A hospital in Idaho is a facility providing care to two or more individuals for 24 or more consecutive hours, is staffed to provide professional nursing care on a 24 hour basis, and is primarily engaged in providing, by or under the daily supervision of physicians, one or more of the following:
- Concentrated medical and nursing care on a 24 hour basis to inpatients experiencing acute illness;
- Diagnostic and therapeutic services for medical diagnosis and treatment, psychiatric diagnosis and treatment, and care of injured, disabled, or sick persons;
- Rehabilitation services for injured, disabled, or sick persons;
- Obstetrical care
To establish State licensure and Centers for Medicare/Medicaid Services (CMS) Medicare Certification as a hospital provider, an applicant must complete and submit an application packet. Application materials are located below, or may be requested through the Bureau of Facility Standards at 208-334-6626.
All building construction plans must be submitted for review and approval by the Fire Safety and Construction Program Supervisor. For additional information regarding these requirements, please refer to the Fire Safety and Construction page.
The application packet includes the items that must be submitted, reviewed, and approved prior to an initial survey (Items #1–5 below), as well as, resources for additional information related to hospitals (Items #6-12 below):
- A temporary hospital license is required to admit patients. To obtain a license, complete the Application for a hospital license and develop and submit to this office for review and approval the information on the Hospital Initial Application Checklist. A temporary hospital license will be issued only after the information has been received, reviewed, and approved by this office and the building has been approved for occupancy.
2. Health Insurance Benefit Agreement (CMS form 1561) (two signed originals required)
3. Fiscal Year Ending Form
4. “Office of Civil Rights Clearance for Medicare Certification” (OCR) Assurance of Compliance HHS-690 (two signed originals required). This form may be answered and submitted, on line, via https://ocrportal.hhs.gov/ocr/aoc/instruction.jsf If the provider chooses to submit the civil rights package on line, 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.
5. CMS requires all new applicants for hospitals to complete the form CMS-855A, Medicare Application for Health Care Providers that will Bill Fiscal Intermediaries, and forward it to the Fiscal Intermediary (FI) or Medicare Administrative Contractor (MAC) for approval. This may be accomplished either by submitting a hardcopy or electronically.
The FI/MAC for Idaho is:
Noridian Administrative Services
P.O. Box 6726
Fargo, ND 58108-6726
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-855). Information about this option may be found at the following site: PECOS
6. S&C-08-03 Initial Surveys Initial surveys for new Medicare providers
7. IDAPA 16.03.14, Idaho Administrative Rules for Hospitals
8. Appendix A, Federal Regulations, Interpretive Guidelines, and Survey Protocols for Hospitals (apply to ALL hospital types)
9. Appendix AA, Federal Regulations and Interpretive Guidance for Psychiatric Hospitals
10. Appendix V, Federal Regulations and Interpretive Guidelines for Responsibilities of Medicare Participating Hospitals in Emergency Cases
11. Appendix Q, Federal Guidelines for Determining Immediate Jeopardy
12. Fire Safety Survey Report - CMS form 2786R (New or Existing)
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
To become an Idaho Medicaid provider, you must submit an Idaho Medicaid provider enrollment application to DXC Technology, 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.