Authority: IC 12-15
Affected: IC 12-13-7-3; IC 12-15-13-6
addition to the prior authorization requirements as outlined in section 3 of
this rule, services provided by a registered nurse, licensed practical nurse,
home health aide, or renal dialysis aide employed by a home health agency must
be as follows:
(1) Prescribed or ordered in
writing by a physician.
Provided in accordance with a written plan of treatment developed by the
Intermittent or part time, except for ventilator-dependent patients who have a
developed plan of home health care.
(4) Health-related nursing care. Homemaker,
chore services, and sitter/companion service are not covered, except as
specified under applicable Medicaid waiver programs.
(5) Medically necessary.
(6) Less expensive than any alternate modes
to the prior authorization requirements as outlined in section 3 of this rule,
physical therapy, occupational therapy, respiratory therapy, and speech
pathology must be as follows:
(1) Provided by
an appropriately licensed, certified, or registered therapist employed or
contracted by the home health agency.
(3) Provided in accordance with a written
plan of treatment developed cooperatively between the therapist and the
necessary. Educational activities, such as the remediation of learning
disabilities, are not covered by Medicaid.
Provided in accordance with 405 IAC
services, which do not meet the definition of emergency services at
, are covered without prior authorization when
provided to a member for whom home health services have been currently
authorized when the attending physician orders a one (1) time home visit due to
a change in the patient's medical condition to prevent deterioration of the
patient's medical condition, for example, reanchoring a foley catheter,
obtaining a laboratory specimen, administering an injection, or assessing a
reported change with signs and symptoms of potential for serious
In addition to
the limitations as outlined in subsection (a) and section 3 of this rule,
telehealth services provided by a home health agency are subject to the
(1) The member must
be receiving home health services.
To initially qualify for telehealth
services, the member must have had two (2) or more of the following events
related to one (1) of the conditions listed in subdivision (3) within the
previous twelve (12) months:
(A) An emergency
(B) An inpatient
member must have one (1) or more of the following conditions:
(A) Chronic obstructive pulmonary
(B) Congestive heart
Additional qualifying conditions may be added by the office
upon satisfying the notice requirements set forth in IC
(4) An emergency room visit resulting in an
inpatient hospital admission does not constitute two (2) separate events for
purposes of meeting the requirements of subdivision (2).
(5) In any telehealth encounter, a licensed
registered nurse must perform the reading of transmitted health information
provided to the member in accordance with the written order of the physician.
(e) Home health services
are reimbursable only if the treating physician certifying the need for home
health services documents that there was a face-to-face encounter with the
individual as outlined in section 2(b) of this rule.