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24.4.1 Client Evaluation
When a home health agency receives a referral to provide home health services, supplies, or DME for a Medicaid-eligible client, the agency-employed RN should evaluate the client in the home before calling TMHP for prior authorization. Although recommended, a home visit is not required if only DME or supplies are needed and being requested by the physician on a Title XIX form. DME or supplies requested on a Home Health Services POC require an RN home evaluation. It is expected that appropriate referrals will be made between home health agencies and DME suppliers for care. It is recommended that DME suppliers keep open communication with the client's physician for current reporting.
This evaluation should include assessment of the following:
• Medical necessity for home health services, supplies, or DME.
•Safety.
•Appropriateness of care in the home setting.
•Capable caregiver available if clients are unable to perform their own care or monitor their own medical condition.
Following the RN's assessment/evaluation of the client in the home setting for home health services needs, the agency RN who completed the home evaluation must contact TMHP for prior authorization within three business days of the SOC.
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