Home Health Services
What Home Health Services are Covered?
Covered home health services must be prescribed by a physician. Services shall follow a written plan of care to help the Medicaid recipient to receive medically necessary and reasonable care to remain at home. Services include:
- intermittent skilled nursing services;
- physical, speech and occupational therapies;
- non-routine medical supplies;
- medical social services; and
- home health aide services.
Who May Receive Home Health Covered Services?
Home health services are available to Medicaid recipients of all ages and are intended to be short-term in duration.
- All services and/or supplies must meet medical necessity criteria for the treatment of the illness or injury per 907 KAR 3:130.
- Homebound status - The recipient's medical condition should be such that there exists a normal inability to leave the home and consequently leaving the home would require a considerable and taxing effort.
- A large part of the medical care involves teaching the recipient or family members, whenever possible, appropriate care techniques for the recipient's condition and needs.
Prior Authorization and HCPCS Code Information for Home Health Covered Services
- All services and/or supplies must be prior authorized to ensure the service or modification of the service is medically necessary and adequate for the needs of the recipient.
- Requests for re-certifications may be submitted for review up to five business days prior to the service plan start date. If a request for re-certification is not submitted prior to the expiration of the current certification period, the re-certification shall begin on the date that a completed packet is received by the QIO. The physician shall sign, date and recertify the plan of care no less frequently than every two months, with a maximum of 60 days per certification period.
- HCPCS codes are required on prior authorization requests and claims submitted for payment for revenue codes 270 non–routine medical supplies and 279 nutritional supplements.
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Provider Updates, Policy Clarifications |
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Provider Update as of Aug. 1, 2009
The A4212 Noncoring needle or stylet with or without catheter (Huber needle) has been reinstated on the Home Health Supply Schedule.
The A4221 Supplies for maintenance of drug infusion catheter includes all cannulas, needles, dressings and infusion supplies.
Provider Update as of June 26, 2009
Mediplanner Prefills
DMS wishes to provide for effective medication assistance for members who need this service, as efficiently as possible and with maximum coordination with the pharmacy and with other home health visits. To accomplish this, home health agencies should request prior authorization for a reasonable number of visits to fill the mediplanner and educate the patient—we ask that agencies plan to prefill mediplanners every two weeks, unless there are factors which may have an adverse effect on the recipient. Additional PRN visits may be authorized if a medication is added or the patient experiences an unanticipated problem. SHPS has been instructed to ask home health agencies why additional visits are needed if the agency requests more frequent mediplanner prefill visits. If the home health agency can document medical necessity, additional visits may be authorized.
Provider Update as of June 24, 2009
View the Map 248 Clarification
Provider Update as of March 15, 2009
Recipients who are Medicare/Medicaid dual eligible should not receive their disposable medical supplies through the Medicaid program unless it is for:
- incontinence supplies not covered by DME; or
- supplies necessary for an episode of skilled care through the Medicaid home health program.
Dual eligible recipients should be educated by the provider about the Medicare process for obtaining needed disposable medical supplies through the Medicare DME program. Medicaid is always the payer of last resort per 907 KAR 1:005 and KRS 205.520.
Provider Update as of Jan. 23, 2009
Tracheostomy supplies identified on the home health supply schedule are approved in the course of a home health certification period in which trach care is an integral part of the home health treatment plan. An example is a skilled nursing visit to perform trach care and provide care training for a new tracheostomy patient.
Ventilator-dependent individuals and trach supply-only individuals who do not have an active home health certification should receive the medically necessary trach supplies through the DME program.
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