TMPPM 2008 > Texas Medicaid Services > Texas Medicaid (Title XIX) Home Health Services > Home Health Services

24.4.2.1 Written Plan of Care

A Home Health Services POC is required for SN services, HHA, PT, and OT services. The POC is not required as an attachment with the claim, but a signed and dated POC must be retained in the client's medical record with the provider and requesting physician. The client's attending physician must recommend, sign, and date a POC. The POC does not need to be signed by the physician before contacting TMHP for authorization when orders for home care have been received from the physician. The POC shall be initiated by the RN in a clear and legible format. The POC must contain the following information:

•Activities permitted.

•All pertinent diagnoses.

•Available caregiver.

•Client Medicaid number.

•Date the client was last seen by the physician. The client must be seen by a physician within 30 days of the initial SOC and at least once every six months thereafter unless a diagnosis has been established by the physician and the client is currently undergoing physician care and treatment. The physician visit may be waived when a diagnosis has already been established by the physician and the recipient is under the continuing care and medical supervision of the physician. Any waiver must be based on the physician's written statement that an additional evaluation visit is not medically necessary. The original must be maintained by the requesting physician and a copy must be maintained in the providing provider's files.

•Equipment/supplies required.

•Instructions for timely discharge or referral.

•List all community or state agency services the client receives in the home (e.g., primary home care [PHC], PCS, community-based alternative [CBA], Medically Dependent Children's Program [MDCP]).

•Medications including the dose, route, and frequency.

•Mental status.

•Nutritional requirements.

•Physician license number.

•Prior and current functional limitations.

•Prognosis.

•Provider Medicaid number.

•Rehabilitation potential.

•Safety measures to protect against injury.

•SOC date for home health services.

•Treatments, including amount, duration, and frequency.

•Types of services including amount, duration, and frequency.

•Wound care orders and measurements.

Physician orders for PT and/or OT services must include the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes for an acute or exacerbated event, if the following conditions apply:

•PT/OT is being requested.

•Specific procedures and modalities are to be used.

•Amount, frequency, and duration of therapy needed.

•Physical and/or occupational therapy and goals.

•Name of therapist who participated in developing the POC is listed.

The physician and home health agency nursing, PT, and OT personnel must review the POC as often as the severity of the client's condition requires or at least once every 60 days. This signed and dated documentation must be maintained in the client's medical record with the ordering physician and requesting provider. This applies to all written and verbal orders, and plans of care.

Verbal physician orders may only be given to people authorized to receive them under state and federal law. They must be reduced to writing, signed, and dated by the RN or qualified therapist responsible for furnishing or supervising the ordered service, and placed in the client's chart. The physician must sign the written copy of the verbal order within two weeks or per agency policy if less than two weeks. A copy of the written verbal order must be maintained in the client's chart before and after being signed by the physician.

The type and frequency of visits, supplies, or DME must appear on the POC before the physician signs the orders, and may not be added after the physician has signed the orders. If any change in the POC occurs during an authorization period (additional visits, supplies, or DME), the home health agency must call TMHP Home Health Services Authorization Department for authorization and maintain a completed revised request POC signed by the physician.

Coverage periods do not necessarily coincide with calendar weeks or months but instead cover a number of services to be scheduled between a start and end date that is assigned during the prior authorization. The agency must contact TMHP within three business days after the SOC date for prior authorization.

Refer to: "Home Health Services Plan of Care (POC)".

"Physical Therapy (PT) Services" .