Find & Ask › Indiana › this rule

405 IAC 5-16-3.1 - Home Health Agency Services; Limitations

IndianaregulationOffice of the Secretary of Family and Social Services (405 IAC)

What this rule requires your agency to do

  • 1Nursing and aide services must be intermittent or part time, except for ventilator-dependent patients with a developed home health care plan.(405 IAC 5-16-3.1 - Home Health Agency Services; Limitations)
  • 2Home health agency nursing/aide services must be prescribed or ordered in writing by a physician and provided per a written plan of treatment developed by the attending physician.(405 IAC 5-16-3.1 - Home Health Agency Services; Limitations)
  • 3For telehealth, the member must have had two or more qualifying events (ER visit or inpatient stay) within the previous 12 months related to a qualifying condition (COPD, CHF, or diabetes).(405 IAC 5-16-3.1 - Home Health Agency Services; Limitations)
  • 4Homemaker, chore, and sitter/companion services are not covered except as specified under applicable Medicaid waiver programs.(405 IAC 5-16-3.1 - Home Health Agency Services; Limitations)
  • 5Therapy services (PT, OT, respiratory, speech) must be provided by an appropriately licensed/certified/registered therapist employed or contracted by the agency, ordered in writing, and provided per a written plan of treatment developed cooperatively with the attending physician.(405 IAC 5-16-3.1 - Home Health Agency Services; Limitations)
  • 6Home health services are reimbursable only if the certifying physician documents a face-to-face encounter with the individual as outlined in section 2(b).(405 IAC 5-16-3.1 - Home Health Agency Services; Limitations)
  • 7In any telehealth encounter, a licensed registered nurse must perform the reading of transmitted health information in accordance with the written order of the physician.(405 IAC 5-16-3.1 - Home Health Agency Services; Limitations)

Applies to: home health only

Sets Medicaid coverage conditions and limitations for home health agency services, including physician orders, written plans of treatment, intermittent/part-time limits, telehealth qualifying conditions, and the face-to-face encounter documentation requirement.

Regulatory information, not legal advice — always confirm against the cited official source. Verification reduces error; it does not certify compliance.