Home Health Agencies

A Home Health Agency is an agency providing Skilled Nursing Services and at least one (1) of the following other therapeutic services in the place of residence used as the patient’s home:

Physical Therapy
Speech Language Pathology
Occupational Therapy
Medical Social Services
Home Health Aide Services

To establish Centers for Medicare/Medicaid Services (CMS) Medicare certification of an HHA, an applicant must request, complete, and submit an application packet. Application materials are located below or can be requested by contacting the Idaho Bureau of Facility Standards (BFS) at 208-334-6626.

In accordance with the Streamlined Facilities Licensing and Inspection Act, effective July 1, 2025, Medicare Certified Home Health Agencies are no longer required to be licensed in the State of Idaho. No new licenses will be issued after July 1, 2025. Please review the updated Idaho Statute for more information.

https://legislature.idaho.gov/statutesrules/idstat/Title39/T39CH13/SECT39-1303/

Medicaid Provider Application and Certification Process

The application packet includes what must be submitted, reviewed, and approved (Items #1-5) prior to an initial survey and resource information related to HHAs (Items #6-12):

Prior to referring to the information below, please take time to review this document for better understanding of the certification process: CMS Enrollment and Certification Roadmap

1. Health Insurance Benefits Agreement - CMS 1561 Form (two signed originals required).

2. Fiscal year ending date Form.

3. Home Health Agency Survey and Deficiencies Report - CMS 1572a Form (complete sections 1-22).

4. CMS requires all new applicants for HHAs to complete the form CMS-855A, Medicare Application for Health Care Providers that will Bill Fiscal Intermediaries, and forward it to the Regional Home Health Intermediary (RHHI). This may be accomplished either by submitting a hard copy or electronically. Submit the hard copy to:

The RHHI for Idaho is:

National Government Services
Provider Enrollment
P.O. Box 7143
Indianapolis, IN 46207-7143

805-367-0734

www.ngsmedicare.com

The internet-based Provider Enrollment, Chain, and Ownership System (Internet-based PECOS) may be used in lieu of the Medicare enrollment application (i.e., paper CMS-855A). Information regarding this option may be found at: PECOS

5. “Office of Civil Rights Clearance for Medicare Certification” (OCR), Assurance of Compliance Portal. This compliance may be completed and submitted online, via https://ocrportal.hhs.gov/ocr/aoc/instruction.jsf. The submission will go directly into the OCR intake queue, and the provider will receive an e-mail from OCR stating that the provider completed the civil rights submission. The e-mail will contain an OCR number, which is critical to OCR’s ability to access the provider’s submission from the OCR intake queue. The provider will submit a copy of this e-mail to the SA, and the SA will submit it to the CMS Regional Office in lieu of the completed civil rights package.

6. Appendix Q, Guidelines for Determining Immediate Jeopardy.

7. Appendix Z, Emergency Preparedness for All Provider and Certified Supplier Types Interpretive Guidance.

8. CMS State Operations Manual (SOM) – Chapter 2, Provider Certification (§2180 through §2186).

9. Home Health Agency Regulations, Survey Protocols, & Interpretive Guidelines, SOM Appendix B

10. Initial Surveys for New Medicare Providers, CMS S&C Letter 08-03.

11. Revised HHA Initial Certification Process, CMS S&C Letter 12-15.

12. Refer to CMS Exhibit 63 for additional document assistance.

Become a Medicaid Provider:

To become an Idaho Medicaid provider, you must submit an Idaho Medicaid Provider Enrollment application to Gainwell, Idaho’s Medicaid Management Information Systems (MMIS) vendor. To submit an Idaho Medicaid provider enrollment application, go to www.idmedicaid.com and register for a trading partner account. A step-by-step user guide can be found by selecting Reference Material, User Guides, New Provider Enrollment Guide. Additional provider enrollment help is available by contacting your Provider Relations Consultant or Provider Services. Contact information can be found at www.idmedicaid.com or call 866-686-4272.

Applying to be an Idaho Medicaid provider is a separate process from federal certification and state licensure.

Medicare/Medicaid reimbursement is not retroactive and usually becomes effective only after your enrollment application is approved, the initial survey is completed, and you are in compliance with all regulations or have submitted an acceptable plan of correction.