Medicaid exclusion screening requirements in Colorado
What Colorado Medicaid requires of the organizations that take part in it: whether the state keeps its own exclusion list, how often it expects you to check, what the penalties are, and how an action taken in another state reaches you here. Every claim on this page links to the source it came from.
What Exclia screens for this state
Exclia screens Colorado HCPF Terminated Provider List — last refreshed Oct 15, 2026, 14:24 UTC.
Updated quarterly at the source.List version in use: f3c5e1e3-bd5e-4f4c-a3e4-2ee7bd8e4b54What the state requires
HCPF publishes the list but does not state how often to check it.
The Provider Termination and Reinstatements page explains the list and its consequence but sets no screening frequency. Consult your Health First Colorado provider agreement, program rules and contracts for any interval that applies to you; federal guidance on monthly checks of the OIG list applies regardless.
Why monthly, and where the exposure comes from
The HHS Office of Inspector General publishes the federal exclusion list (the LEIE) monthly, and its guidance to providers is that screening staff and contractors each month is what best limits the risk of overpayment and civil monetary penalty liability. State Medicaid agencies are themselves required to check the LEIE no less frequently than monthly (42 C.F.R. § 455.436(c)(2)), which is the rhythm the lists move on.
The state’s own list
Terminated Provider List
Colorado keeps its own Medicaid exclusion list, separate from the federal OIG list. Searching one does not cover the other.
HCPF’s list of providers whose participation in Health First Colorado (Colorado’s Medicaid program) has been terminated for cause, published as an Excel workbook with a separate Reinstated Provider List.
- Published by
- Colorado Department of Health Care Policy & Financing (HCPF)
- Refreshed
- Not stated by HCPF; each edition is dated in its file name, per the publishing agency.
What happens if it is not done
Colorado states the consequence as a reimbursement rule: a provider terminated for cause is not paid by the Medicaid program.
- A provider who has been terminated for cause may not receive reimbursement under the Medicaid program.
- The reasons a provider may be terminated for cause are set out under the definition of good cause at 10 CCR 2505-10, Section 8.076.1.7.
- Reinstatement is not automatic: a terminated provider must apply in writing, show that the conduct behind the termination has not recurred and will not recur, and receive notice from HCPF’s Program Integrity Section that reinstatement was granted before re-enrolling (10 CCR 2505-10, Section 8.076.5.E).
The federal exposure behind the state requirement
Where a federal health care program pays for an item or service furnished, ordered, or prescribed by a person on an exclusion list, the OIG can seek repayment of what was paid, civil monetary penalties for each item or service claimed (a statutory $10,000, adjusted annually for inflation), and an assessment of up to three times the amount claimed. The standard is what the organization knew or should have known — which is why the date of your last check is the fact that matters.
How another state’s action reaches you here
Section 6501 of the Affordable Care Act (42 U.S.C. § 1396a(a)(39), implemented at 42 C.F.R. § 455.416(c)) requires a state Medicaid agency to deny or end the enrollment of any provider that was terminated for cause on or after January 1, 2011 under Medicare, or under the Medicaid or CHIP program of any other state, and that appears in the federal termination database. In practice that means an action taken against a provider in one state reaches their participation in every other — so the list that matters to you is not only your own state's.
Common questions
Yes. HCPF publishes a Terminated Provider List of providers whose Health First Colorado participation was terminated for cause, with the provider name, any “doing business as” name, the NPI, the termination authority and the effective date. It is separate from the federal OIG list.
HCPF removes them from the Terminated Provider List and lists them on a separate Reinstated Provider List with both dates. A provider can be terminated again after a reinstatement, in which case they return to the termination list.
HCPF does not state an interval on its page. For the federal list, the HHS Office of Inspector General describes monthly screening of its federal list as the approach that best limits liability; confirm any state requirement in your provider agreement or contract.
No. A Colorado for-cause termination ends participation in Health First Colorado; a federal OIG exclusion bars payment by every federal health care program. Check both, and treat a name match on either as a potential match until identity is confirmed.
Exclia imports the edition effective October 9, 2026 (321 rows), parsed on October 15, 2026. A name on the list is shown as a potential match for your team to review, never as a determination.
Check one name against the federal lists, free
One name, no account, and the result states which sources it covered and which it did not. It is a spot check rather than monitoring — it does not satisfy a monthly requirement on its own.
Run a free checkOr do it for everyone you monitor, every month
Exclia screens every person and vendor you monitor each month against the sources we cover, and keeps the dated audit trail that shows you did it.
See pricingEvery published state in one printable table, with the source for each row and a publication date you can check. Get the state-by-state requirements table
This states what each state publishes and links to where it says it. It is not legal advice, and where your own obligations are unclear your counsel is the right reader of these sources.