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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 : 3.4.2 * Home Health Services Plan of Care Requirements : 3.4.2.1 Written Plan of Care (POC)

3.4.2.1
A home health services POC is required for SN, HHA, OT, or PT services. The POC is not required as an attachment with the claim, but a signed and dated POC must be maintained by the provider and primary physician in the client’s medical record. The client’s primary physician must recommend, sign, and date a POC. The POC must be initiated by the RN in a clear and legible format.
Refer to:
Subsection 4.5, “Frequency and Duration Criteria for PT, OT, and ST Services” in the Physical Therapy, Occupational Therapy, and Speech Therapy Services Handbook (Vol. 2, Provider Handbooks) for additional information about PT, OT, and ST services.
Services billed in excess of those authorized for the prior authorization week or month are subject to recoupment.
For the home health services POC to be valid, the primary physician must sign and date it, and indicate when the services will begin. The home health agency must update and maintain the POC at least every 60 days or as necessitated by a change in the client’s condition.

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