Rule 5160-12-01 | Home health services: provision requirements, coverage and service specification

What this rule requires your agency to do

• 1Providers must bill only after all documentation for the services rendered during a visit is completed, using the appropriate procedure code and modifiers.(Rule 5160-12-01 | Home health services: provision requirements, coverage and service specification)
• 2Home health services are covered only on a part-time or intermittent basis: no more than eight hours per day combined and no more than fourteen hours per week of nursing and aide services (except as specified or prior authorized), with visits not more than four hours.(Rule 5160-12-01 | Home health services: provision requirements, coverage and service specification)
• 3To bill increased home health services, the MCHHA must assure and document that the individual meets all paragraph (H) requirements and use the U5 modifier.(Rule 5160-12-01 | Home health services: provision requirements, coverage and service specification)
• 4Home health services are reimbursable only if a qualifying treating physician, APRN, or PA documents a face-to-face encounter with the individual within ninety days before or thirty days after the start of care date.(Rule 5160-12-01 | Home health services: provision requirements, coverage and service specification)
• 5Home health services may only be provided by a Medicare-certified home health agency (MCHHA) meeting rule 5160-12-03 requirements.(Rule 5160-12-01 | Home health services: provision requirements, coverage and service specification)
• 6Providers must deliver home health services as specified in the individual's plan of care (and documented on the PCSP when on an HCBS waiver); services not specified in the plan of care are not reimbursable.(Rule 5160-12-01 | Home health services: provision requirements, coverage and service specification)
• 7A home health aide cannot be the parent, step-parent, foster parent, or legal guardian of an individual under eighteen, or the individual's spouse.(Rule 5160-12-01 | Home health services: provision requirements, coverage and service specification)