HOME HEALTH SERVICES PROVIDER IN ILLINOIS

DELIVERING SKILLED NURSING, THERAPY, AND PERSONAL CARE SERVICES TO INDIVIDUALS IN THEIR OWN HOMES

Home Health Services in Illinois provide medically necessary skilled nursing, therapeutic, and personal care services to individuals recovering from illness, managing chronic conditions, or requiring support to remain safely in their homes. These services are authorized under the Illinois Medicaid State Plan and Medicare programs, helping individuals avoid institutional care and maintain health and independence.

​​​​1. GOVERNING AGENCIES

Agency: Illinois Department of Public Health (IDPH) — Division of Health Care Facilities and Programs

Role: Licenses and regulates Home Health Agencies (HHAs) to ensure compliance with state and federal requirements

Agency: Illinois Department of Healthcare and Family Services (HFS)

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

Agency: Centers for Medicare & Medicaid Services (CMS)

Role: Oversees Medicare-certified Home Health Agencies, ensuring quality and compliance with Conditions of Participation (CoPs)

2. HOME HEALTH SERVICE OVERVIEW

Home Health Services provide skilled healthcare and personal care support in an individual’s residence under a physician's order and based on a written plan of care.

Approved providers deliver:

• Skilled nursing services (e.g., wound care, medication administration, disease management)

• Physical therapy, occupational therapy, and speech-language pathology

• Medical social services and counseling

• Home health aide services to assist with personal care activities such as bathing, dressing, grooming, and toileting

• Patient and caregiver education for health condition management

• Coordination with physicians and case managers to adjust care plans as needed

Services must be medically necessary, ordered by a licensed physician, and provided under the supervision of a registered nurse or licensed therapist.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

• Register business entity with the Illinois Secretary of State

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

• Apply for and obtain a Home Health Agency License through IDPH

• Obtain Medicare Certification through CMS (if serving Medicare beneficiaries)

• Enroll as a Medicaid provider through the Illinois Medicaid Provider Enrollment Portal (IMPACT system)

• Secure professional and general liability insurance

• Develop a comprehensive Home Health Services Policy and Procedure Manual

• Establish systems for clinical record-keeping, billing compliance, and quality assurance

• Ensure that all clinical and administrative staff meet licensing, background checks, and continuing education requirements

4. IDPH AND CMS PROVIDER ENROLLMENT PROCESS

Initial Application and Pre-Licensure Preparation:

• Submit Home Health Agency License application to IDPH along with required operational policies, staffing plans, financial documents, and quality management plans

Licensure and Medicare Certification Survey:

• IDPH conducts a pre-licensure inspection and an initial survey to verify compliance with Illinois Home Health regulations and CMS Conditions of Participation

• Successful survey results allow the agency to obtain state licensure and, if applicable, Medicare certification

Enrollment in Medicaid and Medicare:

• Complete enrollment via the IMPACT system for Medicaid billing authorization

• Complete enrollment via CMS PECOS for Medicare billing authorization

5. REQUIRED DOCUMENTATION

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

• IRS EIN confirmation

• NPI confirmation

• IDPH-issued Home Health Agency License

• Medicare Provider Number (if Medicare-certified)

• Proof of general liability and professional insurance

• Home Health Services Policy & Procedure Manual including:

  • Patient admission, care planning, and service delivery procedures

  • Skilled nursing, therapy, and aide service protocols

  • Emergency preparedness, infection control, and patient safety plans

  • Patient rights, HIPAA confidentiality, and grievance procedures

  • Staff credentialing, background checks, training, and competency verification

  • Billing, coding, and audit readiness documentation

6. STAFFING REQUIREMENTS

Role: Administrator

Requirements: Bachelor's degree preferred; experience managing home health operations; background screening clearance

Role: Clinical Director / Director of Nursing (DON)Requirements: Licensed Registered Nurse (RN) with at least one year of supervisory experience in home health; background clearance

Role: Registered Nurses (RNs) and Licensed Practical Nurses (LPNs)Requirements: Active Illinois nursing license; CPR certification; clinical competency assessments

Role: Physical Therapists, Occupational Therapists, Speech-Language Pathologists

Requirements: Active Illinois licensure in respective therapy disciplines; CPR certification

Role: Home Health Aides (HHAs)Requirements: Completion of state-approved HHA training and competency evaluation; background clearance

All staff must complete:

• Patient rights and HIPAA compliance training

• Infection control, emergency preparedness, and abuse prevention training

• Skills competency verification and continuing education updates

7. MEDICAID STATE PLAN AND MEDICARE COVERAGE

Home Health Services are reimbursed through:

• Illinois Medicaid State Plan Home Health Benefit: For eligible participants requiring skilled services in the home setting

• Medicare Part A Home Health Benefit: For short-term, medically necessary skilled services following physician certification of homebound status

• Medicaid Waiver Programs: Certain waivers allow expanded in-home service options for targeted populations (e.g., elderly, persons with disabilities)

Approved providers deliver:

• Intermittent skilled nursing and therapy services

• Personal care support through home health aides

• Health education and chronic disease self-management training

• Transition support post-hospital discharge

8. TIMELINE TO LAUNCH

Phase: Business Formation and Licensing Preparation

Timeline: 2–4 months

Phase: Staffing, Clinical Program Development, and Pre-Survey Readiness

Timeline: 2–4 months

Phase: IDPH Licensure Inspection and Medicare Certification Survey

Timeline: 3–6 months

Phase: IMPACT Medicaid Enrollment and PECOS Medicare Enrollment

Timeline: 60–90 days

Phase: Billing Setup and Home Health Service Launch

Timeline: 30–45 days

9. CONTACT INFORMATION

Illinois Department of Public Health (IDPH) — Home Health Licensing

Website: https://dph.illinois.gov/topics-services/health-care-regulation/home-health-agencies.html

Illinois Department of Healthcare and Family Services (HFS)

Website: https://www.hfs.illinois.gov/

Centers for Medicare & Medicaid Services (CMS)

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

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

WCG assists Home Health Agencies (HHAs), skilled care providers, and therapy service organizations in launching Medicaid and Medicare-compliant Home Health Services across Illinois.

Scope of Work:

• Business registration, Home Health Agency licensure application, and Medicare certification support

• Medicaid provider enrollment (IMPACT) and Medicare enrollment (PECOS) assistance

• Development of Home Health Services Policy & Procedure Manual

• Staff credentialing templates, clinical documentation systems, and compliance tracking tools

• Medicaid and Medicare billing setup and revenue cycle management

• Website, domain, and professional marketing setup

• Survey preparation services, quality assurance program development, and corrective action planning

• Patient satisfaction initiatives and healthcare referral network development strategies

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