OAC 5160-12-04 — Home health and private duty nursing: visit policy

What this rule requires your agency to do

• 1During a group visit the ratio of provider to individuals served may never exceed one to three, and a modifier HQ must be used to identify each group setting (para. (D)(1), (D)(3)).(OAC 5160-12-04 — Home health and private duty nursing: visit policy)
• 2Each visit must be verified using an ODM-approved electronic visit verification (EVV) system per rule 5160-1-40 (para. (A)(4)).(OAC 5160-12-04 — Home health and private duty nursing: visit policy)
• 3There must be a lapse of two or more hours between the provision of home health nursing and PDN service (para. (A)(3)).(OAC 5160-12-04 — Home health and private duty nursing: visit policy)
• 4Each covered visit must be billed as a separate line item, with one line equaling one visit (para. (C)).(OAC 5160-12-04 — Home health and private duty nursing: visit policy)
• 5Multiple visits must be medically necessary per rule 5160-1-01 as documented in the plan of care (and services/all-services plan for waiver individuals), with documentation supporting the medical need and use of U2/U3 modifiers (para. (E)).(OAC 5160-12-04 — Home health and private duty nursing: visit policy)
• 6A visit for the same covered service must have a lapse of two or more hours between any previous or subsequent visit, unless a PDN visit's length requires an agency to provide a change in staff (para. (A)(2)).(OAC 5160-12-04 — Home health and private duty nursing: visit policy)