Primary Care Quality Measures For Medicaid Home Health Beneficiaries (Page 2 of 4) in pdf

Primary Care Quality Measures For Medicaid Home Health Beneficiaries Page 2

If providers are seeking an initial prior authorization for a beneficiary who received services in

accordance with the previous program limitations, documentation must include the 485 form or

plan of care which includes the physician’s orders, the Outcome and Assessment Information Set

(OASIS) assessment, and other supporting documentation. These beneficiaries should be

assigned to the Long-Term Care Home Health Service Plan if the primary reason for nursing

visits is to manage a chronic condition or the Diabetes Management Home Health Service Plan if

the primary reason for nursing visits is for diabetes management.

For services rendered for diabetes management, the provider must include the prior authorization

request form for the Diabetes Management Home Health Service Plan and HCFA-485. Providers

are also required to use the attached Primary Care Quality Measures for Medicaid Home Health

Beneficiaries form. This form must be updated with each certification. The form is also available

under Publications at

https://

and on the secure website

at https://

For additional information, see the paperwork requirements in Appendix III of the updated Home

Health Agency Provider Manual.

Providers can begin submitting prior authorization documentation to the fiscal agent on

February 8, 2010, for dates of service on and after March 1, 2010. Prior authorization requests

for dates of service on and after March 1, 2010, must be received prior to April 1, 2010, for

consideration. Initial requests received after this date will be denied.

Information about the KHPA Medical Plans as well as provider manuals and other publications are available at

https:// For the changes resulting from this provider bulletin, please view the updated Home

Health Agency Provider Manual.

If you have any questions, please contact Customer Service at 1-800-933-6593 (in-state providers) or

785-274-5990 between 7:30 a.m. and 5:30 p.m., Monday through Friday.

HP Enterprise Services is the fiscal agent and administrator of the KHPA Medical Plans.

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Primary Care Quality Measures For Medicaid Home Health Beneficiaries Page 2