|
24.5.1 Home Health Skilled Nursing Services
Home health SN services are a benefit of the Home Health Services when a client requires nursing services for an acute condition or an acute exacerbation of a chronic condition that can be met on an intermittent or part-time basis and typically has an end-point. SN visits may be provided on consecutive days. SN visits are intended to provide SN care to promote independence and support the client living at home. Home Health Services must be provided by a licensed and certified home health agency enrolled in the Texas Medicaid Program.
Note: Nursing visits for the primary purpose of assessing a client's care needs to develop a POC are considered administrative and not billable. These visit costs are reflected on the cost report.
An acute condition is considered a condition or exacerbation that is anticipated to improve and reach resolution within 60 days. An intermittent basis is considered an SN visit provided for less than eight hours per visit and less frequently than daily. Intermittent visits may be delivered in interval visits up to 2.5 hours per visit, not to exceed a combined total of three visits per day. A part-time basis is considered an SN visit provided less than eight hours per day for any number of days per week. Part-time visits may be continuous up to 7.5 hours per day (not to exceed a combined total of three 2.5 hour visits).
SN visits are considered medically necessary for clients who require the following:
• Skillful observations and judgment to improve health status, skilled assessment, or skilled treatments/procedures.
•Individualized, intermittent, acute skilled care.
•Skilled interventions to improve health status, and if skilled intervention is delayed, it is expected to result in the deterioration of a chronic condition or one of the following:
•Loss of function.
•Imminent risk to health status due to medical fragility, or risk of death.
When documentation does not support medical necessity for home health SN visits, providers may be directed to possible alternative services based on the client's age and needs.
|
