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:
a. A hospital;
b. Nursing facility;
c. Intermediate care facility for individuals with intellectual disabilities, except when the facility is not required to provide the home health service; or,
d. Any setting in which payment is or could be made under Medicaid for inpatient services that include room and board. Home health services must be provided in accordance with the beneficiary’s physician’s orders as part of a written plan of care, which must be reviewed every sixty (60) days. The beneficiary’s attending physician must document that a face-to- face encounter occurred no more than ninety (90) days before of thirty (30) days after the start of home health services. The face-to-face encounter must be related to the primary reason the beneficiary requires the home health service. The home health agency providing home health services must be certified to participate as a home health agency under Title XVIII (Medicare) of the Social Security Act, and comply with all applicable state and federal laws and requirements.
Home Health Services. If the Grantee provides Home Health Services (as defined in Medicare Part B), the following requirements apply:
1. The Grantee must not use State ELPHS or categorical grant funds provided under this Agreement to unfairly compete for home health services available from private providers of the same type of services in the Grantee’s service area.
2. For purposes of this Agreement, the term “unfair competition” will be defined as offering of home health services at fees substantially less than those generally charged by private providers of the same type of services in the Grantee’s area, except as allowed under Medicare customary charge regulations involving sliding fee scale discounts for low-income clients based upon their ability to pay.
3. If the Department finds that the Grantee is not in compliance with its assurance not to use state ELPHS and categorical grant funds to unfairly compete, the Department will follow the procedure required for failure by local health departments to adequately provide required services set forth in Sections 2497 and 2498 of 1978 PA 368 as amended (Public Health Code), MCL 333.2497 and 2498, MSA 14.15 (2497) and (2498).
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. 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. 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. The Health Plan shall provide medically necessary home health services in accordance with the Home Health Services
Home Health Services. 5.1 Covered Home Health Services
A. Definitions
1. The institutionalization of the Member in a hospital or related institution, or Qualified Skilled Nursing Facility would otherwise have been required if Home Health Care were not provided; and,
2. The Plan of Treatment covering the Home Health Care service is established and approved in writing by the Health Care Practitioner, and determined to be Medically Necessary by CareFirst.
Home Health Services. Home Health Services are those services as defined in 42 C.F.R. §440.70.
Home Health Services. WHERE CAREFIRST BLUECHOICE PROVIDES MEMBER PAYS HOME HEALTH SERVICES MUST BE AUTHORIZED OR APPROVED BY CAREFIRST BLUECHOICE
4.1 Definitions
1. the institutionalization of the Member in a hospital or related institution, or skilled nursing facility would otherwise have been required if home health services were not provided; and,
2. the plan of treatment covering the home health service is established and approved in writing by the health care practitioner, and determined to be Medically Necessary by CareFirst BlueChoice.
Home Health Services. If the Contractor provides Home Health Services (as defined in Medicare Part B), the following requirements apply:
1. The Contractor shall not use State Local Public Health Operations (LPHO) or categorical grant funds provided under this agreement to unfairly compete for home health services available from private providers of the same type of services in the Contractor’s service area.
2. For purposes of this agreement, the term “unfair competition” shall be defined as offering of home health services at fees substantially less than those generally charged by private providers of the same type of services in the Contractor’s area, except as allowed under Medicare customary charge regulations involving sliding fee scale discounts for low- income clients based upon their ability to pay.
3. If the Department finds that the Contractor is not in compliance with its assurance not to use state LPHO and categorical grant funds to unfairly compete, the Department shall follow the procedure required for failure by local health departments to adequately provide required services set forth in Sections 2497 and 2498 of 1978 PA 368 as amended (Public Health Code), MCL 333.2497 and 2498, MSA 14.15 (2497) and (2498).
