Home Health Agencies provide skilled nursing services and other therapeutic services to patients in their homes. Home Health Agencies are not licensed or registered by the Ohio Department of Health, but must be certified by the Centers for Medicare and Medicaid Services (CMS) if they intend to collect Medicare or Medicaid payments.
The Ohio Department of Health certifies approximately 800 Home Health Agencies.
A Home Health Agency (HHA) is an agency or organization that is primarily engaged in providing skilled nursing services and other therapeutic services, and that has policies established by a group of professionals (associated with the agency or organization), including one or more physicians and one or more registered professional nurses, to govern the services which it provides. Home Health Agencies are not licensed or registered by the Ohio Department of Health and Home Health Agencies that are certified by the Centers for Medicare and Medicaid Services (CMS) are regulated under 42 CFR 484. Ohio requires criminal records checks for all Home Health Agency staff who provide direct care to patients; these criminal records check rules are set forth in Chapter 3701-60 of the Ohio Administrative Code.
The Bureau of Regulatory Operations is responsible for processing initial and change of ownership applications.
The Bureau of Regulatory Operations certifies Home Health Agencies for participation in the Medicare and Medicaid programs. The Centers for Medicare and Medicaid Services (CMS) determines whether a provider can participate in the Medicare program with the help of its regional home health intermediary. The Ohio Department of Health (ODH) also assists CMS in making this determination by compiling information and, based on the information ODH collects, recommending to CMS whether the provider should be approved to participate. ODH uses the application process to compile information and make the recommendation. This approval is also a prerequisite for participation in the State Medicaid program as well. Please note that you cannot claim provider reimbursement for services furnished prior to your approval.
MEDICAID CERTIFICATION is administered by the Ohio Department of Medicaid (ODM). An application for Medicaid certification can be requested by calling ODM at (800) 686-1516.
CMS has instructed states to place a higher priority on recertification of existing providers, on complaint investigations, and on similar work for existing providers than for initial surveys of providers/suppliers newly seeking to participate in the Medicare program. Due to severe resources limited for Medicare survey and certification functions, in most states few providers that have an approved CMS accreditation organization (AO) option will be surveyed by CMS or the State. Home Health Agencies have the option of “Deemed Accreditation” status through Accreditation Organization (ACHC, CHAP or Joint Commission); and have the option of applying to one of the CMS approved AOs attached to this memorandum. If the facility would incur a hardship by going through a CMS approved AO; then the provider may apply by letter to the state agency for CMS consideration to grant an exception to the priority assignment of the initial survey if lack of Medicare certification would cause significant access-to-care problems for Medicare beneficiaries served by the provider or supplier. The state agency may choose to make a recommendation to CMS before forwarding the request to CMS.
There is no special form required to make a priority exception request. However, the burden is on the applicant to provide data and other evidence that effectively establishes the probability of adverse beneficiary health care access consequences if the provider is not enrolled to participate in Medicare. CMS will not endorse any request that fails to provide such evidence and fails to establish the special circumstances surrounding the provider’s or supplier’s request.
We regret that the resource limitations under which we operate may complicate the process of enrolling in Medicare as a certified provider or supplier.
Annual & Complaint Surveys:
The Bureau of Survey and Certification is responsible for conducting on-site surveys for compliance federal regulations. HHAs are not currently subject to an annual survey visit but do receive an unannounced survey on a schedule established by the Centers for Medicare and Medicaid Services. During these surveys, all aspects of care and services are evaluated based on federal laws and regulations.
You may view quarterly and annual quality of care reports online through our publications page.
Effective July 2, 2014, federal regulations for enforcement of Home Health Agencies (HHAs) went into effect. These regulations provide for the option of alternative sanctions against HHAs that are found to be out of compliance with the federal regulations and therefore in jeopardy of losing certification and receiving Medicare reimbursements. The alternative sanction option allows the state to make a recommendation of: civil money penalty (CMP), temporary management, suspension of payment of new admissions, directed plans of correction, and directed in-service training.
Investigation of a complaint in a HHA is completed by surveyors after receiving the written documentation from the Ohio Department of Health complaint unit located in Columbus, Ohio. For more information on how to file a complaint please visit our Complaints page. The toll free number for registering complaints is 1-800-342-0553 or you may obtain a Complaint Form online. The complainant may choose to be anonymous.
Health Care Provider Services: To obtain real-time information, generate, print and download reports regarding health care providers that are licensed and/or Medicare/Medicaid certified by the Ohio Department of Health.
Ohio Department of Health
Bureau of Regulatory Operations, HHA
246 North High Street
Columbus, OH 43215