(1) To be
reimbursed, the home health provider must bill the medicaid agency according to
medicaid program rules, including chapter
182-502 WAC and agency published
billing instructions.
(2) Payment
to home health providers is:
(a) A set rate
per visit for each discipline provided to a client;
(b) Based on the county location of the
providing home health agency; and
(c) Updated by general vendor rate
changes.
(3) For clients
eligible for both medicaid and medicare, the medicaid agency may pay for
services described in this chapter only when medicare does not cover those
services or pays less than the medicaid maximum payment. The maximum payment
for each service is medicaid's maximum payment.
(4) The medicaid agency does not pay for
services provided to clients at a hospital, adult day care, skilled nursing
facility, or intermediate care facility for individuals with intellectual
disabilities, or any setting in which payment is made under medicaid for
inpatient services that include room and board.
(a) Residential facilities contracted with
the state to provide services are not reimbursed separately for those same
services under the medicaid agency's home health program.
(b) It is the responsibility of the home
health agency to request coverage for a client when the services are not
available to the client in the community or through long-term care.
(5) Providers must submit
documentation to the medicaid agency during the home health agency's review
period. Documentation includes, but is not limited to, the requirements listed
in WAC
182-551-2210.
(6) After the medicaid agency receives the
documentation, the medicaid agency or the agency's designee reviews the
client's medical records for program compliance and quality of care.
(7) The medicaid agency may take back or deny
payment for any insufficiently documented home health care service when the
medic-aid agency or the agency's designee determines that:
(a) The service did not meet the conditions
described in WAC
182-550-2030; or
(b) The service was not in compliance with
program policy.
(8) For
any in-home home health services to be payable, the medicaid agency requires
claims to meet the electronic visit verification requirements. The claims must
electronically verify the following data points:
(a) Type of service performed;
(b) Individual receiving the
service;
(c) Date of the
service;
(d) Location of service
delivery;
(e) Individual providing
the service; and
(f) Time services
begin and the time services end.
(9) Covered home health services for clients
enrolled in an agency-contracted managed care organization (MCO) are paid for
by that MCO.
Notes
Wash. Admin.
Code §
182-551-2220
Amended by
WSR
16-03-035, Filed 1/12/2016, effective
2/12/2016
Amended
by
WSR
18-24-023, Filed 11/27/2018, effective
1/1/2019
Amended by
WSR
23-24-026, Filed 11/29/2023, effective
1/1/2024
11-14-075, recodified as §182-551-2220, filed 6/30/11,
effective 7/1/11. Statutory Authority:
RCW
74.08.090, chapter 74.09 RCW, and 2009 c 326.
10-10-087, § 388-551-2220, filed 5/3/10, effective 6/3/10. Statutory Authority:
RCW
74.08.090,
74.09.520,
74.09.530, and
74.09.500. 02-15-082, §
388-551-2220, filed 7/15/02, effective 8/15/02. Statutory Authority:
RCW
74.08.090 and
74.09.530. 99-16-069, §
388-551-2220, filed 8/2/99, effective
9/2/99.
