CMS/Federal Resources

Skilled Nursing Facilities are licensed by the State of Idaho and Federally certified by CMS.  Providers can submit an application for the purposes of initial licensure and change of ownership.  The requirements below must be submitted to the Idaho Bureau of Facility Standards a minimum of ninety (90) days prior to the anticipated date of ownership.

The Skilled Nursing Facility licensure includes items that must be submitted and approved by the Department of Health and Welfare prior to an Initial Certification Survey being conducted.  

State licensure requirements include the following:

1.  Complete the Nursing Home Application. 

2.  Complete the Fiscal Year Ending Form: form.

3.  Submit a full copy of the Facilities Policies and Procedures via USB/flash drive.

You will need to develop your policies and procedures and send them to this office to be reviewed at least ninety (90) days prior to your scheduled opening.  The following are guidelines for developing your policies and procedures:

• They should address, but not be limited to, all Federal regulations and State rules as they apply to the provision of care for residents in the SNF.
• Use consistent style and format throughout the documents.
• If using policies established by other facilities, ensure they reflect only the name of the facility requesting the license.
• Be organized with a table of contents and/or index, indicating page numbers and sections.  
• Policies listed in table of contents should indicate the general areas to Federal regulations and State rules to which they apply. 

4.  A copy of lease agreement/deed for building and property.

5.  A copy of final bill-of-sale.

6.  A copy of management group contract (if applicable).

7.  A copy of ownership, leadership, and staff/professional organizational chart(s).

8.  An understanding and compliance with all State Administrative Rules found at:  IDAPA 16.03.02, Rules and Minimum Standards for Skilled Nursing and Intermediate Care Facilities

In addition to State licensure requirements, Federal certification requirements include the following:

1.  CMS requires all initial applicants/CHOWs/CHOIs for Skilled Nursing Facilities to complete a CMS-855a, Medicare Application for Health Care Providers, and submit to the Medicare Administrative Contractor (MAC).

The MAC for Idaho is: 

Noridian Administrative Services
P.O. Box 6726
Fargo, ND  58108-6726

888-608-8816

www.noridianmedicare.com

2.  Complete the Health Insurance Benefit Agreement CMS-1561.

3.  Complete the CMS-671.

4.  Complete the CMS-672.

5.  Complete the “Office of Civil Rights Clearance for Medicare Certification” (OCR) Information is available at Assurance of Compliance with Non-Discrimination Laws and Regulations.

6.  A copy of transfer agreement(s) with acute care hospital(s).  The new owner must be a party to the transfer agreement, not the previous owner.

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

In addition to the above, here are additional steps which must be completed:

Medicaid Provider Enrollment: reach out to Gainwell Technologies at 1-866-686-4272 which is the Provider line or go to www.idmedicaid.com and look under the Provider tab for information on how to become a Medicaid provider or by email at idproviderenrollment@gainwell.com

All state licensed and/or federally certified health care facilities must complete the Facility Fire Safety and Construction requirements. Fire and Safety Standards