37.40.702 HOME HEALTH SERVICES, REQUIREMENTS
(1) These requirements are in addition to those rule provisions generally applicable to Medicaid providers.
(2) A home health agency must be:
(a) licensed by the Montana department of public health and human services;
(b) Medicare certified; and
(c) an enrolled Medicaid provider.
(3) Home health services may be provided by providers located outside of the borders of the state of Montana only if the service meets the requirements of ARM 37.85.207(3) and the service is prior authorized by the department or the department's designee.
(4) Home health services must be:
(a) ordered by the member's attending physician;
(b) part of a written plan of care; and
(c) reviewed and renewed by the member's attending physician at a minimum of 60 day intervals.
(5) A written plan of care must include:
(a) how care is to be provided;
(b) a summary of the member's condition;
(c) documentation of the medical necessity;
(d) rationale for the required skill level;
(e) treatment plans;
(f) discharge goals; and
(g) certification by the member's physician.
(6) A member's need for medical supplies, equipment, and appliances must be reviewed annually by the member's attending physician.
(7) All member records related to the delivery of home health services must be current and available upon request of the department or its designated representative.
(8) For the initiation of home health services, the department requires an initial face-to-face encounter which must be related to the primary reason the member requires home health services and must occur within 90 days before or within 30 days after the start of care.
(a) The face-to-face encounter shall be conducted by the certifying physician, an authorized non-physician practitioner (NPP), or an attending or post-acute physician when the member is being admitted to home health services immediately following an acute or post-acute stay.
(b) NPPs authorized to perform the face-to-face encounters for home health services are:
(i) a nurse practitioner;
(ii) a certified nurse midwife;
(iii) a clinical nurse specialist working with a physician; or
(iv) a physician assistant working under the supervision of a physician.
(c) If a NPP performs the face-to-face encounter, findings must be communicated to the certifying physician and included in the member's record.
(9) For the initiation of medical supplies, equipment, and appliances, a face-to-face encounter related to the reason the member requires medical equipment is required and must occur within six months prior to the start of the services.
(a) The face-to-face encounter for medical equipment shall be conducted by the certified physician or an authorized NPP, with the exception of a certified nurse midwife.
(10) Home health services are limited to 180 visits within 365 days from the day of the first authorized visit.
(a) The department may, within its discretion, authorize additional visits in excess of this limit. Any services exceeding this limit must be prior authorized by the department or the department's designee.
(11) Home health aide services are subject to the following limitations:
(a) Home health aide services must be prior authorized by the department or the department's designee.
(b) Home health aide services must be provided under the supervision of a registered professional nurse and in accordance with a written plan of treatment certified by a physician.
(c) A person receiving personal care attendant services or Community First Choice services may not receive home health aide services.
History: 53-6-113, MCA; IMP, 53-6-101, 53-6-131, MCA; NEW, 1980 MAR p. 1761, Eff. 6/27/80; AMD, 1986 MAR p. 2017, Eff. 1/1/87; AMD, 1989 MAR p. 1285, Eff. 9/1/89; AMD, 1995 MAR p. 1182, Eff. 7/1/95; AMD, 1997 MAR p. 1042, Eff. 6/24/97; TRANS, from SRS, 2000 MAR p. 489; AMD, 2019 MAR p. 141, Eff. 1/26/19.