California Code of Regulations
Title 22 - Social Security
Division 3 - Health Care Services
Subdivision 1 - California Medical Assistance Program
Chapter 3 - Health Care Services
Article 4 - Scope and Duration of Benefits
Section 51337 - Home Health Agency Services
Current through Register 2024 Notice Reg. No. 12, March 22, 2024
(a) Home health agency services are covered as specified below when prescribed by a physician and provided at the home of the beneficiary in accordance with a written treatment plan which the physician reviews every 60 days. The plan shall indicate a need for one or more of the following:
(b) One visit in a six-month period for evaluation of the patient is covered without prior authorization. More than one visit in a six-month period is subject to prior authorization. The request for prior authorization for additional visits shall be accompanied by a written treatment plan approved and signed by the physician. This shall include the following:
(c) One early discharge visit is covered without prior authorization when the requirements of Section 51327(b) are met.
(d) Authorizations may be granted for home health agency services only when the beneficiary's medical condition requires either home nursing care or other covered service, exclusive of physician services.
(e) A maximum of 30 visits may be authorized at any one time and authorizations shall be valid for up to 120 days. When the Department contracts with an agency to provide in-home medical services, the scope, duration, and cost of services will be defined in a written agreement between the provider agency and the Department of Health Services.
(f) In areas serviced by a home health agency, all home health agency services shall be limited to those provided by approved home health agencies as defined in Sections 51125, 51145 and 51217.
(g) In areas determined by the Director not to be serviced by a home health agency, part-time or intermittent skilled nursing care may be furnished by any qualified provider using the services of a registered nurse. These services shall be subject to the same limitations as described in this section and to the same requirements for prior authorization and reimbursement as home health agency services.
1.
Repealer of subsection (f) filed 8-8-78; effective thirtieth day thereafter
(Register 78, No. 32). For prior history, see Register 72, No.
18.
2. Amendment filed 7-24-79 as an emergency; effective upon
filing (Register 79,No. 30).
3. Certificate of Compliance
transmitted to OAH 11-20-79 and filed 11-29-79 (Register 79, No.
48).
4. Amendment filed 7-7-86; effective thirtieth day thereafter
(Register 86, No. 28).
5. Editorial correction of subsection (c)
(Register 95, No. 45).
6. New subsection (c), subsection relettering
and amendment of NOTE filed 3-13-2000 as an emergency; operative 3-13-2000
(Register 2000, No. 11). A Certificate of Compliance must be transmitted to OAL
by 7-11-2000 or emergency language will be repealed by operation of law on the
following day.
7. Certificate of Compliance as to 3-13-2000 order
transmitted to OAL 7-5-2000 and filed 8-14-2000 (Register 2000, No.
33).
Note: Authority cited: Sections 10725, 14105 and 14124.5, Welfare and Institutions Code; and Section 100275, Health and Safety Code. Reference: Sections 14132 and 14132.42, Welfare and Institutions Code; and Section 1727, Health and Safety Code.