A Home Health Agency is an agency providing skilled nursing services and at least one of the following other therapeutic services: physical therapy, speech language pathology, occupational therapy, medical social services, or home health aide services in the place of residence used as the patient’s home.
To establish State licensure and 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 requested through the Bureau of Facility Standards at 208-334-6626.
The application packet includes what must be submitted, reviewed, and approved (Items #1-6) prior to an initial survey and resource information related to HHAs (Items #7-12):
- An HHA license is required to serve patients.To obtain a license, complete the HHA license Application and develop and submit, to this office for review and approval, the information on the HHA Licensure Checklist. You may use this Personnel Review Form to track compilation of personnel documents to be submitted. An HHA license will be issued only after the information has been received, reviewed, and approved by this office.
- Health Insurance Benefits Agreement - CMS 1561 Form (two signed originals required)
- Fiscal year ending date Form,
- Home Health Agency Survey and Deficiencies Report - CMS 1572a Form Complete sections 1-22 of the form
- 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 hardcopy or electronically. Submit the hardcopy to:
The RHHI for Idaho is:
National Government Services
P.O. Box 7143
Indianapolis, IN 46207-7143
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
6. “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.
7. Appendix Q, Guidelines for Determining Immediate Jeopardy,
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. State Rules, IDAPA 16.03.07, Rules for Home Health Agencies in Idaho,
11. Initial Surveys for New Medicare Providers, CMS S&C Letter 08-03,
12. Revised HHA Initial Certification Process CMS S&C Letter 12-15
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 survey is completed, and you are in compliance with all regulations or have submitted an acceptable plan of correction.
Resources for Home Health Agencies
PO Box 83720
Boise, ID 83720-0009