Minnesota Minnesota

Community-Based Services Manual (CBSM)

Community-Based Services Manual (CBSM)


Home health agency services

Page posted: 10/1/14

Page reviewed: 10/24/19

Page updated: 10/24/19

Legal authority

Minn. Stat. §256B.0651, Minn. Stat. §256B.0652, Minn. Stat. §256B.0653, Minn. Stat. §256B.0625 subd. 6A, 42 CFR 440.70.

Definitions

Home health agency services: Services a home health agency provides to a person with medical needs due to illnesses, disabilities or physical conditions. These services are delivered in the person’s place of residence or in the community. They cannot be delivered in a hospital, nursing facility or intermediate care facility for persons with developmental disabilities (ICF/DD) (except in certain circumstances; see skilled nursing visit ICF/DD exception).

Overview

Home health agencies require a Medicare certification and a comprehensive license from the Minnesota Department of Health (MDH).

People may receive both home health agency services and personal care assistance (PCA)/Community First Services and Supports (CFSS) or home care nursing (HCN) services.

An agency’s registered nurse or appropriate therapist must conduct an assessment within 30 days of a person’s request for home health agency services to determine the person’s need for service.

Services

The following services can be delivered by a home health agency:

  • · Home health aide (HHA)
  • · Home health therapies
  • · Skilled nursing visit (SNV)
  • · Extended home care services.
  • The process to request prior authorization varies by service.

    Face-to-face visit requirement

    All home health agency services require a face-to-face visit at the start of services, in addition to any other prior authorization requirements. This requirement applies to people who use:

  • · Alternative Care (AC)
  • · Brain Injury (BI) Waiver
  • · Community Access for Disability Inclusion (CADI) Waiver
  • · Community Alternative Care (CAC) Waiver
  • · Developmental Disabilities (DD) Waiver
  • · Elderly Waiver (EW)
  • · Fee-for-service Medical Assistance (MA)
  • · Managed care.
  • Exception

    The face-to-face requirement does not apply when an SNV is provided for a one-time perinatal visit.

    Process

    A face-to-face visit can occur in person or through telehomecare. This visit must:

    1. Occur within 90 days before or 30 days after the start of services

    2. Address the primary reason the person needs home health agency services

    3. Be completed by one of the following qualified providers licensed in Minnesota:

  • · Physician
  • · Physician assistant
  • · Nurse practitioner
  • · Clinical nurse specialist
  • · Certified nurse midwife.
  • Documentation

    If a qualified provider other than the person’s physician completes the face-to-face visit, the provider must send the documentation, including clinical findings of the visit, to the person’s physician.

    The physician’s documentation must include all of the following information:

    1. The name of the qualified provider who completed the visit

    2. The date the provider completed the visit

    3. Confirmation that:

  • · The person’s medical record includes all clinical findings of the visit
  • · The visit is related to the primary reason the person needs home health agency services
  • · The visit occurred within the required timeline.
  • The home health agency must:

  • · Keep the required documentation as part of the person’s record
  • · Only bill if the required documentation is part of the person’s record
  • · Submit the required documentation to DHS or the person’s managed care organization upon request.
  • Additional resources

    MDH – Health care provider directory
    MDH – Home care and assisted living
    MHCP Provider Manual – Home care services

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