In-Home and Community Services. The PH-MCO may not deny personal care services for members under the age of 21 based on the Member’s diagnosis or because the need for personal care services is the result of a cognitive impairment. The personal care services may be in the form of hands- on assistance (actually performing a personal care task for a person) or cuing so that the person performs the task by him/her self. The PH-MCO may not deny a request for Medically Necessary in- home nursing services, home health aide services, or personal care services for a Member under the age of 21 on the basis that a live-in caregiver can perform the task, unless there is a determination that the live-in caregiver is actually able and available to provide the level or extent of care that the Member needs, given the caregiver’s work schedule or other responsibilities, including other responsibilities in the home. The PH-MCO must include in its Provider Network any Home Health Agency that offers in-home nursing services, home health aide services, or personal care services for Members under the age of 21 that is enrolled in Pennsylvania Medical Assistance and is willing to comply with all of the PH-MCO’s quality and non-quality contract standards, utilization management standards and accept PH-MCO rates that are consistent with reimbursement rates paid to similar In - Network Providers. The PH-MCO must submit to the Department for prior review and written approval any Home Health Agency requests for entrance to the Network that it intends to deny based upon quality of care, program integrity or other relevant concerns. The PH-MCO must implement a Public Health Dental Hygiene Practitioner (PHDHP) program or a dental hygienist program under the direct supervision of a dentist. The hygienists must spend the majority of their time face-to-face performing direct patient preventive care in the community.
In-Home and Community Services. The Pennsylvania Medicaid State Plan requires personal care services coverage for individuals under age 21. Personal care services may not be denied based on the member’s diagnosis or because the need for assistance is the result of a cognitive impairment. The assistance may be in the form of hands-on assistance (actually performing a personal care task for a person) or cuing so that the person performs the task by him/her self. A request for medically necessary in-home nursing services, home health aide services, or personal care services for a member under the age of 21 may not be denied on the basis that a live-in caregiver can perform the task, unless there is a determination that the live-in caregiver is actually able and available to provide the level or extent of care that the member needs, given the caregiver’s work schedule or other responsibilities, including other responsibilities in the home.
In-Home and Community Services. The PH-MCO may not deny personal care services for members under the age of 21 based on the Member’s diagnosis or because the need for personal care services is the result of a cognitive impairment. The personal care services may be in the form of hands-on assistance (actually performing a personal care task for a person) or cuing so that the person performs the task by him/her self. The PH-MCO may not deny a request for Medically Necessary in- home nursing services, home health aide services, or personal care services for a Member under the age of 21 on the basis that a live- in caregiver can perform the task, unless there is a determination that the live-in caregiver is actually able and available to provide the level or extent of care that the Member needs, given the caregiver’s work schedule or other responsibilities, including other responsibilities in the home.
In-Home and Community Services. Therapeutic activities provided to persons and/or their families in the home, school, pre-school, after school, nursery/day-care or other residential or non-office setting.
