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Outpatient Physical Therapy (OPT)/Speech Pathology Providers

Outpatient Physical Therapy (OPT)/Speech Pathology Providers

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Overview

OPT/speech pathology providers may apply for certification to participate in the Medicare/Medicaid programs. The Centers for Medicare and Medicaid Services (CMS) contracts with LARA to evaluate compliance with the federal regulations by conducting certification surveys and complaint investigations.

State licensing is not required for OPT/Speech Pathology. Individual health professionals should check on licensure requirements with the Bureau of Professional Licensing.

Resources

State Operations Manual (SOM) Chapter 2

SOM Appendix E for Regulations

SOM Appendix Z for Emergency Preparedness

Administrator/Leadership Changes

Administrator/Leadership Change Request Form

Submitted form is sent to LARA-BSCSupport@michigan.gov.

Initial Certification

To voluntarily become a Medicare certified provider, you will need to complete the following steps and submit the paperwork electronically to LARA-BSCSupport@michigan.gov, unless otherwise noted in the instructions.

  • Complete Provider Enrollment Application (CMS-855A) and submit to Medicare Administrative Contractor (MAC). The MAC will provide you a recommendation letter once the initial review is complete.
  • An e-mail confirming a successful electronic submission of your Civil Rights Clearance for Medicare Provider Certification from the Office for Civil Rights (OCR).
  • A signed “Health Insurance Benefit Agreement” (CMS-1561).
  • Currently, CMS has prioritized initial surveys as a lower tier work. Following the guidance of the CMS Mission and Priority Document, Michigan is currently not performing initial surveys. A provider can become accredited to obtain certification.
  • Contact Accrediting Organization (AO) to schedule survey *Once the deeming survey is complete, please ensure the Department of Licensing and Regulatory Affairs (LARA), Bureau of Survey and Certification (BSC) receives a copy of the survey report and final approval letter from your deeming authority.
  • A completed “Request for Certification in the Medicare and/or Medicaid Program to Provide Outpatient Physical Therapy and/or Speech Pathology Services” form (CMS-1856) (if not provided by your accrediting organization).
  • Once all of the above documents have been received your application will be deemed complete, the Bureau of Survey and Certification will review and forward the packet to the MAC for final determination and issuance of the Medicare provider number.
  • Please note, this process can take up to 30-60 days from the day of receipt by the MAC.

Address Change

  • Complete Provider Enrollment Application (CMS-855A) and submit to MAC within 90 days of the move.
  • The MAC will provide you a recommendation letter once the initial review is complete.
  • An onsite survey must be completed for primary site changes.For deemed providers, please submit the accrediting agency survey report that includes the new site(s).
  • After all of the above documents have been received and deemed complete, the Bureau of Survey and Certification will add the provider to our survey workload.Once the survey is complete and the provider is found compliant, the Bureau of Survey and Certification will forward the packet to the MAC for final determination and issuance of final approval letter.
  • If you do not receive a final approval notice from the MAC within 90 days of submission, please reach out to LARA-BSCSupport@michigan.gov for assistance.

Extension Sites

  • Complete Provider Enrollment Application (CMS-855A) and submit to MAC within 90 days of the move.
  • The MAC will provide you a recommendation letter once the initial review is complete.
  • Complete Application for Extension Location and submit to LARA-BSCSupport@michigan.gov.
  • For deemed providers, please submit the accrediting agency survey report that includes the new site(s).
  • After all of the above documents have been received and deemed complete, the Bureau of Survey and Certification will review and forward the packet to the MAC for final determination and issuance of final approval letter.
  • Currently, additional practice location reviews are Tier 4 work according to the CMS Mission and Priority Document (MPD).Please be aware that onsite survey work takes priority over this type of request.

Change of Ownership (CHOW)

  • Complete Provider Enrollment Application (CMS-855A) and submit to Medicare Administrative Contractor (MAC). The MAC will provide you a recommendation letter once the initial review is complete.
  • An e-mail confirming a successful electronic submission of your Civil Rights Clearance for Medicare Provider Certification from the Office for Civil Rights (OCR)
  • A completed “Request for Certification in the Medicare and/or Medicaid Program to Provide Outpatient Physical Therapy and/or Speech Pathology Services” (Form 1856)
  • A signed Health Insurance Benefit Agreement (CMS-1561)
  • Once the paperwork is complete, BSC will forward the packet to the MAC for final determination and issuance of final approval letter.
  • Please note, this process can take up to 30-60 days from the day of receipt by the MAC.

Contact Us

Bureau Phone: 517-284-0193

Bureau Fax Number: 517-763-0214

Help for general questions: LARA-BSCHelp@michigan.gov

Certification Support email (document submission): LARA-BSCSupport@michigan.gov