Haw. Code R. § 17-1737-45 - Home health services

(a) Home health services means services provided to a recipient by a home health agency or under a home or community-based waiver:

(1) At the recipient's place of residence or at a location other than a hospital, skilled nursing facility, intermediate care facility - mental retardation, or intermediate care facility;

(2) On a physician's orders as part of a written plan of care that the physician reviews every sixty days; and

(3) Medical authorization as specified in section 17-1739-4 is needed for all home health services, medical supplies, equipment and appliances unless otherwise specified under this section.

(b) Home health services shall include:

(1) Nursing service, as defined in chapter 457, HRS provided on a part-time or intermittent basis;

(2) Home health aide services;

(3) Medical supplies, equipment, and appliances suitable for use in the home, subject to prior authorization as specified in section 17-1739-4;

(4) Physical therapy, occupational therapy, speech pathology and audiology services subject to prior authorization as specified in section 17-1739-4; and

(5) Medical social services and other services not specifically listed in this section are not covered.

(c) Reimbursement for home health services shall be limited to the following:

(1) Home health services shall be reimbursable on the basis of "per visit". A visit shall encompass approximately one or two hours of service;

(2) One visit per day only;

(3) Daily home visits without medical authorization are permitted for home health aide and nursing services in the first two weeks of care if part of the written plan of care;

(4) Initial physical therapy and occupational therapy evaluations only without medical authorization are permitted if part of a written plan of care;

(5) No more than three visits a week for each service shall be reimbursed for the third week to the seventh week of patient care;

(6) No more than one visit a week for each service shall be reimbursed from the eighth week to the fifteenth week of patient care;

(7) No more than one visit every other month for each service shall be reimbursed from the sixteenth week of patient care; and

(8) Services exceeding the parameters of this section shall be prior authorized by the department's medical consultant or its authorized representative.

Notes

Haw. Code R. § 17-1737-45

[Eff 08/01/94; am 02/10/97] (Auth: HRS § 346-14) (Imp: 42 C.F.R. §§440.70, 441.15)