Home Health Services. Services provided to a beneficiary at the beneficiary’s place of residence defined as any setting in which normal life activities take place, other than:
Home Health Services. If the Grantee provides Home Health Services (as defined in Medicare Part B), the following requirements apply:
Home Health Services. In the event that a member’s mental health status renders them incapable or unwilling to manage their medical condition and the member has a skilled medical need, the Contractor must arrange ongoing medically necessary nursing services. The Contractor shall also have a mechanism in place for tracking members for whom ongoing medically necessary services are required.
Home Health Services. CONDITION--a disease, illness, injury, disorder, or biological or psychological condition or status for which treatment is indicated. CONTESTED CLAIM--a claim that is denied because the claim is an ineligible claim, the claim submission is incomplete, the coding or other required information to be submitted is incorrect, the amount claimed is in dispute, or the claim requires special treatment. CONTINUITY OF CARE--the plan of care for a particular enrollee that should assure progress without unreasonable interruption.
Home Health Services. Those services provided under a home care plan authorized by a physician including full-time, part-time, or intermittent skilled nursing care and home health aide services as well as physical therapy, occupational therapy and speech –language pathology, as ordered by a health plan physician and provided by a Medicare certified home health agency. This service also includes medical social services, other services, DME and medical supplies for use at home. Home Health Services do not include respite care, relief care, or day care.
Home Health Services. 5.1 Covered Home Health Services
Home Health Services. Home health services are healthcare services delivered in a person’s place of residence, excluding nursing homes and institutions, and include intermittent skilled nursing, home health aide, physical, occupational and speech therapy services, and Physician-ordered supplies. The CONTRACTOR must comply with 42 CFR §440.70(b)(3)(v) in the administration of the Home health benefit. The CONTRACTOR shall:
Home Health Services. The Health Plan shall provide medically necessary home health services in accordance with the Home Health Services
Home Health Services. 1. The MCO shall be responsible for management and payment of claims when home health services are required for the treatment of medical diagnoses alone and when home health services are required to treat both medical and behavioral diagnoses, but the medical diagnosis is primary.
Home Health Services. A. The Contractor shall perform prior authorization reviews for all Home Health Services by Record Abstract Review. The policy for these services is in MAD-768. The requests are initiated by the home health service provider using the New Mexico Uniform Prior Authorization Form and supporting documentation. Each request usually contains a “package” of several types of covered services. Each “package” constitutes a single review. The focus of the review is a determination of the medical necessity for skilled nursing and/or ancillary services, the amounts requested, and the adequacy of services requested given the complete clinical, social and functional history.
