1. Program Definition and Services 

Home health services in Michigan provide medical care and support to individuals in their homes, including skilled nursing care, physical therapy, occupational therapy, speech-language pathology, and home health aide services. These services are designed for individuals who require intermittent care due to an illness, injury, or disability and cannot access services in an outpatient setting. 

2. Regulations 

Key regulations governing home health services include: 

• Michigan Medicaid Regulations: Services must comply with Medicaid standards for reimbursement. 

• Federal Requirements for Medicare and Medicaid: Home health agencies must meet federal Conditions of Participation (CoPs) for certification. 

• Michigan Public Health Code: While not specific to home health, it outlines general health service standards. 

3. Licensing or Certification 

While Michigan does not require a state license for home health agencies, they must be certified by the Centers for Medicare and Medicaid Services (CMS) to participate in Medicare and Medicaid programs. Certification involves meeting federal standards and undergoing surveys by CMS or an accrediting organization. 

4. Responsible State Agency 

The Michigan Department of Licensing and Regulatory Affairs (LARA) handles federal certification surveys, while the Michigan Department of Health and Human Services (MDHHS) oversees Medicaid services. 

5. Application Process 

To become certified, home health agencies must complete the CMS-855A application and submit it to the Medicare Administrative Contractor (MAC). Agencies may also choose to become accredited by a CMS-approved accrediting organization to meet certification requirements. 

6. Required Documentation 

• Business Registration Documents: Proof of business registration in Michigan. 

• Insurance and Liability Coverage: Proof of adequate insurance coverage. 

• Staff Qualifications: Documentation of staff qualifications, including licenses and certifications. 

• CMS-855A Application: Completed application for Medicare certification. 

• Accreditation Report (if applicable): From a CMS-approved accrediting organization. 

• Clinical Records and Policies: Documentation of clinical records and policies governing service delivery. 

7. Timeline for Approval 

The approval timeline varies depending on the completeness of the application and certification process. Generally, it can take several weeks to a few months. 

8. Pre-Application Process 

Prospective providers should familiarize themselves with federal and state regulations before applying. 

9. Pre-Application Training 

While not explicitly mandated, providers must ensure their staff are trained in home health care principles and practices, including the use of the Outcome and Assessment Information Set (OASIS) for Medicare and Medicaid beneficiaries. 

10. Additional Notes 

• Electronic Visit Verification (EVV): Required for Medicaid home health services to ensure accurate billing. 

• OASIS Assessments: Mandatory for Medicare-certified home health agencies to assess patient outcomes and needs.