Home Health Policy Manual

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Home Health Policy TOC and Definitions
Title/Content Policy/Form Number Issued/Revised
Table of Contents 001 01/01/2020
Definitions 002 04/01/2019
Home Health Policy Section 100: General Information
Title/Content Policy/Form Number Issued/Revised
Manual Program 101 04/01/2019
Reserved 102
Home Health Policy Section 200: Program Description
Title/Content Policy/Form Number Issued/Revised
Program Goals 201 04/01/2019
Legal Authority 202 04/01/2019
Federal Requirements 203 04/01/2019
Organizational Requirements 204 04/01/2019
Home Health Policy Section 300: General Administration
Title/Content Policy/Form Number Issued/Revised
Reserved 301
Fair Hearings 302 04/01/2019
Reserved 303
Third Party Liability 304 04/01/2019
Home Health Policy Section 400: Eligibility of Services
Title/Content Policy/Form Number Issued/Revised
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 04/01/2019
Member's Rights/Freedom of Choice 408 04/01/2019
Reserved 409 04/01/2019
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
Home Health Policy Section 500: Eligible Services
Title/Content Policy/Form Number Issued/Revised
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
Home Health Policy Section 600: Payments for Home Health
Title/Content Policy/Form Number Issued/Revised
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
Home Health Policy Section 700: Service Coordination
Title/Content Policy/Form Number Issued/Revised
Reserved 701
Reserved 702
Developmental Disabilities 703 04/01/2019
Reserved 704 04/01/2019
Home Infusion Therapy 705 04/01/2019
Coordination with Big Sky Waiver 706 04/01/2019
Coordination with Community First-Choice and Personal Care Services 707 04/01/2019
Reserved 708
High-Risk Pregnancy 709 04/01/2019
Services for Children 710 04/01/2019