Hospice & palliative care

Choosing a Hospice in Colorado: Reading the Public Data

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Colorado hasn't required a certificate of need for a new hospice since 1987, so entry is comparatively open across the state. That matters differently along the Front Range than in one of the 23 counties Colorado's own rural-health system designates as frontier, where a single hospice may cover a wide, sparsely populated territory.

Last updated: July 2026

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Care Compare Covers Every Licensed Hospice in Colorado

Medicare's Care Compare website lets anyone search Medicare-certified hospices anywhere in Colorado, from the Front Range to the Western Slope, by ZIP code, and see the same quality measures CMS collects nationwide: family-experience survey results and claims-based utilization data 1. It's free, requires no account, and returns the same kind of results whether the search is centered on a city or a small mountain town.

That data comes from the Hospice Quality Reporting Program (HQRP), which requires every Medicare-certified hospice nationwide to submit standardized measures or accept a reduced Medicare payment rate 2. HQRP includes the CAHPS Hospice family-experience survey and the newer HOPE assessment, a clinical data-collection tool CMS phased in to track how patients are doing during a stay. Reading Care Compare first means starting from the same public record everywhere in the state, rather than from whatever a hospice's own brochure happens to say. That consistency matters in a state as geographically varied as Colorado, where a family in Denver and a family in a mountain valley are otherwise working from very different amounts of local information.

Colorado Has Had No Certificate-of-Need Law Since 1987

Colorado repealed its certificate-of-need law in 1987 and hasn't reinstated one since, making it one of roughly a dozen states with no CON requirement for healthcare facilities or services, hospice included. A hospice can begin operating anywhere in Colorado once it holds a state license, without first demonstrating unmet community need to a state board.

That comparatively open entry shapes what a family finds when comparing options: Colorado's more populated corridors can carry a fair number of Medicare-certified hospices, while some smaller communities may have only one, or a program based well outside the immediate area. Either way, the absence of a certificate-of-need filter means a hospice's presence on Care Compare says nothing on its own about quality; that still has to come from CAHPS scores, live-discharge patterns, and a direct conversation with the hospice itself. Open entry also means a hospice based in a populated corridor can choose to extend service into a rural county without waiting on a regulator's permission, which is part of how some rural areas end up covered at all.

How the CAHPS Hospice Survey Is Built

CMS mails the CAHPS Hospice Survey to the primary caregiver of a patient who died under hospice care, typically a few months afterward, asking about communication, help with pain and other symptoms, timeliness of care, caregiver training, and whether the family would recommend the hospice 3. It's a retrospective account, describing what actually happened rather than a satisfaction rating collected in real time.

Because each hospice's published score reflects a limited number of respondents collected over a set period, a single strong or weak domain shouldn't stand in for the whole picture, particularly for a smaller Colorado hospice that may have fewer survey responses to draw from than a large urban program. Reading multiple domains together, rather than one overall recommend-us figure, gives a fuller sense of where a hospice was strong and where families reported gaps.

Twenty-Three of Colorado's Counties Are Officially Frontier

Colorado's rural health system uses a specific term, frontier, for counties with six or fewer residents per square mile, a formal designation used by the state's own health-policy agencies. Twenty-three of the state's 64 counties carry that designation, and rural and frontier counties combined cover roughly three-quarters of Colorado's land area, even though most of the state's population lives along the Front Range.

For a family outside the Front Range corridor, that geography changes what comparing hospices actually looks like. A frontier county may be served by a hospice based an hour or more away, arranging visits across a wide territory rather than a compact service area, and general inpatient care for a symptom crisis may mean a longer drive to a facility than it would in a denser part of the state. Confirming how a hospice actually covers a rural or frontier county is worth asking directly, since Care Compare's ZIP-code search won't show the driving distance behind a listing.

Live Discharge, Ownership, and the Pattern Researchers Found

Being discharged alive from hospice isn't automatically a sign anything went wrong; some patients stabilize and no longer meet the terminal prognosis hospice requires. Researchers have still identified a pattern worth knowing: patients discharged alive are more likely to be hospitalized, readmitted, or die in a hospital shortly afterward, and this kind of burdensome transition is more common at for-profit hospices and after unusually short stays 4.

A separate national analysis of CAHPS Hospice results found family caregivers reported worse experiences, across every measured domain, at for-profit hospices compared with nonprofit ones, and were less likely to recommend them 5. Ownership status doesn't decide the outcome for any one Colorado hospice — individual programs of either kind can perform well — but it's a pattern worth checking alongside a hospice's own CAHPS scores and live-discharge history.

Colorado's Health Department Licenses Hospices; Its Medicaid Program Has Its Own Name

The Colorado Department of Public Health and Environment (CDPHE) licenses and inspects hospices statewide and handles Medicare and Medicaid certification alongside state licensure. Colorado's Medicaid program itself carries its own public name, Health First Colorado, administered by the state's Department of Health Care Policy and Financing, which is where hospice billing and eligibility questions actually go.

That's two different agencies for two different questions, on top of the four levels of care CMS defines for every Medicare-certified hospice nationwide: routine home care, continuous home care during a brief crisis, general inpatient care, and inpatient respite care for a caregiver's break 6. A licensing or inspection concern about a Colorado hospice goes to CDPHE; a Health First Colorado billing or eligibility question goes to the state's Medicaid agency, and neither one replaces the federal Care Compare and CAHPS data that already covers every Medicare-certified hospice in the state.

Common questions

Not directly. Colorado repealed its certificate-of-need law in 1987, so a hospice doesn't need to prove unmet community need before opening anywhere in the state. That makes entry easier and can mean more Medicare-certified programs in populated areas, but it says nothing about which specific hospice performs well; that still comes down to CAHPS scores and live-discharge data.

Frontier is an official rural-health designation for counties with six or fewer residents per square mile. Twenty-three of Colorado's 64 counties carry it, and rural and frontier counties together cover most of the state's land area. In a frontier county, the nearest hospice may cover a wide territory and travel some distance for a home visit or facility-based care.

Health First Colorado is the public name for Colorado's Medicaid program, administered by the state's Department of Health Care Policy and Financing. It's a separate agency from the Colorado Department of Public Health and Environment, which licenses and inspects hospices. Billing and eligibility questions go to Health First Colorado; licensing and quality concerns go to the health department.

Routine home care is the everyday level most hospice patients receive, wherever they live. General inpatient care is short-term and facility-based, used when symptoms need more intensive management than a home setting allows, which can mean travel to a facility in a rural part of Colorado. Continuous home care covers a brief home crisis, and inpatient respite care gives a caregiver a short break.

No single ownership label guarantees an outcome for an individual family. National research has found for-profit hospices score lower on average across CAHPS domains and show more burdensome live discharges, but averages describe a whole industry, not one Colorado program. A specific hospice's own public record is the more reliable thing to check.

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When a Concern Needs to Go Beyond the Hospice Team

  • —the hospice's on-call clinical line goes unanswered, or reaches only voicemail, during an active symptom crisis
  • —pain, breathlessness, or agitation that isn't addressed within the response time the hospice promised in writing
  • —no clinician contact for several days after a family reports a real change in a patient's condition, especially in a rural or frontier county

If a hospice patient is in acute distress and the hospice's 24-hour clinical line cannot be reached, call 911 and tell the dispatcher the patient is enrolled in hospice care.

This article explains how to read public hospice-quality data for Colorado; it does not replace guidance from a hospice's own clinical team or a treating physician.

References

  1. 1.Centers for Medicare & Medicaid Services (2024). Find Healthcare Providers: Compare Care Near You (Hospice). Medicare.gov / Care Compare (CMS). link ✓Supports that Colorado families can search and compare Medicare-certified hospices statewide by ZIP code on publicly reported quality and CAHPS measures.
  2. 2.Centers for Medicare & Medicaid Services (2024). Hospice Quality Reporting Program. Centers for Medicare & Medicaid Services (CMS). link ✓Supports the existence and structure of the Hospice Quality Reporting Program, including CAHPS Hospice and the HOPE assessment, as the data source behind Care Compare.
  3. 3.Centers for Medicare & Medicaid Services (2024). CAHPS Hospice Survey. Centers for Medicare & Medicaid Services (CMS). link ✓Supports what the CAHPS Hospice Survey is, who it samples, and which domains it measures.
  4. 4.Peer-reviewed cohort study (see article) (2024). Hospice Readmission, Hospitalization, and Hospital Death Among Patients Discharged Alive from Hospice. JAMA Network Open (PMC11099680). PMID 38753329 ✓Supports that patients discharged alive from hospice face higher rates of hospitalization, readmission, or hospital death, and that this is more common at for-profit hospices and after short stays.
  5. 5.Anhang Price R, Parast L, Elliott MN, et al. (2023). Association of Hospice Profit Status With Family Caregivers' Reported Care Experiences. JAMA Internal Medicine. doi:10.1001/jamainternmed.2022.7076 ✓Supports that family caregivers report worse experiences across CAHPS domains at for-profit hospices compared with nonprofit hospices.
  6. 6.Centers for Medicare & Medicaid Services (2024). Medicare-Certified 4 Levels of Hospice Care. Medicare.gov / Care Compare (CMS). link ✓Supports the definitions of the four Medicare hospice levels of care.

6 sources, numbered by first appearance. General health information, not medical advice. AI-assisted editorial content — every citation independently verified. Editorial policy

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