Current through Register 1531, September 27, 2024
(A)
Conditions of Payment. Home health aide services are
payable only if all of the following conditions are met:
(1) home health aide services are medically
necessary to
(a) directly support curative,
rehabilitative, or preventative aspects of nursing or therapy services provided
by the home health agency; and/or
(b) provide hands-on assistance throughout
the task or until completion, with at least two activities of daily living
(ADLs) defined as: bathing, grooming, dressing, toileting/ continence,
transferring/ambulation, and eating.
(2) the frequency and duration of the home
health aide services must be ordered by the physician or ordering non-physician
practitioner and must be included in the plan of care for the member;
(3) the services are medically necessary to
provide personal care to the member, to maintain the member's health, or to
facilitate treatment of the member's injury or illness;
(4) prior authorization, where applicable,
has been obtained where required in compliance with
130 CMR
403.410;
(5) the home health aide is supervised by a
registered nurse or therapist for nursing services or therapy services,
respectively, employed or contracted by the same home health agency as the home
health aide. In the event that the home health agency contracts for, rather
than directly employs, home health aides, such aides must be supervised in
accordance with
42 CFR §
484.80(h), and
130 CMR
403.419(C);
(6) all services provided by the home health
aide must be delivered at the direction of the registered nurse or therapist
supervising the home health aide. The individualized patient care instructions
must be included in the member's plan of care or attached to the member's plan
of care; and
(7) the home health
aide has completed a training and competency evaluation program as specified in
42 CFR
484.80(a)(b)(c) and the
servicing home health agency has documented the home health aide's competency
in all subject areas as described in
42 CFR
484.80(b)(3) within the last
12 months.
(B)
Payable Home Health Aide Services Provided Pursuant to Nursing or
Therapy Services. Payable home health aide services when home
health aide services are provided pursuant to nursing or therapy services
include, but are not limited to,
(1)
personal-care services; such as bathing, dressing, grooming, caring for hair,
nail, and oral hygiene, which are needed to facilitate treatment or to prevent
deterioration of the member's health, changing the bed linen, shaving,
deodorant application, skin care with lotions and/or powder, foot care, ear
care, feeding, assistance with elimination, routine catheter care, and routine
colostomy care;
(2) simple dressing
changes that do not require the skills of a registered or licensed
nurse;
(3) medication reminders for
medications that are ordinarily self-administered and that do not require the
skills of a registered or licensed nurse;
(4) assistance with activities that are
directly supportive of skilled therapy services; and
(5) routine care of prosthetic and orthotic
devices.
(C)
Payable Home Health Aide Services for ADL Supports
Only. Home health aide services for ADL supports are only
reimbursable if the member has two or more ADL needs that require hands-on
assistance. This service requires a non-skilled nursing visit for assessment of
the member and assessment and supervision of the home health aide care plan
once every 60 days. Payable home health aide services for ADL supports only
include:
(1) hands-on assistance with ADLs as
described in
130 CMR
403.402;
(2) IADL support services provided incidental
to hands-on ADL assistance;
(3)
monitoring or supervision provided incidental to or concurrently with hands-on
ADL support;
(4) personal care
services as described in 130 CMR 403.416(B)(1) if provided in addition to
hands-on ADL support as described in
130 CMR
403.402.
(D)
Nonpayable Home Health Aide
Services. The MassHealth agency does not pay for homemaker,
respite, or chore services provided to any MassHealth member in the absence of
ADL needs. It is not permissible for home health agencies to bill MassHealth
for home health aide services for the primary purpose of providing nonpayable
home health aide services, or incidental services as described in 130 CMR
403.416(E). Additionally, home health aide services are nonpayable for
monitoring of anticipatory and unpredictable services.
(E)
Incidental
Services. When a home health aide visits a member to provide a
health-related service, the home health aide may also perform some incidental
services that do not meet the definition of a home health aide service (for
example, light cleaning, preparing a meal, removing trash). However, the
purpose of a home health aide visit must not be to provide these incidental
services and home health aide visits are not reimbursable if used to primarily
conduct incidental services, since they are not health-related
services.
