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Home Health Policy Manual

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Section/ Subsection

Title/Content

Policy Number

Issue/ Revised

 
Table of Contents
001
01/01/2020
 
Definitions
002
04/01/2019

100 General Information

 
 
 
 
Manual Program
101
04/01/2019
 
Reserved
102
 

200 Program Description

     
 
Program Goals
201
04/01/2019
 
Legal Authority
202
04/01/2019
 
Federal Requirements
203
04/01/2019
 
Organizational Requirements
204
04/01/2019

300 General Administration

 
 
 
 
Reserved
301
 
 
Fair Hearings
302
04/01/2019
 
Reserved
303
 
 
Third Party Liability
304
04/01/2019

400 Eligibility for Services

     
 
Eligibility Requirements
401
04/01/2019
 
Service Criteria
402
04/01/2019
 
Reserved
403
 
 
Plan of Care
404
04/01/2019
 
Physician Certification and Recertification
405
04/01/2019
 
Face-to-Face Encounter
406
04/01/2019
 
Certification and Plan of Care Form
SLTC 126
04/01/2019
 
Reserved
407
 
 
Member's Rights/Freedom of Choice
408
04/01/2019
 
Reserved
409
 
 
Prior Authorization Process
410
04/01/2019
 
Initial Prior Authorization and Amendment Form
SLTC-124
04/01/2019
 
Prior Authorization for Extended Services Form
SLTC-125
04/01/2019
 
Referral Process
411
04/01/2019
 
Termination of Services
412
04/01/2019

500 Eligible Services

     
 
Reserved
501
 
 
Service Limitations and Exclusions
502
04/01/2019
 
Reserved
503
 
 
Skilled Nursing
504
04/01/2019
 
Therapy Services
505
04/01/2019
 
Home Health Aide Services
506
04/01/2019
 
Medical Supplies, Equipment, and Appliances
507
04/01/2019
 
Drugs and Treatments
509
04/01/2019

600 Payment for Home Health

     
 
Provider Eligibility
601
04/01/2019
 
Provider Responsibilities
602
04/01/2019
 
Payment Requirements
604
04/01/2019
 
Licensure Requirements
607
04/01/2019
 
Clinical Records
610
04/01/2019

700 Service Coordination

     
 
Reserved
701
 
 
Reserved
702
 
 
Developmental Disabilities
703
04/01/2019
 
Reserved
704
 
 
Home Infusion Therapy
705
04/01/2019
 
Coordination with Big Sky Waiver
706
04/01/2019
 
Coordination with Community First Choice and Personal Assistance Services
707
04/01/2019
 
Reserved
708
 
 
High Risk Pregnancy
709
04/01/2019
 
Services for Children
710
04/01/2019