Idaho Medicaid Provider Handbook, Home Health and Hospice Services § 3.2

Home health agencies must at a minimum offer skilled nursing, home health aides, and

durable medical equipment and supplies. Home health agencies must be certified to

participate in the Medicare Program. Services must be within the scope of practice,

certification/licensure, and training of the provider rendering them. The provider must have

a National Provider Identifier (NPI) to be eligible for enrollment. Enrollment as an Idaho

Medicaid provider and entering into a provider agreement must be completed prior to

providing services for Idaho Medicaid participants.

All employees of a home health agencies must receive a clearance from a background check

through the Idaho Department of Health and Welfare.

Before a provider agreement can be entered into, the agency must have a surety bond of

$50,000, 15% of the most recent annual total of Medicaid payments the provider received for

home health services, or the most recent annual period’s total overpayments, whichever is

greater. A copy must be furnished to the department. An annual or continuous bond is

acceptable. Changes in ownership do not affect the annual review or requirement for

submitting a bond before entering into a provider agreement. New home health agencies do

not use the 15% calculation. The bond must specify the home health agency as the principal,

Medicaid as the obligee and the surety company. The department reserves the right to

determine a surety company is ineligible to provide the necessary bond for good cause, which

will be specified by public notification and effective date. Government operated home health

agencies do not require a bond unless they have had uncollected overpayments. Government

operated agencies have 60 days to furnish a bond if notified by Medicaid that they are not

eligible for an exclusion.

The surety bond must guarantee that, upon written demand by Medicaid or its designee with

sufficient evidence to establish liability under the bond, the Surety will timely pay Medicaid

the amount, up to the stated amount of the bond. The bond must include the Surety is liable

for uncollected overpayments and amounts if the agency doesn’t renew or meet their bond

requirements. Liability to Medicaid cannot be revoked or limited by:

•

Any action of the home health agency or the surety to limit the scope or term the

bond.

•

The Surety no longer meeting requirements and becoming unauthorized.

•

Termination of the home health agency’s provider agreement.

•

Any action by the Medicaid agency to suspend, offset, or otherwise recover payments.

•

Any action by the home health agency to:

o

Cease operation.

o

Sell or transfer any assets or ownership;

o

File for bankruptcy.

o

Failure to pay the surety.

•

Any fraud, misrepresentation, or negligence by the agency in obtaining the surety

bond or by the Surety in issuing the bond, except that any fraud, misrepresentation,

or negligence by the agency in identifying to the Surety the amount of Medicaid

payments upon which the amount of the surety bond is determined shall not cause the

Surety's liability to the Medicaid agency to exceed the amount of the bond.

Liability can be revoked if the agency obtains a new acceptable bond, or the Surety informs

Medicaid within 10 days of notice from the home health agency that the bond is being

terminated or limited, or no later than 60 days before the effective date of the Surety

terminating the bond. If a new bond is obtained, the agency has 60 days to submit it to

Medicaid.

Medicaid must deny or cancel the agency’s provider agreement, if these requirements are not

met. Medicaid can request proof of compliance at any time. Appeal rights are available for

actions involving sureties. See the General Information and Requirements for Providers, Idaho

Medicaid Provider Handbook for more information about appeals.

Home health agencies must have an Electronic Visit Verification (EVV) system compatible with

the state’s EVV aggregator, Sandata, for all home health services that require an in-home

visit. See the EVV section in the General Billing Instructions, Idaho Medicaid Provider

Handbook for more information about EVV requirements.

All provider handbook and applicable state and federal regulations must be followed to

maintain eligibility for reimbursement. See the General Information and Requirements for

Providers, Idaho Medicaid Provider Handbook for more information on enrolling as an Idaho

Medicaid provider.