Or. Admin. Code § 410-127-0040 - Coverage
(1) Medically
appropriate home health services may be covered on a visiting basis to eligible
clients as ordered by a physician and part of a written plan of care. Coverage
of home health services is not contingent on the client needing nursing,
nursing facility or therapy services.
(2) Home health services may be provided in
the client's home or any setting in which normal life activities take place
other than a hospital, nursing facility, intermediate care facility for
individuals with intellectual disabilities, any setting that exists primarily
for the purpose of providing medical/nursing care, or any setting in which
payment is or could be made under Medicaid for inpatient services that include
room and board.
(3) Home health
services require a face-to-face encounter as described in OAR 410-127-0045
consistent with federal Medicaid regulations at
42 CFR
440.70.
(4) Home health services must be prescribed
by a physician, and the signed order must be on file at the home health agency.
The prescription must include the ICD-10-CM diagnosis code indicating the
reason the home health services are requested. The orders on the plan of care
must specify the type of services to be provided to the client with respect to
the professional who will provide them, the nature of the individual services,
specific frequency, and specific duration. The orders must clearly indicate how
many times per day, each week or each month the services are to be provided.
The plan of care must include the client's condition, the rationale for the
care plan including justification for the required skill level of care, and the
summary of care for additional certification periods.
(5) The plan of care must be reviewed and
signed by the physician who established the plan of care at least every 60 days
to continue services.
(6) The
following services or items are covered, if diagnoses are on the portion of the
prioritized list above the line funded by the legislature:
(a) Skilled nursing services;
(b) Skilled nursing evaluation (includes
Outcome and Assessment Information Set (OASIS) assessment);
(c) Home health aide services;
(d) Occupational therapy services;
(e) Occupational therapy evaluation, which
may include OASIS assessment;
(f)
Physical therapy services;
(g)
Physical therapy evaluation, which may include OASIS assessment;
(h) Speech-language pathology services, which
may include OASIS assessment;
(i)
Speech-language pathology evaluation, which may include OASIS
assessment;
(j) Medical and
surgical supplies.
Notes
Statutory/Other Authority:ORS 413.042
Statutes/Other Implemented:ORS 414.065
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