Utah Admin. Code R414-14-4 - Program Access Requirements

(1) A home health agency may only provide home health services to an individual who is under the care of a physician. An attending physician shall write the orders on which a plan of care is established and certify the necessity for home health services.

(2) A home health agency may only accept a member for home health services if there is a reasonable expectation the agency can meet the member's needs.

(3) The attending physician and home health agency personnel must review and sign a total plan of care as often as the severity of the member's condition requires, but at least once every 60 days in accordance with 42 CFR 440.70.

(4) The home health agency must provide quality, cost-effective care and a safe environment in the home through registered or licensed practical nurses who have adequate training, knowledge, judgment, and skill.

(5) The home health agency may only provide home health aide services pursuant to written instructions and under the supervision of a registered nurse by a person selected and trained to assist with routine care not requiring specialized nursing skills.

(6) Over the long -term service period, the cost to provide the required service in the member's home must be no greater than the cost to meet the member's medical needs in an alternative setting.

(7) A home health agency may provide an initial assessment visit without prior authorization to assess the member's needs and establish a plan of care. After the initial visit, home health care and service must be based on prior authorization.

(8) The home health agency must meet the face-to-face requirement, as stated in Section R414-1-30, or the Department may deny or recover reimbursement.

Notes

Utah Admin. Code R414-14-4

Adopted by Utah State Bulletin Number 2017-14, effective 7/1/2017 Amended by Utah State Bulletin Number 2023-15, effective 7/26/2023