Primary Care Quality Measures For Medicaid Home Health Beneficiaries

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February 2010
Provider Bulletin Number 10005
Home Health Agency Providers
Home Health Program Changes
Effective with dates of service on and after March 1, 2010, the following changes will be
implemented regarding coverage of KHPA Medical Plans fee for service home health:
• All services billed by a home health provider require prior authorization.
• Three distinct home health service plans are available:
o Acute Care Home Health Service Plan
o Long-Term Care Home Health Service Plan
o Diabetes Management Home Health Service Plan
• Each home health service plan has specific service codes.
• Each home health service plan has a distinct prior authorization request form
and instructions.
• Acute care home health services include skilled nursing, home health aide visits, and
rehabilitative occupational, speech and physical therapy services.
• Acute care home health services are limited to 120 visits per beneficiary per calendar
year. Services that exceed these limitations may be reimbursed through the Long-Term
Care Home Service Plan or the Diabetes Management Home Health Service Plan.
• Medically necessary home health aide services are limited to two visits per week.
Current home health prior authorizations will be end dated on February 28, 2010. Providers must
obtain prior authorizations effective March 1, 2010, using the most appropriate service plan
and codes.
There will be a one-time documentation exception for providers with prior authorizations already
in place. These providers can fax the following to the Prior Authorization department:
• HCFA-485 form (Home Health Certification and Plan of Care)
• Physician’s orders
• Appropriate home health service request form
Note: This form must include the number of codes needed on the new service plan
through the previously approved prior authorization end date.
The request will be processed and assigned a new prior authorization number.
HP Enterprise Services is the fiscal agent and administrator of the KHPA Medical Plans.
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