Contacts
Division of Health Care Facility Licensure and Certification
The Details of Apply for Home Health Agency Medicare Certification
What you need for Apply for Home Health Agency Medicare Certification
State Regulations
- You don't have to apply to the Department to open a home health business. Massachusetts laws for the Department of Public Health do not include licensure of home health agencies.
- The Massachusetts Department of Labor Standards licenses certain home health agencies under its regulations for employment agencies. This licensure is a state requirement for conducting a home health business. For more information, call (617) 626-6970.
- A home health agency is required to report employee misconduct toward persons receiving services to the Department. This regulation applies to any home care agencies whether is it Medicare certified on not.
Medicare HHA Program Regulations
- The agency must provide skilled nursing and at least one other qualifying service (i.e. physical therapy, occupational therapy, speech/language pathology, medical social services, home health aides).
- Agency employees must provide at least 1 qualifying service. All other services may be provided by contract with a third party.
Application Instructions
If you wish to apply for Medicare certification, complete all steps included in the HHA Application Instructions.
Required forms
- Home Health Agency Medicare Deemed Status Certification Checklist
- CMS-1561 Health Insurance Benefit Agreement (PDF)
- 3 copies, all of which must be fresh-ink originals
- CMS-1572 Home Health Agency Survey & Deficiencies Report
- Omit numbers 7, 8, 11, 21, 22
- HHS-690 Assurance of Compliance
- Either a fresh-ink original copy or an email receipt from an online submission
- OMB 0990-2043 Civil Rights Information Request Form
- Either printed with signed checklist and attachments or an email receipt from an online submission
- See the CMS Technical Assistance Regarding Civil Rights
Resources
- See a list of CMS accrediting agencies
- Obtain a National Provider Identifier (NPI)
- CMS tech assistance regarding civil rights
Medicaid Enrollment
- In order for your agency to participate in the Massachusetts Medicaid program, it first must be certified as an HHA in the Medicare program. To pursue Medicaid enrollment, contact MassHealth Provider Enrollment at (800) 841-2900.
How to apply Apply for Home Health Agency Medicare Certification
- Complete all steps in the HHA Application Instructions
- Compile all required documents in the following order:
- Home Health Agency Medicare Deemed Status Certification Checklist (cover sheet)
- CMS-1561 Health Insurance Benefit Agreement
- 3 copies, all of which must be fresh-ink originals
- HHS-690 Assurance of Compliance
- Either a fresh-ink original copy or an email receipt from an online submission
- OMB 0990-2043 Civil Rights Information Request Form
- Either printed with signed checklist and attachments or an email receipt from an online submission
- See the CMS Technical Assistance Regarding Civil Rights
- A deemed status letter from a Medicare-approved Accrediting Agency. It will state that your agency meets Medicare Conditions of Participation and the effective date of this finding.
- CMS-1572 Home Health Agency Survey & Deficiencies Report
- Omit numbers 7, 8, 11, 21, 22
- Mail the request to:
Licensure Coordinator
Department of Public Health
Division of Health Care Facility Licensure and Certification
67 Forest Street
Marlborough, MA 01752
Next steps for Apply for Home Health Agency Medicare Certification
Processing and Medicare provider number
According to CMS protocol, the Division of Health Care Facility Licensure and Certification will process these materials to the CMS Regional Office (CMS-RO). Subsequently, CMS-RO will assign a Medicare provider number to your agency.
Contact for Apply for Home Health Agency Medicare Certification
Address
67 Forest St., Marlborough, MA 01752