Vermont Medicaid Covered Services Rule — Section 7401 Home Health Agency Services & Section 7406 Personal Care Services (Other Medicaid Services 7400)

What this rule requires your agency to do

• 1Home health items and services are ordered and furnished under a written plan, signed by the attending physician and incorporated into the agency's permanent record for the patient, specifying diagnosis/functional limitation, type and frequency of service, and long-range forecast (7401.3(B)).(Vermont Medicaid Covered Services Rule — Section 7401 Home Health Agency Services & Section 7406 Personal Care Services (Other Medicaid Services 7400))
• 2A "Personal Care Attendant" means an individual at least 18 years of age having successfully passed required background checks; a personal care attendant may not be a biological/adoptive parent, guardian, shared living provider, foster parent, step-parent, domestic/civil union partner of the child's primary caregiver, or a relative serving in the primary caregiver capacity (7406.1(g)).(Vermont Medicaid Covered Services Rule — Section 7401 Home Health Agency Services & Section 7406 Personal Care Services (Other Medicaid Services 7400))
• 3A personal care attendant may provide personal care services to only one recipient at a time (7406.4(D)).(Vermont Medicaid Covered Services Rule — Section 7401 Home Health Agency Services & Section 7406 Personal Care Services (Other Medicaid Services 7400))
• 4In the case of self/family/surrogate-directed personal care, the employer must use the state-sanctioned fiscal employer agent for payroll and administrative services, and is responsible for paying the appropriate payroll taxes out of the awarded amount (7406.4(A)(ii),(C)).(Vermont Medicaid Covered Services Rule — Section 7401 Home Health Agency Services & Section 7406 Personal Care Services (Other Medicaid Services 7400))
• 5Home health agency providers must be a Medicaid-certified provider and be enrolled with Vermont Medicaid (7401.5).(Vermont Medicaid Covered Services Rule — Section 7401 Home Health Agency Services & Section 7406 Personal Care Services (Other Medicaid Services 7400))
• 6Prior authorization shall be required prior to the provision of personal care services; services shall be individualized and provided exclusively to the authorized individual (7406.3(B),(D)).(Vermont Medicaid Covered Services Rule — Section 7401 Home Health Agency Services & Section 7406 Personal Care Services (Other Medicaid Services 7400))
• 7Services of a home health aide are covered when assigned in accordance with a written plan of treatment established by a physician and supervised by a registered nurse or appropriate therapist; supervisory visits by an RN or appropriate therapist must be performed at least every 62 days, and more frequently if necessary (7401.3(F)).(Vermont Medicaid Covered Services Rule — Section 7401 Home Health Agency Services & Section 7406 Personal Care Services (Other Medicaid Services 7400))
• 8The plan is reviewed by the attending physician, in consultation with professional agency personnel, every 62 days or more frequently as the severity of the patient's condition requires, and shows the day of each review and physician's signature (7401.3(B)).(Vermont Medicaid Covered Services Rule — Section 7401 Home Health Agency Services & Section 7406 Personal Care Services (Other Medicaid Services 7400))