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Michigan - Home Health Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

Michigan does not issue a state-level facility license for Home Health Agencies; instead, providers must obtain Medicare certification through the Department of Licensing and Regulatory Affairs (LARA) Bureau of Survey and Certification to enroll in Medicaid. The service delivers intermittent skilled nursing and therapeutic care under a physician-ordered plan of care, distinct from the non-medical personal care provided through the Home Help program.

Because the Centers for Medicare and Medicaid Services (CMS) has deprioritized initial state surveys, new agencies must achieve deemed status through an approved accrediting body to avoid indefinite processing delays. Providers must also integrate with the state's mandatory Electronic Visit Verification (EVV) system, HHAeXchange, before claims can be generated in the Medicaid portal.

1. Service Definition and Scope

Home Health services in Michigan provide medically necessary skilled nursing and therapeutic interventions to treat injuries, illnesses, or disabilities. These services are delivered intermittently in the beneficiary's residence under a physician's plan of care.

This service category strictly excludes non-medical personal care, which the Michigan Department of Health and Human Services (MDHHS) administers separately under the Home Help program. Providers must offer skilled nursing and at least one additional therapeutic service, such as physical therapy or medical social services, to qualify for certification.

2. Regulatory and Oversight Agencies

While Michigan does not license Home Health Agencies, LARA oversees the federal certification process on behalf of CMS. The LARA Bureau of Survey and Certification (BSC) processes deeming reports and conducts surveys for non-deemed providers when federal priorities permit.

The Michigan Department of Health and Human Services (MDHHS) manages Medicaid provider enrollment and billing. Individual clinicians employed by the agency are regulated by the LARA Bureau of Professional Licensing.

3. Gatekeeping Prerequisites: Who Can Even Apply

Michigan explicitly does not require a state facility license for Home Health Agencies. However, to become a Medicaid provider, an agency must first secure Medicare certification. CMS has designated initial surveys as lower-tier work, meaning Michigan will not conduct initial state surveys for non-deemed providers until higher-priority work is completed.

To bypass this indefinite delay, agencies must obtain deemed status through a CMS-approved accrediting organization (such as ACHC or CHAP). If an agency insists on the non-deemed route, they must submit a survey readiness letter proving they have already provided care to a minimum of 10 skilled patients, with at least 7 actively receiving care at the time of the survey.

4. Licensure and Certification Requirements

Because state licensure is not required, the primary regulatory hurdle is Medicare certification. Agencies must submit the CMS-855A Provider Enrollment Application to their Medicare Administrative Contractor (MAC) and undergo an initial certification survey.

Agencies utilizing an accrediting body for deemed status must ensure LARA's BSC receives a copy of the survey report and the final approval letter from the deeming authority. LARA then forwards the completed packet to the MAC for final determination.

5. Medicaid Provider Enrollment

Once Medicare certification is achieved, agencies must enroll in Michigan Medicaid through the Community Health Automated Medicaid Processing System (CHAMPS). Providers must enroll as a Facility/Agency/Organization (FAO).

Following CHAMPS enrollment, new Home Health Agencies must complete the HHAeXchange provider onboarding form to establish their Electronic Visit Verification (EVV) portal, which is a mandatory prerequisite for billing.

6. Staffing, Training and Background Checks

While the agency itself is not state-licensed, all clinical staff must hold active, unencumbered licenses through the LARA Bureau of Professional Licensing. This includes Registered Nurses, Physical Therapists, and Occupational Therapists.

Agencies must adhere to federal Medicare Conditions of Participation regarding staff qualifications, background checks, and ongoing in-service training requirements for home health aides.

7. Documentation, Policies and Records

Home Health Agencies must maintain comprehensive clinical records that comply with Medicare Conditions of Participation. This includes physician-signed plans of care, visit notes, and discharge summaries.

Additionally, agencies must maintain strict Electronic Visit Verification (EVV) records. Missing or incomplete EVV records in the HHAeXchange system will prevent claims from being created in CHAMPS.

8. Billing, Rates and Claims

Michigan Medicaid reimburses Home Health services on a fee-for-service basis through CHAMPS. As of June 1, 2024, MDHHS implemented a hard cutover requiring EVV for specific Home Health Care Services (HHCS) codes.

Claims for EVV-mandated codes must be billed exclusively through HHAeXchange. The EVV system validates the visit data and subsequently creates and submits the claim to CHAMPS for payment.

9. Approval Sequence and Timeline

The approval sequence begins with submitting the CMS-855A to the MAC, followed by achieving accreditation from a deeming authority. Once the deeming report is sent to LARA, the state forwards the packet to the MAC.

The MAC's final determination and issuance of the Medicare Provider Number can take 30 to 60 days from receipt of the completed packet from LARA. Only after this number is issued can the agency enroll in CHAMPS.

10. Common Denials and Survey Findings

A frequent cause for application denial or cessation of business notices is operating outside the approved geographic area. Any address or location change outside the initially specified area requires the provider to seek initial certification as a new Medicare provider.

In the billing phase, the most common cause of claim denial is incomplete EVV data. If caregivers fail to properly log visits in HHAeXchange, the system will block the claim from reaching CHAMPS.

11. Key Contacts and Resources

Providers must coordinate with federal contractors, state agencies, and EVV vendors to maintain compliance. LARA's Bureau of Survey and Certification handles the state-level routing of Medicare certification documents.

MDHHS manages the CHAMPS enrollment portal and the HHAeXchange EVV integration. Providers should monitor MDHHS L-Letters for policy updates.

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