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Home Health (HH) Services

HH services are available to Medicaid recipients of all ages and are intended to be short-term in duration. HH 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. Teaching the recipient or family members, whenever possible, appropriate care techniques for the recipient's condition and needs should occur in the episode of care.

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Program Updates

October 2014 Provider Update: The current Home Health Manual and the current regulation has been posted to the website. The MAP-34 and its instruction sheet for Medicare recipient with Medicaid eligibility (dual eligible) have been revised. The internal utilization review has been replaced to allow for identified and approved Medicaid services and/or supplies that Medicare does not cover. See MAP-34 Instruction sheet for the DMS-approved services and/or supplies.

Oct. 7, 2014 - Home Health Provider Letter #A-114; Home and Community Based Provider Letter #A-2; Adult Day Care Provider Letter #A- 42 - Survey of Non-Residential Waiver Providers

April 11, 14 - The Home Health TAC webpage is now available.

July 29, 2013 - Use of Electronic Signatures - HH shall comply with the requirements within KRS 369.101 to 369.120.

July 25, 2013 - DMS Clarification: Physician's verbal order(s) for HH services-Electronic medical Records

Oct. 20, 2012 - Physician's orders for HH services

2011 Updates

  • Map 130 Update - Providers shall begin using the revised HH prior authorization (PA) fax form, MAP-130 when requesting HH services. The revision date to the MAP-130 is September 2011. SHPS will not process PA requests from previous versions beginning Dec. 30, 2011. A copy of the revised fax form with instructions has replaced the previous form on line.
  • Homebound Status Update

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Eligibility Requirements

All services and/or supplies must meet medical necessity criteria for the treatment of the illness or injury per 907 KAR 1:030 and 907 KAR 3:130.

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HH Services

HH Services

  • intermittent skilled nursing services;
  • physical, speech and occupational therapies;
  • non-routine medical supplies required for an episode of care;
  • medical social services; and
  • home health aide services

Note: 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. (See Prior Authorization information below)

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Recertification and Prior Authorization

Recertification

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.

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Prior Authorization

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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Archived Provider Updates and Policy Clarifications
Archived Codes

Home Health PA HCPCS Codes - PDF (revised 12/02/2008)

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Home Health Web Resources
  Durable Medical Equipment  

Regulations, Policy Information, Billing Information and Forms
 

Regulations

Policy Information

Provider Letters

To view older provider letters, refer to the Provider Letter page.

Billing Information

Fee and Rate Schedules

  • To view the most current Rates, refer to the Fee and Rate Schedule page.
  • To view a copy of the most current Durable Medical Equipment Fee Schedule, go to the Fee and Rate Schedule page.

Forms

 

For questions on
 

Policy, contact:
Community Alternatives
Home and Community Based Services Branch
275 E. Main St.
6 W-B
Frankfort, KY 40621
Phone: (502) 564-5560
E-mail: CHFS DMS Webmaster

Regarding billing issues, contact (800) 807-1232

 

Last Updated 10/22/2014
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