Provider responsibilities, billing impacts, and prior authorization under the new soft cap

Colorado Access is implementing a soft cap on certain Home- and Community‑Based Services (HCBS). Providers should be aware this is an informational policy change that may affect prior authorization expectations, billing patterns, and documentation practices — providers must follow existing authorization and documentation requirements and monitor member service use relative to the new soft cap.

• Follow existing prior authorization processes and submit requests when services may exceed typical utilization.
• Ensure documentation justifies medical necessity and service frequency/duration when approaching or exceeding the soft cap.
• Monitor member utilization and coordinate with Colorado Access when thresholds are approached to avoid service interruptions.