Home Health Agencies

State Operations Manual (SOM) Chapter 2

SOM Appendix B for HHA Regulations

SOM Appendix Z for Emergency Preparedness

To voluntarily become a Medicare certified provider, you will need to complete the following steps and submit the paperwork electronically to LARA-BSCSupport@michigan.gov, unless otherwise noted in the instructions.

• Complete Provider Enrollment Application (CMS-855A) and submit to Medicare Administrative Contractor (MAC).
• The MAC will provide you a recommendation letter once the initial review is complete.
• An e-mail confirming a successful electronic submission of your Civil Rights Clearance for Medicare Provider Certification from the Office for Civil Rights (OCR).
• A signed Health Insurance Benefit Agreement (CMS-1561).
• Currently, CMS has prioritized initial surveys as a lower tier work. Following the guidance of the CMS Mission and Priority Document, Michigan is currently not performing initial surveys. A provider can become accredited to obtain certification.
• Contact Accrediting Organization (AO) to schedule survey  *Once the deeming survey is complete, please ensure the Department of Licensing and Regulatory Affairs (LARA), Bureau of Survey and Certification (BSC) receives a copy of the survey report and final approval letter from your deeming authority.
• Once all of the above documents have been received your application will be deemed complete, the Bureau of Survey and Certification will review and forward the packet to the MAC for final determination and issuance of the Medicare provider number.
• Please note, this process can take up to 30-60 days from the day of receipt by the MAC.

• Complete Provider Enrollment Application (CMS-855A) and submit to MAC within 90 days of the move.
• The MAC will provide you a recommendation letter once the initial review is complete.
• Complete the Branch Application and submit to LARA-BSCSupport@michigan.gov.
• For deemed providers, please submit the accrediting agency survey report that includes the new site(s).
• Once all of the above documents have been received and deemed complete, the Bureau of Survey and Certification will review and forward the packet to the MAC for final determination and issuance of final approval letter.
• Currently, additional practice location reviews are Tier 4 work according to the CMS Mission and Priority Document (MPD). Please be aware that onsite survey work takes priority over this type of request.

Quick Links:

HHA IDR Request Form

Submit A Case | iMPROve Health

Informal Dispute Resolution (IDR) Process:

• Available for home health agencies when condition-level deficiencies are cited under federal regulations at Title 42, CFR, Part 484.
• Detailed in Chapter 10 of the State Operations Manual.
• iMPROve Health (a peer review organization), contracted by the Bureau of Survey and Certification (BSC), conducts the IDR reviews and sends recommendations to BSC for the final IDR decision.
• The State Agency conducts the final review and notifies the facility of the outcome.

Submitting A Case:

• Acceptable and expected written case submission into the iMPROve Portal includes:
  • Applicable request form AND
  • A list of condition-level deficiency/ies being disputed and why AND
  • Documentation supporting your rebuttal.
• Case must be submitted into the iMPROve portal within 10 calendar days of the date on the CMS-2567.
• You waive the right to an IDR request if the above required information is not received timely.
• Do not submit copies of federal standards, de-identified documents, post-survey information, or legal arguments.

Details:

• Agencies can request IDR for each survey citing condition-level deficienceis.
• Findings from previous surveys cannot be challenged if IDR was already attempted or available.
• Deficiencies not corrected and carried forward from previous surveys are not eligible for IDR. New condition-level deficiencies from a subsequent survey are eligible for IDR.
• IDR cannot be used to delay sanctions or challenge the survey process.

• Unacceptable IDR requests include:
  • The severity assessment of a deficiency(s) at the standard level that constitutes substandard care or immediate jeopardy (IJ);
  • Sanctions imposed by the enforcing agency;
  • Alleged failure of the survey team to comply with a requirement of the survey process;
  • Alleged inconsistency of the survey team in citing deficiencies among agencies; and
  • Alleged inadequacy or inaccuracy of the IDR process.

Optional Conference Call:

• Agencies may request a conference call with iMPROve Health to present their case, in addition to the desk review.
• The home health agency bears the cost of the call.
• The call will be scheduled and led by iMPROve Health.
• BSC will designate a representative to attend in a listen-only capacity.

Contact 

• Questions? LARA-BSC-IDR@michigan.gov
• iMPROve Contacts: Aris Rhodes-Bond (248) 465-7405 or Bailey Brokmeyer (248) 465-1035