Home Health Services: Provider Reimbursement

01. Home Health Services. Payment for home health must not exceed the lesser of reasonable cost as determined by a finalized Medicare cost report or the Medicaid percentile cap. (7-1-26) a. The Medicaid percentile cap is revised annually, effective at the beginning of each state fiscal year. Revisions are made using the data from the most recent finalized Medicare cost reports thirty (30) days prior to the effective date. (7-1-26) b. Payment by the Department for home health will include mileage as part of the visit. (7-1-26) c. Provider claims for services requiring EVV will include the corresponding EVV data elements. EVV data will be submitted to the state’s aggregator prior to billing claims. (7-1-26) d. If a person is eligible for Medicare, all services ordered by the provider will be purchased by Medicare. The Department will pay for the deductible and co-insurance. (7-1-26) IDAHO ADMINISTRATIVE CODE IDAPA 16.03.26 Department of Health & Welfare Medicaid Plan Benefits Section 250 Page 71 02. Medical Supplies, Equipment, and Appliances. Payment uses general procedures. (7-1-26) 247. – 249. (RESERVED) SUB AREA: THERAPY SERVICES (Sections 250-259)