An Outpatient Physical Therapy/Speech Pathology (OPT/SP) provider provides an integrated interdisciplinary rehabilitation program designed to upgrade the physical functioning of disabled individuals by bringing specialized rehabilitation staff together to perform as a team and provide at a minimum the following services: physical therapy or speech-language pathology services and social or vocational adjustment services.
To establish Medicare Certification of an OPT/SP provider, an applicant must complete and submit an application packet. Application materials can be found below or requested through the Bureau of Facility Standards at 208-334-6626, option 4.
The application packet includes what must be submitted and approved by the Bureau of Facility Standards prior to an initial survey (items #1 - #4) and resource information related to OPT/SP providers (items #5 - #9) as follows:
- Request for Certification - CMS-1856,
- Health Insurance Benefits Agreement - CMS-1561, (two originals required)
- “Office of Civil Rights Clearance for Medicare Certification” (OCR) form. This form must be answered and submitted, on line, via https://ocrportal.hhs.gov/ocr/aoc/instruction.jsf You will receive an e-mail from the OCR stating you completed the civil rights submission. The e-mail will contain an OCR number. Submit a copy of this e-mail with the other application materials as indicated below.
- Fiscal year ending date form.
- Appendix E, Guidance to Surveyors: Outpatient Physical Therapy/Speech Pathology Services
- Appendix Z, Emergency Preparedness (EP)
- Appendix Q, Core Guidelines For Determining Immediate Jeopardy
- CMS Letter, S&C-08-03 Initial Surveys
- OPT/SP Survey Report - CMS-1893,
You may submit your completed application to:
Department of Health and Welfare
Bureau of Facility Standards
P.O. BOX 83720
BOISE, ID 83720-0036
PLEASE KEEP A COPY FOR YOUR RECORDS
CMS requires new applicants to complete a new form CMS-855A, when facility changes occur including the addition of a Hospice house. The form CMS-855A can be accessed on the Internet or requested directly from your fiscal intermediary/carrier:
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.