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FAQs Section 4: Medicare and Medicaid

4.1 How does my agency become Medicare and Medicaid certified?

Please see “How to get Medicare” and “How to get Medicaid” information sheets under “Home Health Agencies” at the Home Care Unit pages of this web site.

PLEASE NOTE: Once you receive your license from the Agency, you must begin serving patients. You cannot wait to begin serving patients after your application for Medicare or Medicaid has been processed. Effective July 1, 2008 failure to provide at least one service directly to a patient for a period of 60 days is grounds for denial or revocation of the license. Waiting for Medicare or Medicaid certification is not a valid reason for having no patients. A home health agency must be operational and have patients to stay licensed.

4.2 How do I get a branch office approved for my home health agency?

  1. Branch office must be in a county on the parent agency’s license.
  2. Branch office must be in the same AHCA geographic area as the parent.
  3. Branch must be separately licensed unless it is in the same county as the parent. The process for getting a home health agency license is the same for all home health agencies that are licensed. See question #1 above.
  4. The administrator of the parent HHA may also be the administrator of the branch, if the requirements in 400.462(1), Florida Statutes, are met.

For Medicare -

A Medicare Enrollment Application (CMS Form 855A) must have the branch sections completed according to the instructions on the form and submitted to the regional home health intermediary, Palmetto GBA. The form can be printed from the CMS web site at http://www.cms.hhs.gov/CMSForms/CMSForms/list.asp (at this site, click on “CMS Forms” on the left side of the screen, then pick the 855A form from the list of forms that will appear). If you have questions about completing the form, please contact Palmetto GBA at 803-382-6167. The completed CMS Form 855A must be mailed to the following address:

Palmetto GBA
Part A Provider Enrollment (AG-331)
P.O. Box 100144

The home health agency must also submit the information required to meet the federal requirements shown at “How to Get Medicare”, “Approval Process for Branch Home Health Agency Offices” at the Home Health Agency pages of this website. This information is sent to the Home Care Unit for review and approval.

For Medicaid

See page 1-5 of the Medicaid Home Health Services Coverage and Limitations Handbook. There is a link to this handbook under “How to Get Medicaid” at the Home Health Agency pages of this web site.

4.3 Who do I contact if I have questions regarding patient billing for Medicare and Medicaid certified agencies?

These questions should be directed to the fiscal intermediary and/or fiscal agent.

The Medicare fiscal intermediary for Florida corporations is Palmetto GBA. Their telephone number is toll free 1-866-801-5301 (Option 2), Monday – Friday 8 a.m. until 4 p.m.; and the web site is www.palmettogba.com .

The Medicaid fiscal agent is HP Enterprise Services. Their telephone number is (800) 289-7799. The fiscal agent’s web site can be reached through the AHCA web site, and click on “Medicaid” and the click on “Medicaid Fiscal Agent.”

4.4 Where can I get information about the Statewide Medicaid Managed Care program?

See the Medicaid web pages at this link: http://ahca.myflorida.com/Medicaid/statewide_mc/index.shtml.

4.5 Where can I get information on how to became a provider for the Medicaid Managed Care Long Term Care Program?

Contact the Long Term Care Plans selected for your area of the state from the “Plan Contacts for Providers” list at: http://ahca.myflorida.com/medicaid/statewide_mc/providers.shtml.

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