405 IAC 1-4.2-4 Home health care services; reimbursement methodology

Sec. 4. (a) HHAs will be reimbursed for covered services provided to Medicaid members through standard, statewide rates as: (1) one (1) overhead rate per HHA visit, per member, per day; plus (2) the staffing rate multiplied by the number of billing units spent in the performance of billable patient care activities; to equal the total reimbursement per visit. (b) Retroactive repayment will be required when any of the following occur: (1) A field audit identifies overpayment by Medicaid. (2) The HHA knowingly receives overpayment of a Medicaid claim from the office. In this event, the HHA must: (A) complete appropriate Medicaid billing adjustment forms; and (B) reimburse the office for the amount of the overpayment.