Home health care


AZ | CA | CO | CT | DE | DC | FL | HI | IL | IN | IA | KS | KY | ME | MD | MA | MI | MN | MO | MT | NE | NV
NH | NJ | NM | NY | NC | ND | OH | OR | PA | PABH | RI | SC | TN | UT | VA | WA | WV

AZ

"SECTION D:  PROGRAM REQUIREMENTS
1. SCOPE OF SERVICES…
Home Health: The Contractor shall provide part-time or intermittent care for members who do not require hospital care.  This service is provided under the direction of a physician to prevent re-hospitalization or institutionalization and may include nursing, therapies, supplies and home health aide services."  Arizona Contract, pages 10 and 13.

"K.  Home Health Services
Home health services are defined as intermittent nursing care provided by certified nursing professionals (registered nurses, licensed practical nurses, and home health aides) in the client's home when the client is homebound or semi-homebound.  Home health care must be rendered by a Medicare-certified Home Health Agency that has a surety bond.

Personal care services as defined in the DEPARTMENT's Medicaid Personal Care Provider Manual are included in this Contract.  Personal care services may be provided by a State licensed home health agency...

M.  Private Duty Nursing
Services provided by licensed nurses for ventilator-dependent children and technology dependent adults in their home in lieu of hospitalization if Medically Necessary, feasible , and safe to be provided in the patient's home.  Requests for continuous care will be evaluated on a case by case basis and must be approved by the CONTRACTOR."  Arizona Contract, page C3.

CA

"6.7.3.8 Department of Developmental Services Administered Medicaid Home and Community Based Services Waiver.
The HCBS waiver services are not covered under this Contract…"  California Contract, page 119.

CO

"I. DEFINITIONS
The following terms as used in this Contract shall be construed and interpreted as follows unless the context otherwise expressly requires a different construction and interpretation: ...

AO.   'Home Health Care' shall mean a program of care provided by a public agency or a private organization, or a subdivision of such an agency or organization that:
1.  is primarily engaged in providing intermittent skilled nursing service and other therapeutic services in homes or places of residence of its patients;
2.  has policies established by a group of professional personnel associated with the agency or  organization including policies to govern the services which it provides;
3.  maintains Medical Records of all patients;
4.  has the written approval of the Contractor as an agency or organization to provide Home Health Care under this Contract to Members.
5.  is certified by Medicare and Medicaid."  Colorado Contract, pages 6-7.

"IV.  COVERED SERVICES…
C.  Fee for Service Benefits...
2.  It is understood and agreed that the Contractor shall have no obligation for payment to providers of services that are defined as Home and Community Based Waiver Services (HCBS) by the Department's regulations."  Colorado Contract, pages 18-20.

"EXHIBIT A
COVERED SERVICES…
A.13 Home Health Services
Home Health Care is covered as described in Staff Manual Volume VIII Sections 8.520 through 8.530. Covered services include medically necessary services provided in a Client’s home by a certified home health care agency for the treatment of an illness, injury or disability. The Contractor may approve a Plan of Care and may apply homebound criteria. Homebound shall mean that the client, due to illness, injury or disability, is unable to leave home without considerable or taxing effort to obtain the needed health care service outside the home or that leaving home to obtain the service is contraindicated by the client’s medical condition or would interfere with the effectiveness of the health service. The contractor is not required to cover more than one nurse, home health aide or therapist at one time except when two aides are required for transfers or more than one nurse is needed to perform a procedure.

Services provided specifically as benefits of the Home and Community Based Services Programs (HCBS), which include unskilled personal care, home modification, electronic monitoring, adult day services, alternative care facility services, homemaker services and respite care are not included under this Contract.

Covered Home Health Services include:
PROCEDURE/SERVICE (REQUIRED COVERAGE)
  Professional services of an RN, LPN, LVN or CNA on an intermittent basis
  Home health aide services for purposes of providing skilled personal care, in conjunction with a nurse or therapist and under the supervision of a nurse or therapist
  Physical therapy, speech therapy, occupational therapy by a licensed therapist
  Medical/surgical supplies customarily furnished by the agency for its patients…"  Colorado Contract, Exhibit A, page 26.

CT

"SUMMARY DESCRIPTION OF BENEFITS
A.  Covered Services included in the Capitation Payment…
  30.  Home Health Care - Medically necessary home health services ordered by the patient's physician and provided by a licensed home health agency on a part-time or intermittent basis in the patient's home for the purpose of enabling the patient to remain at home or to provide a less costly alternative to institutional care…"  Connecticut Contract, Appendix A, pages 3-14.

DE

"6.4  Basic Benefit Package

The DHSSHP will provide standard benefits similar to the acute care benefits that are currently provided under Delaware's Medicaid program…"   Delaware RFP, page II.37

"Appendix H
Overview Medicaid Covered Services

SERVICE TYPE/ BASIC BENEFIT PACKAGE...
Other...
Home Health Care/Covered…"  Delaware RFP, Appendix H, page 1.

"6.2  The state elects to provide the following forms of coverage to children:  (Check all that apply.  If an item is checked, describe the coverage with respect to the amount, duration and scope of services covered, as well as any exclusions or limitations) (Section 2110(a))

The following services marked with an 'X' are covered by the State Child Health Insurance Program as part of a basic MCO benefit package when medically necessary with exceptions/limitations noted: ...

6.2.14.  'X'  Home and community based health care services (See instructions) (Section 2110(a)(14)) - limited to medically necessary home health services provided by the MCOs as part of the basic benefit.  Does NOT include personal care, chore services, day care, respite care, or home modifications.  Home health aide services are covered as medically necessary according to the State's published definition…"  Delaware RFP, Appendix A (SCHIP), pages A.18-A.19.

DC

"H.  COVERAGE AND BENEFITS
  1.  Covered services
  a.  This contract provide for coverage and provision by Provider of all medical assistance benefits and  services that are listed in Attachment I, which is incorporated herein as part of this contract…"  District of Columbia Contract, page 21.

"Attachment I
Covered Services

A.  General Classes of Covered Benefits
Coverage of all benefits by Provider shall conform to the definition of the benefit set forth in federal statue and regulation.  The following general categories of benefits are included in the state plan and are not otherwise exempt under this contract...

  10.  Home health services for individuals of all ages including intermittent or part-time nursing care, home health aide services provided by a home health agency, medical supplies, equipment, and appliances suitable for use in the home, and physical therapy, occupational therapy or speech pathology and audiology services.  Services for individuals with speech, language and hearing disorders is limited to children under 21."  District of Columbia Contract, Attachment I, pages 1-2.

FL

"ATTACHMENT I
A.  Services To Be Provided
1.  Services. The plan shall insure the provision of the following covered services as defined and specified in Attachment II:
Mandatory...Covered
Home Health Services and Durable Medical Equipment...X"  Florida Contract, page. 5.

"8.  Home Health Care Services and Durable Medical Equipment.  These services are intermittent nursing services by a registered nurse or licensed practical nurse and/or personal care services by a licensed home health aide with accompanying necessary medical supplies, appliances and durable equipment appropriate for use in the recipient's home which are provided for eligible recipients primarily to maintain physical and emotional comfort and to assist the recipient toward independent living in a safe environment...
b.  Services rendered by a home health aide shall be under the continuous supervision of a registered nurse.
c.  Services do not include homemaker services, Meals on Wheels, companion, sitter, or social services.
d.  All services provided to certified home bound patients shall be prescribed by a physician.  Provision of medically necessary supplies/DME does not require a recipient to be homebound.
e.  Medical equipment furnished to members includes, but is not limited to, custom wheelchairs and custom seating inserts, and other equipment…"  Florida Contract, pages 82-83.

HI

"30.710 Medical Services
 One of the primary focuses of Quest is preventive care; therefore, preventive and diagnostic services are important benefits of the basic health plan.  The services include all medically necessary and preventive services.  The health plan shall provide, at a minimum, whatever services are currently covered by the Hawaii Medicaid program...

*  Home health agency services including:
-  Skilled nursing
-  Home health aides
-  Therapeutic services such as physical, speech, occupational therapies and audiology therapy
-  Medical supplies and durable medical equipment
-  Other therapies, services and supplies, equipment to prevent institutionalization…" Hawaii RFP, pages 16, 18-19.

"Home Health Agency Services
A.  For Adults
1.  Services provided at a member's home or location other than a hospital, skilled nursing facility, intermediate care facility, or intermediate care facility for mental retardation which are prescribed by a physician as pare of a written plan of care.
  a. Services include skilled nursing, home health aide, physical therapy, occupational therapy, speech therapy and audiology.
  b. Also included are non-experimental medical supplies equipment, and appliance suitable for use in the home...

B.  For children (EPSDT)
1.  Services and requirements for adults apply.
2.  In addition, medically necessary home health services allowable by federal Medicaid rules and revelations such as private duty nursing and personal care are included. (Reference: OBRA 1989)…"  Hawaii RFP, Appendix H, page 7.

"Home Health Services:  in providing services to prevent institutionalization, is there a differentiation in the types of services that can be provided to the ABD population?  At what point would the State assume responsibility for these recipients, e.g., if a patient could be maintained at home but only with twenty-four hour care, would the plan be expected to provide this service, or would this patient be presumed to meet the LTC guideline and revert to FFS?

ANSWER:
 Home health services are provided by Medicare certified home health agencies on a per visit basis based on the medical necessity of home health services for a recipient.  The State will evaluate on a case-by-case basis whether a recipient meets the criteria or placement in a LTC facility.  The State agrees that the plan cannot be expected to provide 24 hours of continuous care a day to maintain a recipient in his home unless this care would be of a short term nature." Hawaii RFP, Q&A, pages 10-11.

IL

"(b)  Covered Services...
(2)  Medically Necessary Covered Services
The following services and benefits shall be included as Covered Services under this Contract and will be provided to Beneficiaries whenever medically necessary: ...
•  Home health care services…"  Illinois HMO Contract, page 19.

IN

"3.1.3  Medicaid Covered Services
The Indiana Medicaid program covers the following services for all eligible recipients.  The specific services covered under the managed care initiative are specified in Section 4.4 of this RFP...
  *  Home health) services…"  Indiana RFP, pages 3-3 - 3-4.

"4.4  Description Of Managed Care Services
4.4.1  Hoosier Healthwise RBMC Covered Services...
The following is a general list of covered services under the RBMC program, listed by general categories; an abbreviated list of covered services within each category also is provided...
  *  Home health services..."  Indiana RFP, pages 4-4 - 4-5.

"CHIP Benefit Package

Service:  Home Health Services**

Indiana Medicaid Benefits:  Reimbursement is available to home health agencies for skilled nursing services provided by a registered nurse or licensed practical nurse; home health aide services; physical, occupational, and respiratory therapy services; speech pathology services, and renal dialysis.  Provided with limitations.

CHIP Benefit Package: Reimbursement is available to home health agencies for skilled nursing services provided by a registered nurse or licensed practical nurse; home health aide services; physical, occupational, and respiratory therapy services; speech pathology services, and renal dialysis.  Provided with limitations.

**Prior Approval Always Required
*Prior Approval Required Under Certain Circumstances
+Federally Required CHIP Benefits."  Indiana SCHIP Amendment, Attachment C-1, page 3.

IA

"4.2.1  Covered Services...
Following service categories shall be covered under this contract:
- Home health services…"  Iowa Contract, page 17.

KS

"C.  MEDICAL SERVICES INCLUDED IN THE CONTRACT…
The following services and scope of these services as described in each specific Medicaid Provider Manual are reflective of current SRS Fee-For-Service limitations and must be covered, at a minimum, under the terms of this contract:
•  Home Health Services.
  o  Home health aide services
  o  Skilled nursing services (free-standing and hospital-based)…"  Kansas Contract, pages 4-5.

KY

"D.  Services to Be Provided
  1.  Covered Services
  The Contractor shall provide Covered Services in accordance with Section 7.9.1 and Attachment VIII of the RFA."  Kentucky Contract, page 21.

"Covered Services...
Home Health Services."  Kentucky RFA, Attachment VIII, page 57.

"Home Health Services (907 KAR 1:030)
Medically reasonable and necessary home health service(s) authorized by a doctor of medicine, osteopathy, or podiatric medicine, provided to a recipient in his place of residence, excluding a hospital, skilled nursing facility, and ICF-MR facility in accordance with established plans of care reviewed every sixty (60) to sixty-two (62) days, are covered, including: …" Kentucky RFA, Attachment VIII, page 72.

ME

"B.  COVERED SERVICES...
Covered Services: ...
• Home Health Services…"  Maine Contract, page 20.

MD

"10.09.67.05...
.05  Benefits-Home Health Services.
A.  Subject to the conditions specified in §B of this regulation, an MCO shall provide to its enrollees medically necessary and appropriate home health services, including:
(1)  Skilled nursing services...
(2)  Home health aide services, including biweekly supervisory visits by a registered nurse in the recipient's home, every second visit of which includes observations of the delivery of services by the aide to the enrollee;
(3)  Physical therapy services;
(4)  Occupational therapy services;
(5)  Speech pathology services; and
(6)  Medical supplies that are used during a home health visit."  Maryland COMAR 10.09.67.05.

MA

"APPENDIX C:  MCO COVERED SERVICES
Exhibit 1:  MCO Covered Services for MassHealth Standard Enrollees...

Home Health -- all home health care services, including DME associated with such services; part-time or intermittent skilled nursing care; physical, occupational, and speech language therapy; and part-time or intermittent home health aide services…

Exhibit 4:  MCO Covered Services for MassHealth Basic Enrollees...

Home Health -- intermittent or part-time skilled nursing care when the following conditions are met
1.  Such care is provided following an acute inpatient hospitalization; and
2.  Such care is intended to help resolve an identified short-term (for example 14 days) skilled-nursing need directly related to the member's acute hospitalization…"  Massachusetts Contract, Appendix C, pages 1-2, 14-15.

MI

"II-H  SCOPE OF COMPREHENSIVE BENEFIT PACKAGE
1.  Services Included...
The services provided to Enrollees under this Contract include, but are not limited to, the following: …
*Home Health services…"  Michigan Contract, pages 20-21.

MN

"Section 2.22. Home Care Services includes nursing services, private duty nursing services, home health aide services, personal care services, nursing supervision of personal care services, physical therapy, occupational therapy, speech therapy, respiratory therapy, durable medical equipment, and supplies."  Minnesota Contract, page 12.

"Section 6.1. MA and MinnesotaCare/MA Covered Services. The HEALTH PLAN shall provide, or arrange to have provided to MA and MinnesotaCare/MA Enrollees comprehensive preventive, diagnostic, therapeutic and rehabilitative health care services as defined in Minnesota Statutes… These services shall include but are not limited to, the following…

Section 6.1.8.  Home Care Services.

A.  Home care services include:

1)  Nursing services provided by a certified Home Health Care Agency, up to the service limit described in Minnesota Statutes...

2)  Home Health Aide services provided by a certified Home Health Care Agency, up to the service limit described in Minnesota Statutes...

3)  Personal Care Services, up to the service limits established in Minnesota Statutes…  The HEALTH PLAN must ensure that an explanation of any changes in service levels is documented.

4)  Nursing supervision of Personal Care services, up to the service limits established in Minnesota Statutes...

5)  Private Duty Nursing Services, up to the limits established in Minnesota Statutes...

6)  Therapy Services, including physical therapy, occupational therapy, speech therapy and respiratory therapy, up to the limits established in Minnesota Rules...

7)  Medical Equipment and Supplies, pursuant to Section 6.1.14.

B.  For Enrollees who are ventilator-dependent, the limits described in 1-6 above, do not apply; the limits for these Enrollees are as described in Minnesota Statutes, Section 256B.0627, Subd. 5(e)4...

E.  Enrollees over age 65 who require more than the home care services covered under Minnesota Statutes, Section 256B.0627, Subdivision 2 or who require services provided under the Elderly Waiver program in addition to home care services, shall be referred to the Elderly Waiver program."  Minnesota Contract, pages 48-49, 52-53.

"Section 6.3.2. MinnesotaCare Enrollees. The HEALTH PLAN shall provide, or arrange to have provided to MinnesotaCare Enrollees the same services described in Section 6.1. above with the following modifications...
E.  Home Care Services are covered, with the exception of private duty nursing and personal care attendant services."  Minnesota Contract, page 61.

MO

"b.  Covered Services...
15)  Home health services"  Missouri RFP, page 9.

"2.1.5  Services shall include...
o.  Home health services"  Missouri RFP, page 18.

"HOME HEALTH
Health plans are responsible for covering all medically necessary, provider ordered home health benefits for children and adults who are members.  Health plans shall not terminate such services without a case-specific, clinical decision made by a  provider…Home health services provide primarily medically oriented treatment or supervision to individuals with an acute illness, or an exacerbation of a chronic or long term illness which can be therapeutically managed at home.  The delivered care should follow a written plan of treatment established and periodically reviewed by a physician.

The home health program is divided into two distinct segments based on clients' age.  Clients who are 21 years of age and older, are defined as adults with in the home health program.  Clients 20 and under are classified as children and are eligible to receive expanded home health services as part of the healthy Children and Youth federal mandate.  Services include Skilled Nursing, Aide Visits, Psychiatric Nursing, Physical, occupational , and Speech Therapy, and Supplies."  Missouri RFP, Attachment Five.

MT

"2.5  PROVISION OF SERVICES
2.5.1  COVERED SERVICES...

HMO COVERED SERVICE/DESCRIPTION...
Home Health Care Services (all persons)/care from a nurse, home health aide, physical therapist,
 occupational therapist, speech therapist and supplies; ARM 46.12.550 & 551."  Montana Contract, page 41.

NE

"4.1 Applicable Definitions: The following definitions apply under this contract: ...
4.1.3 The term 'Basic Benefits Package,' means the following medical/surgical services, representing a minimum benefits package, as defined in this contract and 471 Nebraska Administrative Code (NAC), that shall be provided by the plan to clients enrolled in the NHC: ...
(g) Home health agency services (See 471 NAC 14-000). (This does not include non-home health agency approved Personal Care Aide Services under 471 NAC 15-000)…"  Nebraska Contract, page 6.

"13.45 Services in the Basic Benefits Package: Pursuant to this contract, services included in the Basic Benefits Package are...
(g) Home health agency services (471 NAC 9-000). This does not include non-home agency approved Personal care aide services under 471 NAC 15- 000);
(h) Private duty nursing services (471 NAC 13-000)…"  Nebraska Contract, page 94.

NV

"CONTRACTOR DUTIES AND RESPONSIBILITIES
I.  Medical Services
A.  Contractor Mandatory Managed Care Benefit Package.  Except as otherwise provided for in this contract, each Contractor must provide a comprehensive managed care benefit package to Medicaid participants…

B.  Contractor Covered Services.  At a minimum, the Contractor must provide directly or by subcontract all medical services listed below: ...
  12.  Home Health Agency…"  Nevada Contract, page 21.

NH

"Covered Services
I.  Covered Services-General...
G.  Home Health Care Services (including Hospice)
Contractor shall comply with RSA 167.68, II., (e)."  New Hampshire General Service Agreement, Exhibit A.3.,  page 4.

NJ

"ARTICLE 10
COVERED HEALTH CARE SERVICES
10.1 For enrollees who are Medicaid-eligible through Title XIX or the NJ KidCare Plan A program, the contractor shall provide or shall arrange to have provided comprehensive, preventive, diagnostic, rehabilitative, and therapeutic health care services to enrollees that include all services that Medicaid recipients are entitled to receive pursuant to Medicaid, subject to any limitations and/or excluded services as specified in Appendix A of this contract. DMAHS shall assure the continued availability and accessibility of Medicaid covered services not covered under this contract. All services provided shall be in accordance with the New Jersey State Plan for Medical Assistance, the New Jersey Medicaid Managed Care Plan, and all applicable statutes, rules, and regulations.

10.1.1  For beneficiaries eligible solely through NJ KidCare Plan B and Plan C, the contractor shall provide the same managed care services and products provided to enrollees who are eligible through Title XIX. However, non-HMO covered services (i.e., services that continue to be provided fee-for-service) will be limited to certain services for the NJ KidCare Plan B and C populations as indicated in Appendix A.

10.1.2  For beneficiaries eligible solely through NJ KidCare Plan D, the contractor shall provide the managed care services and products as delineated in Appendix S. Non-HMO covered services (i.e., services that will be provided fee-for-service by the Division of Medical Assistance and Health Services) will be limited to the services delineated in Appendix S.

10.2 The contractor hereby agrees that no distinctions shall be made with regard to the provision of services to Medicaid enrollees and the provision of services provided to the contractor's other non-Medicaid members unless required by this contract.

10.3  The scope of services to which an enrollee is entitled from the contractor, while deemed eligible for enrollment in the contractor's plan, is those services included in the benefits package. The remaining services to which enrollees are entitled under the Medicaid program but are not included in the contractor's benefits package will continue to be covered by Medicaid under its fee-for-service program."  New Jersey Contract, page 51.

"APPENDIX  A
BENEFITS PACKAGE-INCLUSIONS AND EXCLUSIONS MEDICAID
   The health care services listed below shall be provided by the contractor to enrollees as covered benefits rendered under the terms of this contract.  Provision of these services shall be equal in amount, duration, and scope as established by the Medicaid program, in accordance with medical necessity without any predetermined limits, unless specifically stated...

SERVICES INCLUDED IN THE CONTRACTOR'S BENEFITS PACKAGE
The following services must be provided and case managed by the contractor...
  17.  Home Health Agency services:  Must be provided by a home health agency that meets state licensure and Medicare participation requirements…"  New Jersey Contract, Appendix A, pages 166-168.

“APPENDIX S
NJ KIDCARE - PLAN D
BENEFITS PACKAGE-INCLUSIONS AND EXCLUSIONS
The health care services listed below shall be provided by the contractor to enrollees as covered benefits rendered under the terms of this contract…

SERVICES INCLUDED IN THE CONTRACTOR'S BENEFITS PACKAGE
The following services must be provided and case managed by the contractor: ...

4.  Home Health Care Services: limited to skilled nursing for a home bound beneficiary which is provided or supervised by a registered nurse, and home health aide when the purpose of the treatment is skilled care; medical social services which are necessary for the treatment of the beneficiary's medical condition; and short-term physical, speech or occupational therapy, with the limitations described under Outpatient Rehabilitation Services."  New Jersey Contract, Appendix S, pages 233-234.

NM

"2.D.20  Home Health Services:
The benefit package includes home health services as set forth in Medical Assistance Division Program Manual Section MAD-768, HOME HEALTH SERVICES." New Mexico Contract, page 40.

NY

"APPENDIX K-1
MANGED CARE PLAN PREPAID BENEFIT PACKAGE
Covered Services
Home Health Services

Managed Care Plan Scope of Benefit:
Home health care services include medically necessary nursing, home health aide services, equipment and appliances, physical therapy, speech/language pathology, occupational therapy, social work services or nutritional services provided by a home health care agency pursuant to an established care plan.  Personal care tasks performed by a home health aide in connection with a home health care agency visit, and pursuant to an established care plan, are covered.

Covered by Medicaid Fee-For-Service...
Coverage for services rendered by a personal care agency which are approved by the local social services district when ordered by the Enrollee’s primary care provider (PCP). The district will determine the applicant’s need for personal care agency services and coordinate with the personal care agency a plan of care…"  New York Contract, Appendix K, page K-5.

"I.  PREPAID BENEFIT PACKAGE DEFINITIONS OF COVERED SERVICES
A.   Medical Services...

4.  Home Health Services...
Home health care services are provided to recipients in their homes by a home health agency certified under Article 36 of the New York State P.H.L. (Certified Home Health Agency – CHHA).  Home health services mean the following services when prescribed by a provider and provided to a Medicaid managed care Enrollee in his or her home:
*  nursing services provided on a part-time or intermittent basis by a CHHA or, if there is no CHHA that serves the county/district,  by a registered professional nurse or a licensed practical nurse acting under the direction of the Enrollee’s PCP;
*  physical therapy, occupational therapy, or speech pathology and audiology services; and
*  home health services provided by a person who meets the training requirements of the SDOH, is assigned by a registered professional nurse to provide home health aid services in accordance with the Enrollee’s plan of care, and is supervised by a registered professional nurse from a CHHA, or if the Contractor has no CHHA available a registered nurse, or  therapist.

Personal care tasks performed by a home health aide incidental to a certified home health care agency visit, and pursuant to an established care plan, are covered."  New York Contract, Appendix K, pages K-13-K-14.

"K_2
MANAGED CARE PLAN PREPAID HEALTH ONLY BENEFIT PACKAGE
For SSI  and SSI Related Recipients

Covered Services
Home Health Services

Managed Care Plan Scope Of Benefit
Home health care services include medically necessary nursing, home health aide services, equipment and appliances, physical therapy, speech/language pathology, occupational therapy, social work services or nutritional services provided by a home health care agency pursuant to an established care plan.  Personal care tasks performed by a home health aide in connection with a home health care agency visit, and pursuant to an established care plan, are covered.

Covered by MA Fee for Service...
Covered for services rendered by a personal care agency which are approved by the local social services district when ordered by the Enrollee’s primary care provider (PCP). The district will determine the applicant's need for personal care agency services and coordinate with the personal care agency a plan of care…"  New York Contract, Appendix K, page K-9.

NC

"Appendix III
Schedule of Benefits
In-Plan Benefits...
  *  Home Health…"  North Carolina Contract, Appendix III.

ND

"ATTACHMENT L:  COVERED SERVICES...
7.  Home health care - includes nurse, home health aide, physical therapy, occupational therapy, speech therapy and appropriate medical supplies furnished by a licensed home health agency."  North Dakota Contract, attachment L, page 1.

OH

"APPENDIX A
BASIC BENEFIT PACKAGE BY SERVICE TYPE
The following types of services must be provided to covered persons by participating health plans and at least to the extent such services are covered by Ohio Medicaid.  Additional covered services required under this contract are outlined in the RFP...
9.  Home health care services…"  Ohio RFP, Appendix A, page 1.

OR

"3.  STATEMENT OF WORK
A.  Subject to the provisions of this Section and Section 4, COVERED SERVICES...
Contractor shall:

 (1)  (a)  Ensure provision of Medically Appropriate Covered Services consistent with OAR 410-141-0120, including Emergency Services and preventive care services, in all those categories listed below as Mandatory and in those Optional categories that are listed below (hereinafter referred to as Capitated Services) for all OMAP Members: …
Home Health/Private Duty Nursing/Hospice…"  Oregon Contract, pages 2-3.

PA

"F. IN-PLAN SERVICES...
2.  Description of Comprehensive Benefits Package
a.  General
The HMO must agree to make available the comprehensive benefits package to program eligibles.  The Comprehensive benefit package includes  home health services…"  Pennsylvania RFP, pages 37-38.

PABH

"3)  Medical Care
  The member's HealthChoices HMO has a comprehensive benefit package provided in a manner comparable to the amount, duration, and scope set forth in the Medical Assistance fee-for-service program, unless otherwise specified by the Department.  The comprehensive benefit package includes…home health services…"  Pennsylvania Behavioral Health RFP, page 53.

RI

"SCHEDULE OF IN-PLAN BENEFITS...
Home Health Services
Covered if ordered by a Health Plan physician.  Includes private duty nursing and homemaking/ personal care services when medically necessary.  Personal care/ homemaking services include such tasks as assisting the client with personal hygiene, dressing, feeding, transfer, ambulatory needs, and household tasks incidental to the client's health needs.  These homemaking tasks might include making the client's bed, cleaning, cleaning the client's living areas such as bedroom and bathroom, and doing the client's laundry and shopping.  These services may be provided for RIte Care members and his/her children if the member is unable, because of illness or disability, to provide caretaking functions for herself/himself and her/his child(ren).  Does not include respite care, relief care, or day care."  Rhode Island RFP, Attachment A, pages 1, 5.

SC

"4.1 Core Benefits For The South Carolina Medicaid HMO Program
Core benefits must be available to each Medicaid HMO Program member within the Contractor's service area and the Contractor must provide a mechanism to reduce inappropriate and duplicative use of health care services...

A summary listing of the core benefits is as follows: ...
Home Health Services…"  South Carolina Contract, page 15.

"HOME HEALTH SERVICES
Home Health services are health care services delivered in a person's place of residence, excluding nursing homes and institutions, and include intermittent skilled nursing, home health aide, physical, occupational and speech therapy services, and physician ordered supplies.

  Current Medicaid Service Limitations:
  75 visits per member, per state fiscal year"  South Carolina Contract, Appendix  C, Tab 1, page 6.

TN

"SECTION 2 - CONTRACTOR RESPONSIBILITIES...
2-2.    CONTRACTOR Qualifications
  The CONTRACTOR shall comply with the following requirements at the inception of this Agreement and at all times during the life of this Agreement: ...

Comprehensive health care services shall include, but not be limited to:
  4.  home health care services…"  Tennessee Contract, pages 3-4.

"2-3.    Benefits/Service Requirements and Limitations
a.  Covered Services

 1.  Medically Necessary Services...

SERVICE/ BENEFIT...
Home Health Care/As medically necessary…"  Tennessee Contract, pages 7-9.

UT

"5.  Enrollee Transition Between MCOs, or Between Fee-For-Service and CONTRACTOR...
  b.  Home Health Services
  Medicaid clients who are under fee-for-service or are enrolled in an MCO other than this MCO and are receiving home health services form an agency not contracting with the CONTRACTOR will be transitioned to the CONTRACTOR's home health agency.  The CONTRACTOR is responsible for payment, not to exceed Medicaid payment, for a period not to exceed seven calendar days, unless the CONTRACTOR notifies the non-participating home health agency of the change in status or the non-participating home health agency notifies the CONTRACTOR that services are being provided by its agency..."  Utah Contract,  Attachment B,  page 25-26.

"11.  Home Health Services
  Home health services are defined as intermittent nursing care provided by certified nursing home professionals (registered nurses, licensed practical nurses, and home health aides) in the client's home when the client is homebound or semi-homebound.  Home health care must be rendered by a Medicare-certified Home Health Agency that has a surety bond.

Personal care services as defined in the DEPARTMENT's Medicaid Personal Care Provider Manual are included in this Contract.  Personal care services may be provided by a State licensed home health agency."  Utah Contract, Attachment C. page 3.

VA

"12.  Home Health Services...
The Contractor shall cover home health services, including nursing services and home health aide services, as set forth in 12 VAC 30-50-160.  The Contractor is not required to cover the following home health services, except if ordered by a physician as a result of an EPSDT screen or high-risk pregnancy screen:  medical social services, services that would not be paid for by Medicaid if provided to an inpatient of a hospital, community food service delivery arrangements, domestic or housekeeping services which are unrelated to patient care, custodial care which is patient care that primarily requires protective services rather than definitive medical and skilled nursing care services, and services relating to cosmetic surgery.

Visits by a licensed nurse and home health aide services shall be covered as medically necessary.  Rehabilitation services (physical therapy, occupational therapy, and speech-language therapy) shall also be covered under the enrollee's home health benefit, in accordance with the guidelines cited in Paragraph 19 of this Section."  Virginia Contract, pages 46-47.

WA

"COVERED SERVICES...
Home Health Services:  When the PCP and Contractor's Medical Director determine that home health services, are appropriate for the member's medical care needs, the Contractor shall cover home health services through Medicare-certified, state-licensed agencies."  Washington Contract, Exhibit 6, Attachment 1, page 4.

WV

"Exhibit A...
HMO Covered Services...
The HMO must promptly provide or arrange to make available for enrollees all medically necessary services listed below and assume financial responsibility for the provision of these services...

MEDICAL SERVICE…/SCOPE OF BENEFITS/LIMITATION ON SERVICES
Home Health Care/Provided at recipients' place of residence on orders of a physician./Residence does not include hospital nursing facility, ICF/MR, or state institution. Certain suppliers have service limits.  Home Health Services require prior authorization and physician's order…"  West Virginia Contract, Exhibit A, pages 1-2.

"MCP Covered Services
The following charts present as explanation of the medical services which the MCP is required to provide...
The MCP must promptly provide or arrange to make available for enrollees all medically necessary services listed below and assume financial responsibility for the provision of these services...

MEDICAL SERVICES/ SCOPE OF BENEFITS/ LIMITATION ON SERVICES
Home Health Care Services/ Provided at recipients' place of residence on orders of a physician./ Residence does not include hospital nursing facility, ICF/MR, or state institution.  Certain suppliers have service limits."  West Virginia RFA, Appendix A, pages A1-A2.