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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 : 3.4 * Authorization Requirements : 3.4.1 * Initial Assessment and Reassessments

3.4.1
When a provider has received a referral and has physician orders for SN or HHA services, the provider must have an RN perform an initial client assessment in the client’s home.
A client can be referred to a home health agency for SN or HHA services by:
The client assessment or reassessment should include, but is not limited to, the following:
Whether the setting can support the health and safety needs of the client and is adequate to accommodate the use, maintenance, and cleaning of all medical devices, equipment, and supplies required by the client.
The initial assessment and any reassessments performed by an RN are required when changes in the client’s condition occur during the course of the authorization period. If there is no change in the client’s condition, the reassessment must document medical necessity, as defined in the Statement of Benefits, to support continued and ongoing SN or HHA visits beyond the initial 60 day authorization period.
A reassessment is required when the SN and/or HHA provider is notified by the client, client’s responsible adult, or the client’s physician that PPECC services have been initiated.

Texas Medicaid & Healthcare Partnership
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