Home Health Policy Manual

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Manual
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

Home Health Policy Manual

Section/ Subsection

Title/Content

Policy Number

Issue/ Revised

Table of Contents