Home Health Services
A "home health agency" is a "public agency or private organization or a subdivision of such an agency or organization that is engaged in providing home health services to individuals in the places where they live. Home health services must include the services of a licensed registered nurse and at least one other therapeutic service and may include additional support services" (50-5-101 , Montana Code Annotated [MCA]). Those services may include physical therapy, occupational therapy, speech therapy, medical social services, or home health aide services (42 Code of Federal Regulations [CFR] 484; see also Administrative Rules of Montana [ARM] 37.106.101).
Core home health services are services that are equivalent to Medicare and/or Medicaid-reimbursable home health services (regardless of the patient's source of payment). These services can include intermittent skilled nursing, physical therapy, occupational therapy, speech therapy, respiratory therapy, medical social services, and home health aide services.
Core home health services should be available and accessible to Montanans who need these types of services. As part of this service availability/accessibility, all patients have the right to expect prompt attention from any home health agency licensed to provide services in the county in which the patient resides.
- To further the development of home health services in areas with no existing home health services, or in areas where the existing agencies are not appropriately serving the home health needs of the entire community.
- To encourage the provision of new, additional "core" home health services to each area by home health agencies.
- To promote the development of home health agencies that serve all patients, regardless of the patient's source of payment or proximity to an agency.
- To advocate the provision of continuing education for agency staff, and ongoing patient education, involving the patient/family as much as possible, in their own treatment.
Certificate of Need Guidelines
As outlined in 50-5-304, MCA, any applicant seeking to provide home health services should address the review criteria in its CON application, including an evaluation of the proposal with the guidelines established in this section. The review criteria consider consistency with the State Health Care Facilities Plan, but also allow consideration of additional data and information.
- The applicant must demonstrate the need for or prove the cost efficiency of a new agency. The applicant should present to the department how the proposed agency would fit into the comprehensive health care delivery system of the service area, in addition to its effect on existing home health services.
- The applicant must demonstrate (based on the results of applying the methodology outlined below) that it would be financially feasible to provide services in a county.
- An applicant must demonstrate that it will serve all communities in a county and all segments of the population in that county. County boundaries function as service area boundaries for home health agencies.
- Certificates of Need should be granted to qualified applicants requesting to offer services in counties which are without home health services.
- Each county will be permitted to have at least two or more home health agencies.
- For approval of a home health agency to be considered in a county with two or more existing home health agencies, the unmet patient need must be at least 75 patients, or documentation that the existing agencies are not meeting the definition, goal, and objectives of the State Health Care Facilities Plan. The unmet patient need is calculated using the methodology outlined below with the most current data available. An unmet patient need of seventy-five (75) patients is considered the minimum threshold.
- Additional consideration should be given to an applicant that proposes to provide home health services in a county with existing home health services, when the applicant offers core home health services that the present agency does not offer.
- After approval of a CON for a home health agency, there will be a waiting period before CON applications for additional home health agencies in that county will be approved. In order for the Department to accurately assess the need of the county, time must be allowed for the development and delivery of the new services. The waiting period will be eighteen (18) months from the date of issuance of the Certificate of Need.
Need Methodology for Home Health Services:
The following elements will be used to calculate the unmet patient need for each county:
- Data on the number of patients served in each county as reported by home health agencies in the most recent Annual Survey of Home Health Agencies.
- The population for each county as estimated in the U.S. Bureau of the Census or as projected by NPA Data Services, Inc., for the same calendar year as that of the most recent Annual Survey of Home Health Agencies.
- A standard multiplier of "patients per 1,000 population aged 65 and over," will be used to estimate the potential patients to be served in each county for the State Health Care Facilities Plan. This multiplier will be updated annually and is determined by taking the average of the ten (10) counties serving the highest number of patients per 1,000 population 65 and older, as reported in the most recent Annual Survey of Home Health Agencies.
Click on the "Current Home Health Need Methodology" (link below) to review the current multiplier and the current patient need for each county .
To Determine Need for Home Health Services for a Particular County:
- Compute the projected potential patients for the county by multiplying the county's population 65 and older in thousands by the standard multiplier.
- Compute the unmet patient need by subtracting the actual patients served during the most recent year for which data is available (as reported on the Annual Survey of Home Health Agencies) from the projected potential patients for the county.
In the process of developing the State Health Care Facilities Plan, several alternatives to the present methodology were devised. These options included using the same methodology, but giving a graduated benefit of the full standard multiplier to counties based on the percentage of the 65+ population in each county. Decreasing benefit was given to counties with decreasing percentages of the 65+ population. Also suggested was the introduction of a moratorium on the development of new agencies, but allowance of expansion of existing agencies. Additional options included the idea of regionalization, whereby the Governor's Health Planning Regions were used to grant Certificates of Need. An agency applying for any of the regions would have the benefit after issuance of serving all of the counties of that region. And, the use of a standard multiplier of 2.5%, was also suggested. This percentage represents a 1995 National Association for Home Care (NAHC) statistic of the percent of total population that receives formal home care services.
After considering all of the options, the Department of Public Health and Human Services (DPHHS) has elected to continue using similar methodology and need threshold for service as was first introduced with the 1993 state health plan. The methodology's reliance upon data that pertains to the 65+ population reflects the prevalence of home health services delivery in Montana to this age group (approximately 85%), in contrast to the national average of 50%. Although the department recognizes the strengths and validity of the various options, it also saw benefit in allowing the present methodology to chart its course for additional years, with numeric updates each year.
The Department does anticipate that the home health industry will continue to change over the next several years, particularly in the area of reimbursement. In addition, the expansion of the home care delivery system, which includes home health care must also be monitored. In order to accurately depict areas of need and respond to those needs, the full spectrum of home care, including personal care, homemaker services, hospice, adult foster care, adult day care, etc., must be considered. With the prospective payment system (PPS), the program must react to any changes that occur. With these industry developments in mind, the Department will continue to assess the appropriateness of the present methodology, and will closely evaluate what role the Certificate of Need process will have in light of any changes that develop.
Office of Inspector General
Licensure Bureau Certificate of Need Program
CON Statute and Rules
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