Administrative Requirements

Whether services are provided by the home health agency directly or through contractual arrangements made by the agency, the agency must (A) accept the member for treatment in accordance with its admission policies; (B) maintain a complete medical record as defined at 130 CMR 403.402 relating to all services provided in accordance with 130 CMR 403.419(C)(3)(b); (C) obtain from the physician or ordering non-physician practitioner the required certifications and recertifications of the plan of care in accordance with 130 CMR 403.420(C); and (D) ensure that the home health agency's staff or designated review group review the medical necessity of services and the physician and ordering non-physician practitioner certification on a regular basis.