Utah Medicaid Provider Manual – Home Health Services

What this rule requires your agency to do

• 1Providers of home health must comply with Electronic Visit Verification requirements under Utah Administrative Code R414-522 and section 12006 of the 21st Century CURES Act, with EVV systems collecting at minimum the type of service, individual receiving service, date, location, individual providing service, begin/end times, and date of record creation (Ch. 11-3).(Utah Medicaid Provider Manual – Home Health Services)
• 2When the nursing assessment indicates a Medicaid member may qualify for home health services, the provider must complete the prior authorization request through PRISM with supporting medical documentation within 10 business days of the nursing assessment (Ch. 10).(Utah Medicaid Provider Manual – Home Health Services)
• 3At least every sixty (60) days the member must undergo reassessment, the physician must review the new plan of care and recertify the need for continuing home health care, and Medicaid must approve an updated plan of care at least every 60 days; reassessment can take place no more than five days prior to, or two days after, the previous certification period expires (Ch. 8-3.3).(Utah Medicaid Provider Manual – Home Health Services)
• 4It is the responsibility of the provider to verify the member's eligibility prior to every rendered service (Ch. 6).(Utah Medicaid Provider Manual – Home Health Services)
• 5The plan of care and progress toward goals for physical, occupational, and speech-language therapy must be reviewed by the nurse reviewer every 60 days and reviewed and recertified by the ordering practitioner every 6 months (Ch. 8-4, 8-5, 8-6).(Utah Medicaid Provider Manual – Home Health Services)
• 6Home health services must be based on a physician's order and a documented plan of care, and must be supervised by a registered nurse employed by an approved, Medicare-certified home health agency (Ch. 1-1).(Utah Medicaid Provider Manual – Home Health Services)
• 7Home health services require prior authorization except for the initial and 60-day recertification assessments (Ch. 8-2).(Utah Medicaid Provider Manual – Home Health Services)
• 8Coverage of private duty nursing requires prior authorization every 180 days, and banking, saving, or accumulation of unused authorized PDN hours for later use is not permitted (Ch. 8-11.2, 8-11.9).(Utah Medicaid Provider Manual – Home Health Services)