Minnesota Minnesota

Community-Based Services Manual (CBSM)

Community-Based Services Manual (CBSM)


Home health therapies

Page posted: 3/21/14

Page reviewed: 7/27/26

Page updated: 7/27/26

Legal authority

42 C.F.R. 440.110, Minn. Stat. §256B.0625, subd. 8, Minn. Stat. §256B.0651, Minn. Stat. §256B.0653, Minn. R. 9505.0295, Minn. R. 9505.0390, Minn. R. 9505.0412

Definition

Home health therapies: Therapies provided to a person eligible for Medical Assistance (MA) in their place of residence or in the community where normal life activities occur. Home health therapies improve or maintain the person’s functioning and include physical, occupational, speech-language pathology and respiratory therapies.

Face-to-face visit requirement

All home health therapies must comply with the face-to-face visit requirement. For more information about this requirement, refer to the face-to-face visit requirement section on CBSM – Home health agency services – Face-to-face visit requirement.

Covered services

Home health therapies are covered if they are classified as either:

  • · Restorative therapy: Designed to restore the person’s functional status to a level consistent with their physical or mental abilities.
  • · Specialized maintenance therapy: Designed to maintain the person’s functional status at a level consistent with their physical or mental abilities.

    • All home health therapies must be:

  • · Ordered by a physician, physician assistant (PA) or advanced practice registered nurse (APRN).
  • · Medically necessary.
  • · Provided to a person whose functional status is expected to progress toward, achieve or maintain the objectives in their care or service plan.

    • Non-covered services

    Home health therapies are not covered if they:

  • · Are provided in non-residential settings (e.g., in a clinic or as an inpatient in a hospital).
  • · Are provided without the required documentation of the face-to-face visit (refer to the face-to-face visit requirement section on CBSM – Home health agency services – Face-to-face visit requirement).
  • · Do not meet the definition of home health therapies.

    • Provider standards and qualifications

    Only Medicare-certified home health agencies can provide home health therapies. The following professionals may provide the services:

  • · Licensed physical therapist (PT).
  • · Licensed physical therapist assistant (PTA).
  • · Licensed occupational therapist (OT).
  • · Licensed occupational therapist assistant (OTA).
  • · Licensed speech-language pathologist (SLP).
  • · Licensed respiratory therapist (RT).

    • Services provided by a PTA or OTA

    If a PTA or OTA provides services, a PT or OT must provide on-site treatment observation and document the treatment’s appropriateness at least every sixth treatment session.

    Billing

    Only a PT or OT may delegate and supervise services. A PT must supervise a PTA, and an OT must supervise an OTA. For more information, refer to Minn. Stat. §148.706 and Minn. Stat. §148.6432.

    The time the PT/OT spends supervising the PTA/OTA is not a covered home health therapy service. The PT/OT and the PTA/OTA cannot both bill for services provided to a person on the same day.

    Documentation requirements

    The home health provider must keep a record of services in each person’s file that includes:

  • · Documentation of the required face-to-face visit (refer to the face-to-face visit requirement section on CBSM – Home health agency services – Face-to-face visit requirement).
  • · All evaluations.
  • · Person’s progress.
  • · Discharge plans.
  • · Date, type, length and scope of each service provided.
  • · Name and title of professional(s) providing each service.
  • · Periodic reviews by the ordering physician, PA or APRN and written progress reports by therapist(s) providing/supervising the services to confirm the therapy’s nature, scope, duration and intensity are appropriate to the person’s medical condition.

    • Access

    To access home health therapies, anyone may make a referral directly to a Medicare-certified home health agency.

    Assessment

    An appropriate therapist completes an assessment to determine the person’s need for services and documents it in the person’s record. This assessment:

  • · Identifies the person’s needs.
  • · Recommends the amount and frequency of visits.
  • · Determines the outcome for the visit(s).
  • · Includes an individualized care or service plan.

    • Authorization

    Services not through a managed care organization (MCO)

    A person not receiving services through an MCO (including both MA state plan and waivers) does not need prior authorization for medically necessary home health therapies ordered by a physician, PA or APRN. For more information, refer to MHCP Provider Manual – Home health therapy services.

    Services through an MCO

    Not on a waiver

    For a person not on a waiver who is enrolled in managed care, the care coordinator follows the MCO’s procedure to authorize the service.

    Brain Injury (BI), Community Alternative Care (CAC), Community Access for Disability Inclusion (CADI) and Developmental Disabilities (DD)

    For a person age 65 and older on the BI, CAC, CADI or DD waiver who is enrolled in managed care, the county/Tribal Nation case manager and MCO care coordinator must use MCO, County Agency and Tribal Nation Communication Form – Recommendation for Home Care Services, DHS-5841 to request home health therapies. The form includes detailed instructions.

    Then, the MCO follows its process to authorize home health therapies.

    Elderly Waiver (EW)

    For a person on EW who is enrolled in managed care, the care coordinator follows the MCO’s procedure to authorize the service.

    Limitations

    The person can only receive one visit per type of therapy, per day, of the following:

  • · Physical therapy.
  • · Occupational therapy.
  • · Speech-language pathology therapy.

    • The person can receive respiratory therapy more than once per day.

    Extended home health therapies

    If a person on the BI, CAC or CADI waiver needs services that exceed the state plan limit, the county/Tribal Nation case manager can authorize extended home health therapies. Extended home health therapies are not available on AC, DD or EW. For more information, refer to CBSM – Extended home care services.

    Additional resources

    DHS – Long-term services and supports rates changes
    MDH – Health Care Provider Directory
    MHCP Provider Manual – Home care services
    MHCP Provider Manual – Home health therapy services
    MCO, County Agency and Tribal Nation Communication Form – Recommendation for State Plan Home Care Services, DHS-5841

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