CMS Issues Letter to State Agency Directors Changing Process for Initial Home Health Agency Enrollment

On December 23, 2011, CMS issued S&C: 12-15-HHA relating to changing the process by which State Agencies process home health agency initial certifications.  The major change initiated with this guidance is that CMS has directed State Agencies to add an additional level of review to the initial certification process for home health agencies.

The new level in the process requires a second review of enrollment criteria
by the Regional Home Health Intermediary (“RHHI”) or Medicare Administrative Contractor (“MAC”).  The guidance advises that the CMS Regional Office (“RO”) will hold off on issuing a CMS certification number (CCN) and provider agreement until the additional review has been completed. The additional review is to include site visit verification, an assessment of compliance with capitalization requirements, and confirmation of no Medicare exclusions.

Once the review is completed, the RO is to be notified.  If the RO concurs with the results of this second level of review, it will then move forward on issuing a CCN and  provider agreement. The RO will forward aForm CMS-2007 to the RHHI/MAC, with the effective date of participation being the date on which the home health agency was determined to the be in compliance.

These new procedures are in line with the new Provider Enrollment requirements that were enacted in the Affordable Care Act and are geared toward ensuring program integrity. CMS continues to implement the new provider enrollment requirements and providers will likely see more guidance and changes in procedure in the future.

You can find a copy of the guidance here —> S&C: 12-15-HHA

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