A. The Division of Medicaid requires the home
health agency to maintain auditable records that substantiate the services
provided and include, at a minimum, the following in each beneficiary's record
verifying services provided by the home health agency are medically necessary
[Refer to Maintenance of Records Part 200, Rule
1.3.]:
1. Physician or non-physician practitioner
(NPP) referral,
2. Appropriate
information identifying the beneficiary,
3. Name of the physician or NPP,
4. Documentation of the face-to-face
encounter with the ordering physician or allowed nonphysician practitioner
(NPP) including:
a) Documentation that the
required face-to-face encounter related to the primary reason the beneficiary
needs the services occurred ninety (90) days before or thirty (30) days after
the start of home health services,
b) Identification of the physician or allowed
NPP who conducted the encounter, and
c) The date of the face-to-face
encounter,
5. If the
face-to-face encounter was performed by an allowed NPP, the clinical findings
of the face-to-face encounter must be incorporated into a written or electronic
document in the beneficiary's medical record.
6. Documentation that the services cannot be
provided in any other setting other than the beneficiary's residence.
7. The initial order and all recertifications
signed by the physician or NPP which must include:
a) Justification home health services are
medically necessary and reasonable for treatment of the beneficiary's illness,
injury, or condition,
b) The type
of services required, and
c) The
estimated duration home health services will be needed,
8. The beneficiary's plan of care,
9. Documentation that the beneficiary's plan
of care is reviewed and recertified by a physician or NPP every sixty (60)
days,
10. Signed copy of orders,
new orders or changes in orders for medications, medical supplies, treatments,
dietary, and activities,
11. Case
conference report(s) covering all disciplines,
12. Lab results and other diagnostic test
results,
13. Discharge summary to
include transfers and hospital stays,
14. Documentation of all verbal
communications between the home health agency and the physician and/or allowed
NPP, and
15. Documentation that a
supervisory visit was made by a registered nurse (RN) at least every sixty (60)
days for home health aide services.
B. Home health agencies must provide and the
physician must maintain copies of the documentation in Miss. Admin. Code Part
215, Rule 1.6.A. in each beneficiary's record verifying services provided by
the home health agency are medically necessary. [Refer to Maintenance of
Records Part 200, Rule
1.3.]
42 C.F.R. §§
440.70,
484.48;
Miss. Code Ann. §§
43-13-117,
43-13-118,
43-13-121,
4313-129.
