLS Exceptions
An exception process for service cap limitations on a member-by-member basis for those enrolled on the SLS waiver. This process does not supercede or replace existing Department processes for select service over the cap processes. The Department process should be utlized first.
Select the service that requires State Review
Select the service that requires State Review
State Review forms must be used when the service a case manager is authorizing requires State Review and PAR line approval.
Frequently Asked Questions
Frequently Asked Questions
Who can use these forms?
Who can use these forms?
The request forms on this page are intended to be used by case management agencies, only. Any submissions received from non-case management agency staff will be automatically denied. Providers and members should coordinate with the assigned case manager prior to requesting an exception.
How early do I need to submit an exception request?
How early do I need to submit an exception request?
Exception requests should be submitted at least 30 days prior to the requested effective date of services. This timeframe allows HCPF adequate time to complete its review, obtain any additional required documentation, and supports timely issuance of a Notice of Action by the case manager if the request is denied.
What should I do if I have an urgent request?
What should I do if I have an urgent request?
Exception requests are generally reviewed in the order received and cannot be rushed or expedited. However, requests identified as urgent may be prioritized for review when specific criteria are met.
Case managers should indicate that a request is urgent only when the request is necessary to address an immediate and significant risk to the member’s health or safety that cannot be mitigated within existing authorized services.
Urgent requests may be prioritized when:
There is an immediate risk to the member’s health or safety if services are not adjusted.
The member’s needs have changed suddenly or unexpectedly and cannot be safely supported within current service limits.
Delay in review would likely result in harm, institutionalization, or loss of community placement.
The urgency is clearly documented in the exception request and supporting documentation.
Requests will not be prioritized as urgent when:
The request could have been submitted earlier with appropriate planning.
The request is related to routine service planning, renewals, or anticipated changes.
The request is submitted late due to administrative delay.
The request lacks documentation supporting an immediate health or safety risk.
Identifying a request as urgent does not guarantee approval and does not change documentation requirements. All exception requests must meet applicable policy criteria and demonstrate service appropriateness.
Who should I contact if I have issues with the request form or questions about my exception request?
Who should I contact if I have issues with the request form or questions about my exception request?
For Community Connecter, Protective Oversight, Service Soft Caps, and Day Hab/SCC: Please contact hcpf_hcbs_exceptions@state.co.us
For SLS Exceptions: hcpf_hcbs_questions@state.co.us
For Respite: hcpf_hcbs_questions@state.co.us
For Home Modification and Vehicle Modification Requests: Emily Walsh emily.walsh1@state.co.us
For Assistive Technology and Remote Supports Technology Prior Authorization Line Approvals: kacey.wardle@state.co.us
What happens after submission?
What happens after submission?
After the exception request is submitted, HCPF will review and provide a response within 14 days. If additional information is needed, HCPF will request for more information prior to making a determination. Once an outcome is rendered, HCPF will notify the submitting case manager via email and upload an outcome determination to the Care and Case Management (CCM) system.
Resources
Resources
Long-Term Services and Supports Case Management Forms and Tools
For access to Notice of Action (803) Forms
CFC Health Maintenance Activities Guide
Health Maintenance Activities Member Documentation Checklist
CFC Direct Care Services Calculator - Adults
CFC Direct Care Services Calculator - Children
Age-Appropriate Task Standards and Task Definitions for Homemaker and Personal Care
OM 25-050: Community Connector Service Unit Cap & Parental Provision Code in the Children's Extensive Supports (CES) & Children's Habilitative Residential Program (CHRP) Waiver
OM 25-075: Ending of the Nurse Assessor Program
OM 25-076: Direct Care Services Calculator and Age-Appropriate Task Standards
OM 24-068: Home Modification, Vehicle Modification and Assistive Technology Benefits Form Requirement
PM 26-001: Health Maintenance Activities (HMA) Documentation Requirements
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