The process for becoming a certified Home Health Agency Medicare provider is as follows:

1.	The applicant completes and submits a CMS-855A (Medicare Enrollment Application) form and all supporting documentation noted in the application to its Fiscal Intermediary.
2.	The Fiscal Intermediary reviews the CMS-855A application and makes a recommendation for approval or denial to the State Survey Agency, the Michigan Department of Community Health (MDCH), with a copy to the Centers for Medicare & Medicaid Services (CMS) Regional Office.
3.	Completed application forms listed below must be sent to MDCH at the address shown below at the same time the CMS-855A is submitted to the Fiscal Intermediary.
	a.	two signed originals of the CMS-1561A form (Health Insurance Benefits Agreement)
	b.	One original CMS-1572 form (Home Health Agency Survey and Deficiencies Report)
	c.	Civil Rights information request forms
	d.	One Medicare Intermediary Information form (BHS-LC-152)
	e.	One signed original of the Michigan OASIS System Agency Application form (BHS-LC-150)
4.	The agency can be entered into the queue for OASIS testing once all application documents described above have been received and reviewed for completeness.
5.	MDCH is not at this time authorized by CMS to conduct initial surveys of home health agencies due to federal budgetary constraints. Provider applicants are therefore responsible for initiating contact with one of the three accrediting organizations (shown below) approved by CMS to conduct initial surveys incorporating Medicare home health agency requirements. Results of the survey indicating compliance with the accrediting organization's standards must be submitted to MDCH.
6.	The application documents are then paired with the survey results and a recommendation to CMS for approval of the application may be made by MDCH.
7.	The CMS Regional Office makes the final decision regarding program eligibility and notifies the provider of its determination . The CMS Regional Office also works with the Office of Civil Rights to obtain necessary Civil Rights clearances. The provider must typically sign a provider agreement if approved.

ACCREDITING ORGANIZATIONS
Home Health Agencies accredited by one of the following programs can be deemed to comply with the Medicare Conditions of Participation (CoP) as published by CMS.

Accreditation Commission for Health Care, Inc. (ACHC)
4700 Falls of the Neuse Road, Suite 280
Raleigh, NC 27609
(919) 785-1214; www.achc.org
(This organization will send survey results to MDCH.)

Community Health Accreditation Program (CHAP)
1300 19^th Street NW, Suite 150
Washington, DC 20036
1-800-656-9656; http://www.chapinc.org/
(This organization will send survey results to MDCH.)

The Joint Commission
One Renaissance Boulevard
Oakbrook Terrace, IL  60093
(630) 792-5000; http://www.jointcommission.org/
(Providers must download survey results from the Joint Commission's website and send to MDCH.)

CONTACT INFORMATION
Michigan Department of Community Health; Bureau of Health Systems
Division of Licensing & Certification
P.O. Box 30664, Lansing, MI 48909
Telephone: (517) 241-3830; Fax: (517) 241-3354