There are about 11,500 Medicare-certified home health agencies in the United States. Becoming a Medicare-certified home health agency requires strict adherence to the rules of the Medicare program. For those interested in participating, here is the latest information.
What is a Certified Home Health Agency (CHHA)?
Certified Home Health Agencies are responsible for providing care and support services to people with home health care needs. Nursing and home health aide services are provided, as well as physical and occupational therapy, speech pathology, medical social work, nutrition services, and other professional services.
How does Medicare cover home health agencies?
The Centers for Medicare and Medicaid Services provides a checklist. Medicare coverage for intermittent home health aide services usually lasts 21 days. It’s generally covered for less than seven days a week and less than eight hours per visit. Medicare-approved health agencies’ requirements include being licensed in the state where the patient is located. They must maintain quality assurance and patient satisfaction programs.
How does Medicare approve home health agencies?
Medicare has implemented a six-step approval process for home health agencies. Before applying for Medicare certification, home health agencies must meet the conditions of participation in 42 Code of Federal Regulations Part 484.
Application process: Licensed home health agencies can apply for enrollment in the Medicare program via mail or online. To submit via mail, the home health care agency must complete the Medicare Enrollment Application, which is available here (CMS-855A). Online applications can be submitted to the Internet-based Provider Enrollment, Chain, and Ownership System (PECOS).
Application review: After the application is submitted via mail or online, Palmetto Government Benefits Administration (Palmetto GBA) has a six-month window to review, approve or deny the Medicare Enrollment Application. A letter of approval or denial will be sent to the Home Health Agency.
Provider requirements: Applicants must complete and submit federal forms and documents to the Laboratory and In-Home Services Unit before certification. The required forms are listed below:
- OASIS G325 Compliance letter
- CMS 1561, Health Insurance Benefit Agreement
- HHS 690, Assurance of Compliance Medicare
- OMB No. 0945-0006, Civil Rights Information Request for Medicare Certification
- Nondiscrimination policies and notices
Skilled care services: The agencies are required to offer skilled nursing care, physical therapy, speech therapy, and occupational therapy. CMS will not reimburse any services before the effective date determined by CMS, so Medicare patients need not apply.
Survey requirement: CMS requires an accredited organization to survey the Medicare Conditions of Participation to comply with federal certification standards.
The deemed survey report must be sent to AHCA Laboratory and In-Home Services once completed. CMS has approved the following organizations for conducting deemed surveys on behalf of Medicare and Medicaid:
- Community Health Accreditation Program – http://www.chapinc.org
- The Joint Commission – www.jointcommission.org
- Accreditation Commission for Health Care – https://www.achc.org/
Enrollment: If the requirements have been met, the AHCA Laboratory and In-Home Services Unit will forward the deemed survey and the civil rights documentation. CMS will send a tie-in notice letter with the home health agency’s Medicare provider number, and this process may take four to six weeks.
Lindsay Malzone is the Medicare expert for Medigap.com. She’s been contributing to many well-known publications as an industry expert since 2017. Her passion is educating Medicare beneficiaries on all their supplemental Medicare options so they can make an informed decision on their healthcare coverage.