Current through Register Vol. 54, No. 12, March 23, 2024
(a) Home health agencies are reimbursed for
services furnished to MA recipients within the MA Program Fee Schedule limits
if the following conditions are met and documented in the recipient's medical
record:
(1) The services are ordered by and
included in the plan of treatment established by the recipient's attending
physician.
(2) The attending
physician certifies that the recipient requires care in the home and one of the
following conditions exist:
(i) The specific
home health services would avoid or delay the need for treatment in a hospital
or other institutional setting for the condition being treated.
(ii) The recipient has an illness, injury or
mental health condition that justifies providing the services at the
recipient's residence instead of a physician's office, clinic or other
outpatient setting.
(3)
The attending physician certifies that the recipient requires the skilled
services of a nurse, physical therapist, occupational therapist or speech
therapist or the services of a home health aide.
(4) A change in the treatment plan is made in
writing and signed by the physician, or if given orally, is put in writing and
signed by the health care professional receiving the oral order on behalf of
the agency. The order shall be countersigned by the physician within 30 days of
the physician's order. The following health care professionals may receive oral
orders from the physician:
(i) Registered
nurses.
(ii) Licensed practical
nurses.
(iii) Physical therapists,
occupational therapists and speech therapists. These health care professionals
may only receive oral orders that pertain to these specialties.
(5) The plan is reviewed by the
attending physician, in consultation with agency professional personnel at
least every 60 days. The review of the recipient's plan must contain the
signature of the attending physician and the date the review was
performed.
(6) The Department has
prior authorized the services.
(b) Home health agencies are reimbursed for
the following services furnished to MA recipients:
(1) Skilled nursing care.
(2) Home health aide services.
(3) Physical and occupational
therapy.
(4) Speech pathology and
audiology services.
(5)
Medical/surgical supplies listed in the MA Program Fee Schedule.
The provisions of this §
1249.52 amended under sections
403(a) and (b), 443.2(2) and 509 of the Public Welfare Code (62 P. S.
§§
403(a) and (b),
443.2(2) and
509).
This section cited in 55 Pa. Code §
1249.51 (relating to general
payment policy); and 55 Pa. Code §
1249.59 (relating to limitations
on payment).
