Common use of Home Health Care Services (Skilled Clause in Contracts

Home Health Care Services (Skilled. Home Health Care). All Home Health Care Services require Prior Authorization. a. The Home Health Care Services listed below are covered when the following criteria are met: i. A Member is unable to leave home without considerable effort and the assistance of another person because the Member is: 1) bedridden or chair bound, or restricted in ambulation whether or not assistive devices are used; or 2) significantly limited in physical activities due to a Condition; and ii. the Home Health Care Services rendered have been prescribed by a Physician by way of a formal written treatment plan. The written treatment plan must be reviewed and renewed by the prescribing Physician at least every 30 days until benefits are exhausted. AvMed reserves the right to request a copy of any written treatment plan in order to determine whether such services are covered under this Contract; and iii. the Home Health Care Services are provided directly by (or indirectly through) a home health agency; and iv. the Member is meeting or achieving the desired treatment goals set forth in the treatment plan as documented in the clinical progress notes. b. Home Health Care Services are limited to: i. intermittent visits (i.e., up to, but not exceeding, two hours per day) for: 1) nursing care by a registered nurse or licensed practical nurse, and home health aide services; 2) medical social services; 3) nutritional guidance; 4) respiratory or inhalation therapy (e.g., oxygen); and 5) short-term physical therapy by a physical therapist, occupational therapy by an occupational therapist, and speech therapy by a speech therapist. Such therapies provided in the home are subject to any rehabilitative outpatient physical, occupational and speech therapy visit limits. c. Services must be consistent with a plan of treatment ordered by the Member’s Physician. Nursing and home health aide services must be rendered under the supervision of a registered nurse. See Part X. LIMITATIONS OF COVERED MEDICAL SERVICES for applicable Limitations.

Home Health Care Services (Skilled. Home Health Care). All Home Health Care Services require Prior Authorization. a. The Home Health Care Services listed below are covered when the following criteria are met: i. A Member is unable to leave home without considerable effort and the assistance of another person because the Member is: 1) bedridden or chair bound, or restricted in ambulation whether or not assistive devices are used; or 2) significantly limited in physical activities due to a Condition; and ii. the Home Health Care Services rendered have been prescribed by a Participating Physician by way of a formal written treatment plan. The written treatment plan must be reviewed and renewed by the prescribing Attending Physician at least every 30 days until benefits are exhausted. AvMed reserves the right to request a copy of any written treatment plan in order to determine whether such services are covered under this Contract; and iii. the Home Health Care Services are provided directly by (or indirectly through) a home health agency; and iv. the Member is meeting or achieving the desired treatment goals set forth in the treatment plan as documented in the clinical progress notes. b. Home Health Care Services are limited to: i. intermittent visits (i.e., up to, but not exceeding, two hours per day) for: 1) nursing care by a registered nurse or licensed practical nurse, and home health aide services; 2) medical social services; 3) nutritional guidance; 4) respiratory or inhalation therapy (e.g., oxygen); and 5) short-term physical therapy by a physical therapist, occupational therapy by an occupational therapist, and speech therapy by a speech therapist. Such therapies provided in the home are subject to any rehabilitative outpatient physical, occupational and speech therapy visit limits. c. Services must be consistent with a plan of treatment ordered by the Member’s Physician. Nursing and home health aide services must be rendered under the supervision of a registered nurse. See Part X. LIMITATIONS OF COVERED MEDICAL SERVICES for applicable Limitations.

Home Health Care Services (Skilled. Home Health Care). All Home Health Care Services require Prior Authorization. a. The Home Health Care Services listed below are covered when the following criteria are met: i. A Member is unable to leave home without considerable effort and the assistance of another person because the Member is: 1) bedridden or chair bound, or restricted in ambulation whether or not assistive devices are used; or 2) significantly limited in physical activities due to a Condition; and ii. the Home Health Care Services rendered have been prescribed by a an in-network Physician by way of a formal written treatment plan. The written treatment plan must be reviewed and renewed by the prescribing Physician at least every 30 days until benefits are exhausted. AvMed reserves the right to request a copy of any written treatment plan in order to determine whether such services are covered under this Contract; and iii. the Home Health Care Services are provided directly by (or indirectly through) a home health agency; and iv. the Member is meeting or achieving the desired treatment goals set forth in the treatment plan as documented in the clinical progress notes. b. Home Health Care Services are limited to: i. intermittent visits (i.e., up to, but not exceeding, two hours per day) for: 1) nursing care by a registered nurse or licensed practical nurse, and home health aide services; 2) medical social services; 3) nutritional guidance; 4) respiratory or inhalation therapy (e.g., oxygen); and 5) short-term physical therapy by a physical therapist, occupational therapy by an occupational therapist, and speech therapy by a speech therapist. Such therapies provided in the home are subject to any rehabilitative outpatient physical, occupational and speech therapy visit limits. c. Services must be consistent with a plan of treatment ordered by the Member’s Physician. Nursing and home health aide services must be rendered under the supervision of a registered nurse. See Part X. LIMITATIONS OF COVERED MEDICAL SERVICES for applicable Limitations.

Home Health Care Services (Skilled. Home Health Care). All Home Health Care Services require Prior Authorization. a. The Home Health Care Services listed below are covered when the following criteria are met: i. A Member is unable to leave home without considerable effort and the assistance of another person because the Member is: 1) bedridden or chair bound, or restricted in ambulation whether or not assistive devices are used; or 2) significantly limited in physical activities due to a Condition; and ii. the Home Health Care Services rendered have been prescribed by a Participating Physician by way of a formal written treatment plan. The written treatment plan must be reviewed and renewed by the prescribing Physician at least every 30 days until benefits are exhausted. AvMed reserves the right to request a copy of any written treatment plan in order to determine whether such services are covered under this Contract; and iii. the Home Health Care Services are provided directly by (or indirectly through) a home health agency; and iv. the Member is meeting or achieving the desired treatment goals set forth in the treatment plan as documented in the clinical progress notes. b. Home Health Care Services are limited to: i. intermittent visits (i.e., up to, but not exceeding, two hours per day) for: 1) nursing care by a registered nurse or licensed practical nurse, and home health aide services; 2) medical social services; 3) nutritional guidance; 4) respiratory or inhalation therapy (e.g., oxygen); and 5) short-term physical therapy by a physical therapist, occupational therapy by an occupational therapist, and speech therapy by a speech therapist. Such therapies provided in the home are subject to any rehabilitative outpatient physical, occupational and speech therapy visit limits. c. Services must be consistent with a plan of treatment ordered by the Member’s Physician. Nursing and home health aide services must be rendered under the supervision of a registered nurse. See Part X. LIMITATIONS OF COVERED MEDICAL SERVICES for applicable Limitations.

Home Health Care Services (Skilled. Home Health Care). All Home Health Care Services require Prior Authorization. a. The Home Health Care Services listed below are covered when the following criteria are met: i. A Member is unable to leave home without considerable effort and the assistance of another person because the Member is: 1) bedridden or chair bound, or restricted in ambulation whether or not assistive devices are used; or 2) significantly limited in physical activities due to a Condition; and ii. the Home Health Care Services rendered have been prescribed by a Physician by way of a formal written treatment plan. The written treatment plan must be reviewed and renewed by the prescribing Attending Physician at least every 30 days until benefits are exhausted. AvMed reserves the right to request a copy of any written treatment plan in order to determine whether such services are covered under this Contract; and iii. the Home Health Care Services are provided directly by (or indirectly through) a home health agency; and iv. the Member is meeting or achieving the desired treatment goals set forth in the treatment plan as documented in the clinical progress notes. b. Home Health Care Services are limited to: i. intermittent visits (i.e., up to, but not exceeding, two hours per day) for: 1) nursing care by a registered nurse or licensed practical nurse, and home health aide services; 2) medical social services; 3) nutritional guidance; 4) respiratory or inhalation therapy (e.g., oxygen); and 5) short-term physical therapy by a physical therapist, occupational therapy by an occupational therapist, and speech therapy by a speech therapist. Such therapies provided in the home are subject to any rehabilitative outpatient physical, occupational and speech therapy visit limits. c. Services must be consistent with a plan of treatment ordered by the Member’s Physician. Nursing and home health aide services must be rendered under the supervision of a registered nurse. See Part X. LIMITATIONS OF COVERED MEDICAL SERVICES for applicable Limitations.

Home Health Care Services (Skilled. Home Health Care). All Home Health Care Services require Prior Authorization. a. The Home Health Care Services listed below are covered when the following criteria are met: i. A Member is You are unable to leave your home without considerable effort and the assistance of another person because the Member isyou are: 1) bedridden or chair bound, bound or because you are restricted in ambulation whether or not you use assistive devices are useddevices; or 2) you are significantly limited in physical activities due to a Condition; and ii. the The Home Health Care Services rendered have been prescribed by a Physician by way of a formal written treatment plan. The written treatment plan must be reviewed and renewed by the prescribing Physician at least every 30 days until benefits are exhausted. AvMed reserves the right to request a copy of any written treatment plan in order to determine whether such services are covered under this Contract; and iii. the The Home Health Care Services are provided directly by (or indirectly through) a home health agency; and iv. the Member is You are meeting or achieving the desired treatment goals set forth in the treatment plan as documented in the clinical progress notes. b. Home Health Care Services are limited to: i. intermittent visits (i.e., a visit of up to, but not exceeding, two hours per day) for: 1) nursing care by a registered nurse, licensed practical nurse or licensed practical nurse, and home health aide services. Home health aide services must be consistent with the plan of treatment ordered by a Physician and rendered under the supervision of a registered nurse; 2) ii. medical social services; 3) iii. nutritional guidance; 4) iv. respiratory or inhalation therapy (e.g., oxygen); and 5) short-term v. physical therapy by a physical therapist, occupational therapy by an occupational therapist, and speech therapy by a speech therapist. Such therapies provided in the home are subject to any rehabilitative outpatient physical, occupational and speech therapy visit limits. c. Services must be consistent with a plan of treatment ordered by the Member’s Physician. Nursing and home health aide services must be rendered under the supervision of a registered nurse. See Part X. LIMITATIONS OF COVERED MEDICAL SERVICES for applicable Limitations.

Home Health Care Services (Skilled. Home Health Care). All Home Health Care Services require Prior Authorization. a. The Home Health Care Services listed below are covered when the following criteria are met: i. A Member is unable to leave home without considerable effort and the assistance of another person because the Member is: 1) bedridden or chair bound, or restricted in ambulation whether or not assistive devices are used; or 2) significantly limited in physical activities due to a Condition; and ii. the Home Health Care Services rendered have been prescribed by a Physician by way of a formal written treatment plan. The written treatment plan must be reviewed and renewed by the prescribing Physician at least every 30 days until benefits are exhausted. AvMed reserves the right to request a copy of any written treatment plan in order to determine whether such services are covered under this Contract; and iii. the Home Health Care Services are provided directly by (or indirectly through) a home health agency; and iv. the Member is meeting or achieving the desired treatment goals set forth in the treatment plan as documented in the clinical progress notes. b. Home Health Care Services are limited to: i. intermittent visits (i.e., up to, but not exceeding, two hours per day) for: 1) nursing care by a registered nurse or licensed practical nurse, and home health aide services; 2) medical social services; 3) nutritional guidance; 4) respiratory or inhalation therapy (e.g., oxygen); and 5) short-term physical therapy by a physical therapist, occupational therapy by an occupational therapist, and speech therapy by a speech therapist. Such therapies provided in the home are subject to any rehabilitative outpatient physical, occupational and speech therapy visit limits. c. Services must be consistent with a plan of treatment ordered by the Member’s Physician. Nursing and home health aide services must be rendered under the supervision of a registered nurse. See Part P art X. LIMITATIONS OF COVERED MEDICAL SERVICES for applicable Limitations.

Home Health Care Services (Skilled. Home Health Care). All Home Health Care Services require Prior Authorization. a. The Home Health Care Services listed below are covered when the following criteria are met: i. A Member is unable to leave home without considerable effort and the assistance of another person because the Member is: 1) bedridden or chair bound, or restricted in ambulation whether or not assistive devices are used; or 2) significantly limited in physical activities due to a Condition; and ii. the Home Health Care Services rendered have been prescribed by a Participating Physician by way of a formal written treatment plan. The written treatment plan must be reviewed and renewed by the prescribing Physician at least every 30 days until benefits are exhausted. AvMed reserves the right to request a copy of any written treatment plan in order to determine whether such services are covered under this Contract; and iii. the Home Health Care Services are provided directly by (or indirectly through) a home health agency; and iv. the Member is meeting or achieving the desired treatment goals set forth in the treatment plan as documented in the clinical progress notes. b. Home Health Care Services are limited to: i. intermittent visits (i.e., up to, but not exceeding, two hours per day) for: 1) nursing care by a registered nurse or licensed practical nurse, and home health aide services; 2) medical social services; 3) nutritional guidance; 4) respiratory or inhalation therapy (e.g., oxygen); and 5) short-term physical therapy by a physical therapist, occupational therapy by an occupational therapist, and speech therapy by a speech therapist. Such therapies provided in the home are subject to any rehabilitative outpatient physical, occupational and speech therapy visit limits. c. Services must be consistent with a plan of treatment ordered by the Member’s Physician. Nursing and home health aide services must be rendered under the supervision of a registered nurse. See Part P art X. LIMITATIONS OF COVERED MEDICAL SERVICES for applicable Limitations.

Home Health Care Services (Skilled. Home Health Care). All Home Health Care Services require Prior Authorization. a. The Home Health Care Services listed below are covered when the following criteria are met: i. A Member is You are unable to leave your home without considerable effort and the assistance of another person because the Member isyou are: 1) bedridden or chair bound, bound or because you are restricted in ambulation whether or not you use assistive devices are useddevices; or 2) you are significantly limited in physical activities due to a Condition; and ii. the The Home Health Care Services rendered have been prescribed by a Participating Physician by way of a formal written treatment plan. The written treatment plan must be reviewed and renewed by the prescribing Physician at least every 30 days until benefits are exhausted. AvMed reserves the right to request a copy of any written treatment plan in order to determine whether such services are covered under this Contract; and iii. the The Home Health Care Services are provided directly by (or indirectly through) a home health agency; and iv. the Member is You are meeting or achieving the desired treatment goals set forth in the treatment plan as documented in the clinical progress notes. b. Home Health Care Services are limited to: i. intermittent visits (i.e., a visit of up to, but not exceeding, two hours per day) for: 1) nursing care by a registered nurse, licensed practical nurse or licensed practical nurse, and home health aide services. Home health aide services must be consistent with the plan of treatment ordered by a Participating Physician and rendered under the supervision of a registered nurse; 2) ii. medical social services; 3) iii. nutritional guidance; 4) iv. respiratory or inhalation therapy (e.g., oxygen); and 5) short-term v. physical therapy by a physical therapist, occupational therapy by an occupational therapist, and speech therapy by a speech therapist. Such therapies provided in the home are subject to any rehabilitative outpatient physical, occupational and speech therapy visit limits. c. Services must be consistent with a plan of treatment ordered by the Member’s Physician. Nursing and home health aide services must be rendered under the supervision of a registered nurse. See Part X. LIMITATIONS OF COVERED MEDICAL SERVICES for applicable Limitations.

Home Health Care Services (Skilled. Home Health Care). All Home Health Care Services require Prior Authorization. a. The Home Health Care Services listed below are covered when the following criteria are met: i. A Member is You are unable to leave your home without considerable effort and the assistance of another person because the Member isyou are: 1) bedridden or chair bound, bound or because you are restricted in ambulation whether or not you use assistive devices are useddevices; or 2) you are significantly limited in physical activities due to a Condition; and ii. the The Home Health Care Services rendered have been prescribed by a Physician by way of a formal written treatment plan. The written treatment plan must be reviewed and renewed by the prescribing Physician at least every 30 days until benefits are exhausted. AvMed reserves the right to request a copy of any written treatment plan in order to determine whether such services are covered under this Contract; and iii. the The Home Health Care Services are provided directly by (or indirectly through) a home health agency; and iv. the Member is You are meeting or achieving the desired treatment goals set forth in the treatment plan as documented in the clinical progress notes. b. Home Health Care Services are limited to: i. intermittent visits (i.e., a visit of up to, but not exceeding, two hours per day) for: 1) nursing care by a registered nurse, licensed practical nurse or licensed practical nurse, and home health aide services. Home health aide services must be consistent with the plan of treatment ordered by a Physician and rendered under the supervision of a registered nurse; 2) ii. medical social services; 3) iii. nutritional guidance; 4) respiratory iv. respiratory, or inhalation therapy (e.g., oxygen); and 5) short-term v. physical therapy by a physical therapist, occupational therapy by an occupational therapist, and speech therapy by a speech therapist. Such therapies provided in the home are subject to any rehabilitative outpatient physical, occupational and speech therapy visit limits. c. Services must be consistent with a plan of treatment ordered by the Member’s Physician. Nursing and home health aide services must be rendered under the supervision of a registered nurse. See Part X. LIMITATIONS OF COVERED MEDICAL SERVICES for applicable Limitations.

Home Health Care Services (Skilled. Home Health Care). All Home Health Care Services require Prior Authorization. a. The Home Health Care Services listed below are covered when the following criteria are met: i. A Member is You are unable to leave your home without considerable effort and the assistance of another person because the Member isyou are: 1) bedridden or chair bound, bound or because you are restricted in ambulation whether or not you use assistive devices are useddevices; or 2) you are significantly limited in physical activities due to a Condition; and ii. the The Home Health Care Services rendered have been prescribed by a Participating Physician by way of a formal written treatment plan. The written treatment plan must be reviewed and renewed by the prescribing Physician at least every 30 days until benefits are exhausted. AvMed reserves the right to request a copy of any written treatment plan in order to determine whether such services are covered under this Contract; and iii. the The Home Health Care Services are provided directly by (or indirectly through) a home health agency; and iv. the Member is You are meeting or achieving the desired treatment goals set forth in the treatment plan as documented in the clinical progress notes. b. Home Health Care Services are limited to: i. intermittent visits (i.e., a visit of up to, but not exceeding, two hours per day) for: 1) nursing care by a registered nurse, licensed practical nurse or licensed practical nurse, and home health aide services. Home health aide services must be consistent with the plan of treatment ordered by a Participating Physician and rendered under the supervision of a registered nurse; 2) ii. medical social services; 3) iii. nutritional guidance; 4) respiratory iv. respiratory, or inhalation therapy (e.g., oxygen); and 5) short-term v. physical therapy by a physical therapist, occupational therapy by an occupational therapist, and speech therapy by a speech therapist. Such therapies provided in the home are subject to any rehabilitative outpatient physical, occupational and speech therapy visit limits. c. Services must be consistent with a plan of treatment ordered by the Member’s Physician. Nursing and home health aide services must be rendered under the supervision of a registered nurse. See Part X. LIMITATIONS OF COVERED MEDICAL SERVICES for applicable Limitations.