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. The Health Plan shall provide medically necessary home health services in accordance with the 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. 5.1 Covered Home Health Services
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.
Home Health Services. Condition—a disease, illness, injury, disorder, or biological or psychological condition or status for which treatment is indicated. DFD—the Division of Family Development, within the New Jersey Department of Human Services that administers programs of financial and administrative support for certain qualified individuals and families. DHHS or HHS—United States Department of Health and Human Services of the executive branch of the federal government, which administers the Medicaid program through the Centers for Medicare and Medicaid Services (CMS). DHSS—the New Jersey Department of Health and Senior Services in the executive branch of New Jersey State government. Its role and functions are delineated throughout the contract. Diagnostic Services—any medical procedures or supplies recommended by a physician or other licensed practitioner of the healing arts, within the scope of his or her practice under State law, to enable him or her to identify the existence, nature, or extent of illness, injury, or other health deviation in an enrollee. Director—the Director of the Division of Medical Assistance and Health Services or a duly authorized representative. Disability—a physical or mental impairment that substantially limits one or more of the major life activities for more than three months a year. Disability in Adults—for adults applying under New Jersey Care Special Medicaid Programs and Title II (Social Security Disability Insurance Program) and for adults applying under Title XVI (the Supplemental Security Income [SS] program), disability is defined as the inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment(s) which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months. Disability in Children—a child under age 18 is considered disabled if he or she has a medically determinable physical or mental impairment(s) which results in marked and severe functional limitations that limit the child’s ability to function independently, appropriately, and effectively in an age-appropriate manner, and can be expected to result in death or which can be expected to last for 12 months or longer. Disenrollment—the removal of an enrollee from participation in the contractor’s plan, but not from the Medicaid program. Division of Developmental Disabilities (DDD)—a Division within the New Jersey Department of Human Services tha...
