HAR §17-1737-45. Home health services

(a) Home health services means services provided to a recipient by a home health agency or under a home or community-based waiver: (1) At the recipient's place of residence or at a location other than a hospital, skilled nursing facility, intermediate care facility - mental retardation, or intermediate care facility; (2) On a physician's orders as part of a written plan of care that the physician reviews every sixty days; and (3) Medical authorization as specified in section 17-1739-4 is needed for all home health services, medical supplies, equipment and appliances unless otherwise specified under this section. (b) Home health services shall include: (1) Nursing service, as defined in chapter 457, HRS provided on a part-time or intermittent basis; (2) Home health aide services; UNOFFICIAL 1737-63 (3) Medical supplies, equipment, and appliances suitable for use in the home, subject to prior authorization as specified in section 17-1739-4; (4) Physical therapy, occupational therapy, speech pathology and audiology services subject to prior authorization as specified in section 17-1739-4; and (5) Medical social services and other services not specifically listed in this section are not covered. (c) Reimbursement for home health services shall be limited to the following: (1) Home health services shall be reimbursable on the basis of "per visit". A visit shall encompass approximately one or two hours of service; (2) One visit per day only; (3) Daily home visits without medical authorization are permitted for home health aide and nursing services in the first two weeks of care if part of the written plan of care; (4) Initial physical therapy and occupational therapy evaluations only without medical authorization are permitted if part of a written plan of care; (5) No more than three visits a week for each service shall be reimbursed for the third week to the seventh week of patient care; (6) No more than one visit a week for each service shall be reimbursed from the eighth week to the fifteenth week of patient care; (7) No more than one visit every other month for each service shall be reimbursed from the sixteenth week of patient care; and (8) Services exceeding the parameters of this section shall be prior authorized by the department's medical consultant or its authorized representative. [Eff 08/01/94; am 02/10/97 ] (Auth: HRS §346-14) (Imp: 42 C.F.R. §§440.70, 441.15)