MaineCare Benefits Manual, Chapter II, Section 40 (Home Health Services), Subsection 40.08 - Policies and Procedures (10-144 C.M.R. ch. 101, § 144-101-II-40.08)

What this rule requires your agency to do

• 1All services require an authorization from the Department or its Authorized Entity; the Home Health Agency must notify the Department of the member's start of care date and submit the admit/discharge form within five (5) days of admission (§ 40.08-1).(MaineCare Benefits Manual, Chapter II, Section 40 (Home Health Services), Subsection 40.08 - Policies and Procedures (10-144 C.M.R. ch. 101, § 144-101-II-40.08))
• 2For each certification period the HHA must submit, within five (5) calendar days of the certification period end date, the CMS 485 (with rehabilitation-potential documentation), documentation of why the member cannot receive services in an outpatient hospital setting, and documentation supporting medical necessity (§ 40.08-1(D)).(MaineCare Benefits Manual, Chapter II, Section 40 (Home Health Services), Subsection 40.08 - Policies and Procedures (10-144 C.M.R. ch. 101, § 144-101-II-40.08))
• 3All Home Health Services must be provided under a written plan of care established by the member's physician (or specified provider) working with the certifying provider; the physician must recertify and sign the plan of care for each certification period, with recertification required at least every 60 days (§ 40.08-2(A)).(MaineCare Benefits Manual, Chapter II, Section 40 (Home Health Services), Subsection 40.08 - Policies and Procedures (10-144 C.M.R. ch. 101, § 144-101-II-40.08))
• 4The certifying physician must document that a face-to-face encounter meeting the requirements of 40.01-7 took place no more than 90 days before (or within 30 days after) the start of Home Health care, in a clearly titled, dated and signed section or addendum to the certification (§ 40.08-4.15).(MaineCare Benefits Manual, Chapter II, Section 40 (Home Health Services), Subsection 40.08 - Policies and Procedures (10-144 C.M.R. ch. 101, § 144-101-II-40.08))
• 5Any increase in frequency or addition of new services during a certification period must be authorized in advance by a physician; the Department pays for care provided on verbal orders only if followed by a written order signed by the physician before billing (§ 40.08-2(D)).(MaineCare Benefits Manual, Chapter II, Section 40 (Home Health Services), Subsection 40.08 - Policies and Procedures (10-144 C.M.R. ch. 101, § 144-101-II-40.08))
• 6Effective January 1, 2023, every provider of Home Health Services must comply with the Maine DHHS Electronic Visit Verification (EVV) system, verifying type of service, individual receiving service, date, location, individual providing service, and start/end time (§ 40.08-7).(MaineCare Benefits Manual, Chapter II, Section 40 (Home Health Services), Subsection 40.08 - Policies and Procedures (10-144 C.M.R. ch. 101, § 144-101-II-40.08))
• 7The physician must sign the plan of care before the HHA submits its claim; the plan of care must specify the nature, frequency and duration of each service and the type of professional who must provide it, and contain the enumerated content (diagnoses, services/supplies/equipment, visit frequency by discipline, prognosis, safety measures, discharge plans, residence type) (§ 40.08-2(B)).(MaineCare Benefits Manual, Chapter II, Section 40 (Home Health Services), Subsection 40.08 - Policies and Procedures (10-144 C.M.R. ch. 101, § 144-101-II-40.08))
• 8The HHA must maintain a specific record for each member including a personalized plan of care, signed CMS-485, written progress notes/flow sheets with the provider's signature, and records showing the entrance and exit times of each skilled nurse's and each aide's visits (excluding travel time) (§ 40.08-4).(MaineCare Benefits Manual, Chapter II, Section 40 (Home Health Services), Subsection 40.08 - Policies and Procedures (10-144 C.M.R. ch. 101, § 144-101-II-40.08))