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
       

 

 
Reserved
708
 
High Risk Pregnancy
709
04/01/2019
Services for Children
710
04/01/2019