Idaho Medicaid requires prior authorization before it covers home health services, and this form is the home health agency's request. The agency enters the ordering physician's information and attaches the physician's current signed order and the home health certification or plan of care. The Medicaid Medical Care Unit reviews the request.
The home health agency completes and submits the form. The ordering physician's part is the signed and dated order and the home health certification or plan of care that must be attached.
Download the current version from the source each time; forms change without notice.
Idaho Medicaid Home Health Prior Authorization Form
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.
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A current physician order that is signed and dated, plus the home health certification or plan of care. Verbal orders and signature stamps are not accepted, so the ordering physician needs to sign and date the order personally before the agency sends the request.
Services may be requested only through December 31 of the current year. A patient whose home health care continues into the next calendar year needs a new prior authorization request, with a current signed physician order and plan of care.