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December 2016 Texas Medicaid Provider Procedures Manual

Home Health Nursing and Private Duty Nursing Services Handbook : 3 Home Health Skilled Nursing and Home Health Aide Services : 3.1 * Services, Benefits, Limitations, and Prior Authorization

3.1
Home health skilled nursing (SN) and HHA visits are a benefit of Texas Medicaid Title XIX home health services when a client requires home 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. For clients who are 20 years of age or younger, SN and HHA visits are a benefit of Texas Medicaid Title XIX home health services when a client requires nursing services for an acute condition, a chronic condition, or an acute exacerbation of a chronic condition that can be met on an intermittent or part-time basis. SN visits are intended to provide SN care to promote independence and support the client living at home. HHA visits are intended to provide personal care services under the supervision of an RN, PT, or OT employed by the home health agency to promote independence and support the client living at home.
The following codes are a benefit of Texas Medicaid:
 
Title XIX home health services must be provided by a licensed and certified home health agency enrolled in Texas Medicaid.
When the client’s needs are beyond the benefit of Title XIX home health services, additional benefits may be accessed through the following:
Refer to:
Section 4, “Private Duty Nursing (PDN) Services - CCP” in this handbook for information about PDN services.
Subsection 2.11, “Personal Care Services (PCS) (CCP)” in the “Children’s Services Handbook” (Vol. 2, Provider Handbooks) for information about PCS services.

Texas Medicaid & Healthcare Partnership
CPT only copyright 2014 American Medical Association. All rights reserved.