Iowa Administrative Code 441—78.9(249A) — Home Health Agencies

What this rule requires your agency to do

• 1A plan of treatment must be completed prior to the start of care and reviewed at a minimum every 60 days, with a face-to-face encounter between a qualifying practitioner and the member no more than 90 days before or 30 days after the start of service; the plan must be signed and dated by the practitioner before the claim is submitted (subrule 78.9(1)).(Iowa Administrative Code 441—78.9(249A) — Home Health Agencies)
• 2Home health aide (personal care) services require that the service, frequency, and duration be stated in a physician-established written plan of treatment; that the member require personal care as determined by an RN or therapist; and that services be given under the supervision of an RN or physical/speech/occupational therapist who assigns the aide (subrule 78.9(7)"a" and "b").(Iowa Administrative Code 441—78.9(249A) — Home Health Agencies)
• 3Prior authorization approvals will not be granted for treatment plans that exceed 16 hours of home health agency services per day (subrule 78.9(10)"b"(3)).(Iowa Administrative Code 441—78.9(249A) — Home Health Agencies)
• 4Covered services are only those provided in the member's residence, except that private duty nursing and personal care for persons aged 20 and under may be provided outside the residence when medically necessary (item 2).(Iowa Administrative Code 441—78.9(249A) — Home Health Agencies)
• 5Private duty nursing or personal care services for persons aged 20 and under must be ordered in writing by a physician and prior-authorized by the department or its review agent before payment, with the provider responsible for requesting and renewing prior authorization (subrule 78.9(10)"b").(Iowa Administrative Code 441—78.9(249A) — Home Health Agencies)
• 6Home health agency services must be prescribed by a physician, nurse practitioner, clinical nurse specialist, or PA in a plan of home health care provided by a Medicare-certified home health agency, evidenced by the practitioner's signature and date on a plan of treatment (rule 441—78.9, opening and item 11).(Iowa Administrative Code 441—78.9(249A) — Home Health Agencies)
• 7Home health aide services must be provided on an intermittent basis (usually two to three times per week; four to seven days per week not to exceed 28 hours per week when ordered and in the plan of care) (subrule 78.9(7)"c").(Iowa Administrative Code 441—78.9(249A) — Home Health Agencies)
• 8Payment is made for RN supervisory visits two times a month over home health aide services (subrule 78.9(2)).(Iowa Administrative Code 441—78.9(249A) — Home Health Agencies)