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What It Is

​Home Health 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.

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

Eligibility

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.

Provider Information

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.

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.

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.

Documentation