Application Request for a Home Health Agency
Certification of a Hospice under a Home Health Agency License
These instructions are to assist you in preparing a home health agency (HHA) licensing and/or certification (for Medi-Cal Title 19 and/or Medicare Title 18 reimbursement) application package to the California Department of Public Health (CDPH), Licensing and Certification (L&C) Program for:
A state license is required to operate a HHA in California, which is defined as:
Home health agency means “a private or public organization, including but not limited to, any partnership, corporation, political subdivision of the state, or other government agency within the state, which provides, or arranges for the provision of, skilled nursing services, to persons in their temporary or permanent place of residence.”
An application is required for: (1) a new (initial) HHA (whether it is a parent or a branch of a parent), (2) whenever a Hospice is requesting to be certified under a HHA license, and (3) within 10 working days whenever a CHOW occurs.
HHA Initial/New applications:
Due to the high volume of HHA initial licensing applications, there is currently a delay of between 3 months to 2 years for HHA initial licensing application surveys depending on the workload of the district office where the HHA is located.
In lieu of having CDPH, L&C conduct the initial licensing survey, beginning October 1, 2017, HHAs have the option of hiring a Centers for Medicare and Medicaid Services (CMS) approved accreditation organization (AO) to perform an initial licensing survey (see page 5 for the listing of AOs).
A new HHA that is beginning the application process and wants an initial licensing survey conducted by an AO must file an application with CAU and include a cover letter indicating they intend to hire an AO, specifying which AO they have selected. Note: See All Facilities Letter 17-20 for further AO instructions.
HHA CHOW applications:
A CHOW is the only “change” requiring a new application. All HHA initial and CHOW application packages are to be submitted to L&C’s Centralized Applications Unit (CAU), pursuant to Section 74667(a) of Title 22 of the California Code of Regulations (CCR).
A “Technical” CHOW requires a new application. An application shall be submitted to the Department within 10 working days whenever a change of ownership occurs. A change of ownership shall be deemed to have occurred where, among other things, when compared with the information contained in the last approved license application of the licensee, there has occurred a transfer of 50 percent or more of the issued stock of a corporate licensee, a transfer of 50 percent or more of the assets of the licensee, a change in partners or partnership interests of 50 percent or greater in terms of capital or share of profits, or a relinquishment by the licensee of the management of the agency. [Title 22 California Code of Regulations (CCR) section 74667] Note: 1) the licensee’s EIN number will not change for a Technical CHOW, and 2) a license application fee applies for a Technical CHOW.
HHA “Other” changes (besides a CHOW):
“Other” changes must be reported to the L&C CAU in writing within 10 days of the change.
If there is a total purchase or transfer of stock of less than 50% it is considered a stock purchase/transfer. These applications will be processed as a change. Note: 1) the licensee’s EIN number will not change for a stock purchase/transfer, and 2) a license application fee does not apply to stock purchase/transfers.
The CAU will assist you on which HHA forms on the checklist that must be submitted for the specific change to the license.
For your convenience, the attached checklist has instructions to complete the forms required for licensing and certification of a HHA. The checklist provides specific item numbers that applicants typically have encountered problems in submitting incorrect or missing information. Please make sure that all item numbers in each form are completely filled out. For example: (1) the applicant’s formal name must be consistently the same throughout all the documents in the application package; or (2) in some instances, a specific attachment may need to be submitted with a specific form.
All forms are required to be signed by the “licensee”, owners or officers, unless otherwise stated.
Please read each required application package form carefully and provide all requested supplemental documents. Do not leave any items blank.
Note: If a question does not apply, please respond with “Not Applicable” or “N.A.”. Do not make changes to these forms. Use blue ink to sign all forms. Do not use white out/correction fluid to make corrections. To correct an error, place a single line through the entry and enter the correct information. The individual responsible for making the correction must initial and date the correction. You should retain a photocopy of the completed documents for your files. We may need to contact you in the future and we will be referring to the information in the documents you provided.
In addition, a check or money order, made payable to the “California Department of Public Health”, for the licensing fee, determined pursuant to Section 1266 of the Health and Safety Code (H&S), must accompany the required forms before your application will be processed. The licensing fees change annually; therefore please check the current licensing fee for a HHA which is posted on the L&C Facility Fee website.
The application fee will not be returned if the application is withdrawn or denied, pursuant to Section 1729 of the H&S Code.
The application package review process will consider the applicant’s and associates’ (i.e., board members, LLC members, managers, etc.) past compliance history. This will be based on a review of all facilities and agencies operated by those individuals in California and nationally. The applicant and associates must demonstrate substantial compliance with state and federal requirements for all facilities that they operate.
Failure to demonstrate substantial compliance history may result in the denial of your application package. You will be notified in writing of L&C’s intent to deny the application.
All completed HHA application packages must be submitted to the L&C, CAU address (regular mail), listed below.
Department of Public Health
Licensing and Certification Program
Centralized Applications Unit
P.O. Box 997377, MS 3207
Sacramento, CA 95899-7377
The CAU will review the application package for completion. Once the application package has been given a recommendation of “approved” by the CAU, and all required surveys have been performed, the CAU will issue the license accordingly.
Choice of Fiscal Intermediary.
The fiscal intermediaries are available from the Federal Department of Health and Human Services website.
To apply for National Provider Identifier (NPI), go to the National Plan and Provider Enumeratrion System website.
Please note the following:
- There are some differences between documents required for a CHOW, and “initial” applications that are noted on the attached checklist.
- An initial licensing survey is part of the application process for “new” HHA applications.
- The initial licensing survey is a scheduled survey conducted by either L&C district offices (DO) or AO. Note: See All Facilities Letter 17-20 for further AO instructions.
- Certification: Certification status will allow the HHA to provide services to Medicare beneficiaries (under Title 18). Once the HHA has become Medicare certified, they may also provide services to Medi-Cal beneficiaries (Title 19), if requested. The HHA is required to be licensed prior to seeking certification status.
Many applicants, including HHA, have the option of becoming certified on the basis of accreditation by the Centers for Medicare & Medicaid Services’ (CMS) approved accreditation organizations (listed below) instead of a survey by L&C.
Once approved by the accreditation organization, submit the approval letter from the accreditation organization to the appropriate DO. Since the Medicare certification forms listed on the attached checklist are submitted with your “initial” application package, if there are any changes to the forms, the DO will request amended forms after they receive the approval letter from the accreditation organization.
If you do not choose to go through one of these accreditation organizations it will be several years before L&C will be able to perform a certification survey since “initial” certification surveys for HHAs have been categorized as a low priority. However, if you still want the L&C DO to consider conducting the “initial” certification survey, you will need to submit justification to the DO for CMS approval. The burden will be on the HHA to provide data and other evidence that effectively establishes the probability of serious, adverse beneficiary health care access consequences if the HHA is not enrolled to participate in Medicare.
- In addition you must be in compliance with state licensing laws and federal conditions of participation. The HHA Provider Manual can be viewed online at the Centers for Medicare and Medicaid Services website.
It is the applicant’s responsibility to obtain the Code of Federal Regulations and to understand the HHA Conditions of Participation, which are located on the Government Publishing Office website.
Except for the Los Angeles (LA) facilities, the DO will notify you (via letter) when the application has been approved by CAU and will schedule an “initial” licensing survey. For the LA facilities, the CAU will notify you (via letter) when the application has been approved and will schedule an “initial” licensing survey.
Note: You must be ready for the initial licensing survey upon notification. It is L&C’s policy that, except for very unusual circumstances, only on inspection visit will be made. Failure of the agency to be in substantial compliance, at the time of the visit, will result in the “denial” of the application. Any further activity regarding your request, after such denial, will require a new application, and license fee.
Please note: An “initial” license will not be issued until the application is approved and, if required, a successful licensing survey is conducted.
If you have any questions, please contact the CAU, at (916) 552-8632 or by e-mail at CAU@cdph.ca.gov.