Home health services are provided in a recipient’s home or other authorized setting to promote, maintain or restore health or to minimize the effects of illness and disability. Medicaid reimburses for home health services rendered by licensed,
Medicaid-participating home health agencies. Medicaid reimbursable services include:
• Home visit services provided by a registered nurse or a licensed practical nurse;
• Home visits provided by a qualified home health aide;
• Private duty nursing;
• Personal care services;
• Therapy (occupational and physical therapy and speech-language pathology) services; and
• Medical supplies, appliances and durable medical equipment.
Medicaid reimbursement for home health services has the following limitations:
• Nursing and home health aide visit services are limited to:
i) a total of four visits by nurses and/or aides per day, per recipient and
ii) a total of 60 visits by nurses and/or aides per lifetime, per recipient.
• Private duty nursing, personal care and therapy services are limited to children under 21 who are medically complex. Private duty nursing and personal care services must be service authorized by the area Medicaid office, service-authorization nurse.
• Private duty nursing and personal care services are limited to:
i) Two to 24 hours of private duty nursing per day, per recipient and
ii) Two to 24 hours of personal care provided by home health aides per day, per recipient.
• Dually-eligible Medicaid/Medicare recipients must receive Medicare reimbursable home health services from a Medicare-enrolled home health agency.
Exceptions to the 60-visit limit for children and adults must be requested through the Medicaid contracted peer review agency.
Service Authorization requests should be submitted before services are provided or billed.
Medicaid reimburses for home health services that are medically necessary and that can be safely, effectively and efficiently provided in the home when either leaving home is medically contraindicated or the Medicaid recipient is unable to leave home without the assistance of another person.
Medicaid reimburses home health agencies the maximum allowable Medicaid fee or the provider’s customary fee, whichever is lower.
There is a $2 recipient copayment for home health services, per provider, per day, unless the recipient is exempt.