RULE NO.: RULE TITLE:
59G-4.130: Home Health Services
The following revisions have been made to the Florida Medicaid Home Health Services Coverage and Limitations Handbook, December 2011.
Page 2-11 Compliance Review
Paragraphs three and four are removed.
The section is changed to read: The Agency for Health Care Administration (AHCA) or its designee will periodically conduct on-site or desk reviews of home health services providers for the purpose of determining compliance with Medicaid requirements.
During such reviews, AHCA or its designee will request from the provider copies of certain records.
At the time of the request, all records must be provided to the AHCA or its designee regardless of the media format on which the original records are retained by the provider. All medical records must be reproduced onto paper copies, at the provider’s expense.
Page 2-12 Covered, Limited and Excluded Services Exclusions.
Paragraph one is changed to read: Listed below are examples of services that are not reimbursable under the Medicaid home health services program:
Bullet eleven is changed to read:
· Transportation services (except when necessary to protect the health and safety of the recipient and no other transportation service is available).
Page 2-13
Bullet thirteen, behavior management has been removed.
Bullet fourteen, supervision has been removed.
Bullets thirteen through seventeen have been added to read:
Care, grooming, or feeding of pets and animals;
Yard work, gardening, or home maintenance work;
Day care or after school care;
Assistance with homework;
· Companion sitting or leisure activities;
Page 2-17 Skilled Nursing Services
Paragraph one is changed to read: The following are examples of nursing services reimbursable by Medicaid:
Page 2-18 Licensed Nurse and Home Health Aide Services, continued
Skilled Nursing Services, continued
The fourth bullet has been restored to read: Nasopharyngeal, tracheotomy aspiration, ventilator care;
Home Health Aide Services
The last paragraph reads: Home health aides must not perform any services that require the direct care skills of a licensed nurse.
Page 2-22 Private Duty Nursing Services
Limitations
Paragraph one is changed to read: Private duty nursing services are limited to a minimum of two continuous hours per day.
Page 2-23 Private Duty Nursing Services, continued
The section titled “Exceptions to the Limitations” is entirely deleted
Page 2-24 Private Duty Nursing Services, continued
The section titled “Exclusions” is entirely deleted
Page 2-26 Personal Care Services, continued
Parental Responsibility
First paragraph is changed to read: Personal care services are authorized to supplement care provided by parents and caregivers. Parents and caregivers must participate in providing care to the fullest extent possible. Training must be offered by the home health service provider to parents and caregivers to enable them to provide care they can safely render without jeopardizing the health or safety of the recipient. The home health services provider must document the methods used to train a parent or caregiver in the medical record.
The second paragraph is changed to read: Medicaid can reimburse personal care services rendered to a recipient whose parent or caregiver is not able to care for him. Supporting documentation must accompany the prior authorization request in order to substantiate a parent or caregiver’s inability to participate in the care of the recipient*.
The third paragraph is changed to read: Note: See Appendix F, G, H, and I for copies of the Parent or Legal guardian medical limitations, work, and school schedule forms, AHCA-Med Serv Forms 5000: 3501, October 2010; 3503, December 2011; 3504, December 2011; and 3505, December 2011. The forms are available by photocopying them from Appendix F, G, H, and I. They are incorporated by reference in Rule 59G-4.130, F.A.C.
The fourth paragraph is entirely deleted.
The fifth paragraph is entirely deleted.
The sixth paragraph is entirely deleted.
The seventh paragraph is entirely deleted.
Page 2-29 The section titled “Exclusions” is entirely deleted.
Page 2-36 Prior Authorization for Home Health Services, continued
Review Criteria
The third paragraph is entirely deleted.
Appendix D: Guidelines for Evaluating Family Support and Care Supplements
Activity Affecting Parental Availability
Employment (Work Hours) is changed to read: Based upon the work schedule submitted from the parent, legal guardian, or caregiver’s employer. If self employed, the parent, legal guardian, or caregiver must document the work schedule in a statement.
Appendix H: Parent or Legal Guardian Statement of Work Schedule
(Note: this form must be notarized) has been removed.
Notary Signature, Notary Printed Name, Notary Address, Notary Telephone Number have all been removed.