Home health services policy under review
Family Voices has heard from some of its members that they have had discussions with the schools regarding children who are receiving home health nursing via Medicaid while at school. Family Voices has sought clarification of the issue and was awaiting an official announcement before disseminating information to ensure it was accurate. Below is info released by IHCP (Indiana Health Coverage Programs) today regarding the original article and a notice that the policy in under review.
If families need assistance with special education services, we encourage them to seek assistance from our state parent training and information center, IN*SOURCE at 800 332 4433
If families need help developing an IHP, individual health plan, Family Voices can provide that information. Contact us at info@fvindiana.org or 317 944 8982
IHCP Bulletin 8/31/11:
Home health services policy under review
An article appearing in BR201124, published June 14, 2011, attempted to clarify certain requirements for providing home health services. The Office of Medicaid Policy and Planning (OMPP) is rescinding the contents of this article, titled “Reminder of home health services requirements and limitations,” pending further policy review.
This is the article this bulletin refers to (6/14/11):
As a reminder, the Indiana Health Coverage Programs (IHCP) provides reimbursement for medically necessary home health services for intermittent or part-time nursing services provided in the member’s home. An intermittent or part-time home health service is defined as up to eight hours of care per member, per day. The only exception to this restriction is ventilator-dependent patients with a developed plan of home healthcare for whom additional hours may be authorized.
Per Indiana Administrative Code 405 IAC 1-4.2-3, Indiana Medicaid reimburses home health agency (HHA) providers for the following home health services:
Skilled nursing performed by a registered nurse or licensed practical nurse
Home health aide services
Physical and occupational therapies
Speech pathology services
Renal dialysis
The services in this subsection must be performed in the home and provided within the limitations set forth in 405 IAC 5-16.
Home health prior authorization
All home health services require prior authorization (PA), except services ordered in writing by a physician prior to a patient’s discharge from a hospital, if such services do not exceed 120 units within 30 calendar days following hospital discharge, and the parameters meet those outlined in the 405 IAC 5-3-12.
Indiana Administrative Code 405 IAC 5-16-3 outlines the necessary prior authorization requirements and factors considered when determining the appropriate service, units of service, and duration of services required by a recipient. Pursuant to 405 IAC 5-16-3(d)(2)(M), one factor considered is “whether the recipient works and/or attends school outside of the home, including what assistance is required.” Prior authorizations for home health services related to this factor are reviewed and approved, modified, or denied, based on the recipient’s specific needs. Although the IHCP reimburses for home health services provided to members who are able to work or attend school, home health services must be performed in the home and are not to be used:
To escort the member to community activities that are therapeutic in nature, or assist with developing and maintaining the member’s natural supports
In a school setting (Note: IHCP coverage is available for in-school special education services for children under 21 years of age, when provided by a public school and included in an Individual Education Plan, or IEP.)
Additional information
For additional information regarding home health requirements and limitations, see:
405 IAC 1-4, 405 IAC 5-3-12, 405 IAC 5-16-3
The IHCP Provider Manual, accessible via indianamedicaid.com
IHCP bulletins BT200237 and BT201022, accessible via indianamedicaid.com
If families need assistance with special education services, we encourage them to seek assistance from our state parent training and information center, IN*SOURCE at 800 332 4433
If families need help developing an IHP, individual health plan, Family Voices can provide that information. Contact us at info@fvindiana.org or 317 944 8982
IHCP Bulletin 8/31/11:
Home health services policy under review
An article appearing in BR201124, published June 14, 2011, attempted to clarify certain requirements for providing home health services. The Office of Medicaid Policy and Planning (OMPP) is rescinding the contents of this article, titled “Reminder of home health services requirements and limitations,” pending further policy review.
This is the article this bulletin refers to (6/14/11):
As a reminder, the Indiana Health Coverage Programs (IHCP) provides reimbursement for medically necessary home health services for intermittent or part-time nursing services provided in the member’s home. An intermittent or part-time home health service is defined as up to eight hours of care per member, per day. The only exception to this restriction is ventilator-dependent patients with a developed plan of home healthcare for whom additional hours may be authorized.
Per Indiana Administrative Code 405 IAC 1-4.2-3, Indiana Medicaid reimburses home health agency (HHA) providers for the following home health services:
Skilled nursing performed by a registered nurse or licensed practical nurse
Home health aide services
Physical and occupational therapies
Speech pathology services
Renal dialysis
The services in this subsection must be performed in the home and provided within the limitations set forth in 405 IAC 5-16.
Home health prior authorization
All home health services require prior authorization (PA), except services ordered in writing by a physician prior to a patient’s discharge from a hospital, if such services do not exceed 120 units within 30 calendar days following hospital discharge, and the parameters meet those outlined in the 405 IAC 5-3-12.
Indiana Administrative Code 405 IAC 5-16-3 outlines the necessary prior authorization requirements and factors considered when determining the appropriate service, units of service, and duration of services required by a recipient. Pursuant to 405 IAC 5-16-3(d)(2)(M), one factor considered is “whether the recipient works and/or attends school outside of the home, including what assistance is required.” Prior authorizations for home health services related to this factor are reviewed and approved, modified, or denied, based on the recipient’s specific needs. Although the IHCP reimburses for home health services provided to members who are able to work or attend school, home health services must be performed in the home and are not to be used:
To escort the member to community activities that are therapeutic in nature, or assist with developing and maintaining the member’s natural supports
In a school setting (Note: IHCP coverage is available for in-school special education services for children under 21 years of age, when provided by a public school and included in an Individual Education Plan, or IEP.)
Additional information
For additional information regarding home health requirements and limitations, see:
405 IAC 1-4, 405 IAC 5-3-12, 405 IAC 5-16-3
The IHCP Provider Manual, accessible via indianamedicaid.com
IHCP bulletins BT200237 and BT201022, accessible via indianamedicaid.com
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