Home Health Services

What are Home Health Covered Services

Home Health covered services, upon physician referral, when necessary to help the Medicaid recipient remain at home, include:

• skilled nursing services
• physical, speech and occupational therapies
• non-routine medical supplies,
• medical social services, and
• home health aide services

Who is eligible to receive Home Health Covered Services

Home Health services are available to Medicaid recipients of all ages and are intended to be short-term in duration. 

• All services and/or supplies must meet medical necessity criteria for the treatment of the illness or injury. 
• The recipient’s medical condition must be such that receipt of Home Health services and/or supplies in their residence is appropriate.  
• A large part of the medical care involves teaching the recipient or family members, whenever possible, appropriate care techniques for the recipient’s condition and needs.

Prior Authorization and HCPCS Code Information for Home Health Covered Services

• All services and/or supplies must be prior authorized (PA) to ensure the service or modification of the service is medically necessary and adequate for the needs of the recipient.  
• HCPCS codes are required on PA requests and claims submitted for payment for revenue codes 270, non–routine medical supplies, and 279, nutritional supplements.

Provider Update as of 12/12/07
Changes to DMS Home Health PA Form effective 1/1/08 and Additional Program Information.  Please refer to Provider Letter #A-110  on the right for information about this change.