Community-Based Services Manual (CBSM)

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Community-Based Services Manual (CBSM)

CBSM Home care Home Health Agency Services Therapies (PT, OT, SLP, RT)

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Home health therapies

Page posted: 3/21/14		Page reviewed: 1/30/20	Page updated: 1/30/20
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 in a person’s 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, see 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 the person’s physical or mental abilities · Specialized maintenance therapy: Designed to maintain a person’s functional status at a level consistent with the person’s physical or mental abilities. All home health therapies, including extended home health therapies, must be: · Ordered by a physician · Medically necessary · Provided to a person whose functional status is expected to progress toward, achieve or maintain the objectives in the person’s 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 · Do not meet the definition of home health therapies.
Provider standards and qualifications	Only Medicare-certified home health agencies can provide home health therapies. Services may be provided by the following professionals: · 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 MA only reimburses providers for PTA and OTA services when a PT or OT provides direction for those services. The PT/OT cannot bill for the oversight of services provided by the PTA/OTA. The PT/OT and the PTA/OTA cannot both bill for services provided to a person on the same day.
Documentation requirements	The provider must keep a record of services in each person’s file that includes: · Documentation of the required face-to-face visit · 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 a physician and written progress reports by therapist(s) providing/supervising the services to confirm that the therapy’s nature, scope, duration and intensity are appropriate to the person’s medical condition.
Process and procedure	See the specific section: · Home health therapies through the MA state plan · Home health therapies through BI, CAC, CADI, DD and EW
Additional resources	DHS – Long-term services and supports rates changes MDH – Health Care Provider Directory MHCP Provider Manual – Home care services MHCP Provider Manual – Rehabilitation therapy services MHCP Provider Manual – Elderly Waiver and Alternative Care Program MCO, County Agency and Tribal Nation Communication Form – Recommendation for State Plan Home Care Services, DHS-5841

Process/procedure: Home health therapies through MA state plan

Applicability	This section applies to home health therapies through the Medical Assistance (MA) state plan.
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 · Determines the outcome for the visit(s) · Includes an individualized care or service plan.
Authorization	A person does not need prior authorization for physician-ordered, medically necessary home health therapies. For additional information, see MHCP Provider Manual – Rehabilitation therapy services.
Limitations	A person can only receive one visit per type of therapy, per day, with the exception of respiratory therapy, which may be provided more than once per day.

Process/procedure: Home health therapies through BI, CAC, CADI, DD and EW

Applicability	This section applies to home health therapies through: · Brain Injury (BI) Waiver · Community Alternative Care (CAC) Waiver · Community Access for Disability Inclusion (CADI) Waiver · Developmental Disabilities (DD) Waiver · Elderly Waiver (EW).
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 · Determines the outcome for the visit(s) · Includes an individualized care or service plan.
Authorization	A person does not need prior authorization for physician-ordered, medically necessary state plan home health therapies. For people on BI, CAC, CADI, DD and EW, the lead agency does not need to take action to authorize these services. For people on BI, CAC and CADI waivers who need services that exceed the state plan limit, the county/tribal nation case manager can authorize extended home health therapies. For more information, see CBSM – Extended home care services. Services through an MCO BI, CAC, CADI and DD For people on BI, CAC, CADI, and DD waivers who are enrolled in managed care, the county/tribal nation case manager and MCO staff members can use the MCO, County Agency and Tribal Nation Communication Form – Recommendation for Home Care Services, DHS-5841 (PDF) to initiate home care recommendations. The form includes detailed instructions. Then, the MCO should follow its process to authorize home health therapies. EW For people on EW who are enrolled in managed care, the care coordinator follows the MCO’s procedure to authorize the service.
Limitations	State plan home health therapies are not available for people on Alternative Care (AC). Extended home health therapies are not available on AC, DD or EW.

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