HOME HEALTH SERVICES PROVIDER IN IDAHO

DELIVERING SKILLED NURSING, THERAPEUTIC, AND PERSONAL SUPPORT SERVICES IN THE COMFORT OF PARTICIPANTS’ HOMES

Home Health Services in Idaho provide skilled medical care, therapy, and support services to individuals who require clinical oversight while remaining in their homes. These services are authorized under Idaho’s Medicaid State Plan and Home and Community-Based Services (HCBS) waiver programs, promoting health, recovery, and independence while preventing unnecessary institutionalization.

1. GOVERNING AGENCIES

Agency: Idaho Department of Health and Welfare (IDHW) — Division of Medicaid

Role: Oversees Medicaid provider enrollment, service authorization, and reimbursement for Home Health Services

Agency: Idaho Department of Health and Welfare (IDHW) — Bureau of Facility Standards

Role: Licenses and inspects Home Health Agencies operating in Idaho

Agency: Centers for Medicare & Medicaid Services (CMS)

Role: Provides federal oversight ensuring Home Health Services meet Medicaid and Medicare standards for quality and safety

2. HOME HEALTH SERVICE OVERVIEW

Home Health Services consist of medically necessary skilled care delivered to participants who are homebound or require intermittent skilled services.

Approved providers may deliver:

• Skilled nursing services (e.g., health monitoring, medication administration, wound care)

• Physical therapy (PT) services (e.g., mobility training, strength rehabilitation)

• Occupational therapy (OT) services (e.g., activities of daily living (ADL) support, adaptive techniques)

• Speech-language pathology (SLP) services (e.g., speech, language, or swallowing therapy)

• Home health aide services (e.g., basic personal care under nurse supervision)

• Medical social work (e.g., counseling, discharge planning, resource linkage)

Services must be ordered by a physician and based on a participant’s individualized Plan of Care (POC), with goals supporting health stabilization, rehabilitation, or the prevention of decline.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

• Register business with the Idaho Secretary of State

• Obtain EIN from the IRS and NPI (Type 2)

• Obtain a Home Health Agency License through IDHW’s Bureau of Facility Standards

• Obtain Medicare Certification (optional but recommended for dual Medicare/Medicaid billing)

• Enroll as a Medicaid provider through Idaho Medicaid Provider Enrollment

• Maintain general liability, professional liability, and malpractice insurance

• Employ licensed clinical staff, including RNs, LPNs, PTs, OTs, SLPs, MSWs, and Home Health Aides

4. IDHW PROVIDER ENROLLMENT PROCESS

Initial Interest and Application:

• Submit application for Home Health Agency Licensing through the Bureau of Facility Standards

• Prepare for a pre-licensure inspection covering staffing, patient care protocols, infection control, and emergency planning

Application and Documentation Submission:

• Submit Articles of Incorporation, proof of EIN/NPI, staff credentialing documentation, operational policies, emergency response plans, and quality assurance programs

Licensure and Readiness Review:

• Undergo licensing survey by IDHW Bureau of Facility Standards

• Undergo Medicare Certification Survey if seeking Medicare enrollment

• Complete Medicaid enrollment through Idaho Medicaid Management Information System (MMIS)

Approval & Medicaid Enrollment:

• Upon approval, configure billing codes for home health skilled nursing visits, therapy sessions, aide services, and medical social work services

5. REQUIRED DOCUMENTATION

• Articles of Incorporation or Business License (Idaho Secretary of State)

• IRS EIN confirmation

• NPI confirmation

• Home Health Agency License (IDHW)

• Proof of general, professional, and malpractice insurance

• HCBS-Compliant Policy & Procedure Manual including:

  • Participant intake, physician orders, and care planning processes

  • Skilled nursing, therapy, and personal care service delivery protocols

  • Infection control and emergency preparedness procedures

  • HIPAA confidentiality, participant rights, and grievance handling policies

  • Staff credentialing, background checks, and clinical supervision documentation

  • Medicaid billing, service tracking, and audit readiness procedures

6. STAFFING REQUIREMENTS

Role: Administrator / Director of Nursing (DON)

Requirements: Licensed Registered Nurse (RN) in Idaho; experience managing home health operations; background screening clearance

Role: Skilled Nursing Staff (RNs, LPNs)

Requirements: Active Idaho nursing license; CPR certification; experience in home health preferred

Role: Licensed Therapists (PTs, OTs, SLPs)

Requirements: Active Idaho licensure in the respective therapy discipline

Role: Home Health Aides (HHAs)

Requirements: Certification from an approved HHA training program; supervised by an RN

Role: Medical Social Workers (MSWs)

Requirements: Master’s degree in social work; Idaho licensure preferred; experience in healthcare settings

All staff must complete:

• HIPAA confidentiality and participant rights training

• Emergency preparedness, infection control, and incident management training

• Annual competency evaluations and continuing clinical education

7. MEDICAID WAIVER PROGRAMS

Home Health Services are authorized under:

• Medicaid State Plan Home Health Benefit

• Aged and Disabled (A&D) Waiver (where applicable for short-term skilled supports)

• Developmental Disabilities (DD) Waiver (for specific skilled interventions)

Approved providers may deliver:

• Intermittent skilled nursing, therapy, and aide services

• Short-term rehabilitation and recovery support

• Health maintenance services in community living settings

8. TIMELINE TO LAUNCH

Phase: Business Formation and Licensing Setup

Timeline: 2–4 months

Phase: Staff Hiring, Credentialing, and Clinical Program Development

Timeline: 2–3 months

Phase: IDHW Licensure and (Optional) Medicare Certification

Timeline: 3–6 months

Phase: Medicaid Enrollment and Billing System Configuration

Timeline: 45–60 days

9. CONTACT INFORMATION

Idaho Department of Health and Welfare (IDHW) — Medicaid Division

Website: https://healthandwelfare.idaho.gov/services-programs/medicaid-health

Idaho Department of Health and Welfare (IDHW) — Bureau of Facility Standards

Website: https://healthandwelfare.idaho.gov/providers/facility-licensing-certification

Centers for Medicare & Medicaid Services (CMS)

Website: https://www.cms.gov/

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — IDAHO HOME HEALTH SERVICES PROVIDER

WCG supports home health agencies, healthcare startups, and clinical organizations in launching Medicaid-compliant Home Health Services under Idaho’s HCBS waiver programs and Medicaid State Plan benefits.

Scope of Work:

• Business registration and EIN/NPI setup

• Home Health Agency licensing and Medicare certification support

• Medicaid provider enrollment assistance

• Development of Home Health Services Policy & Procedure Manual

• Staff credentialing templates and participant intake/care planning forms

• Medicaid billing system setup and claims management

• Website, domain, and email setup

• Clinical documentation, infection control, and quality assurance systems

• Emergency preparedness planning and incident response documentation

• Community networking and healthcare partnership strategies

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