Ch. 12, § 4. Covered Services and Supplies

(a) The services and supplies specified in subsection (b) are covered services if the services are: (i) Intermittent; (ii) Medically necessary; (iii) Ordered by a practitioner; (iv) Documented in a plan of treatment; and (v) Expected to last six months or less. (b) Covered services. The following are covered services: (i) Skilled nursing services provided by a registered nurse for a client's condition while in the acute phase; (ii) Home health aide and LPN services supervised by a registered nurse, which must include the following: (A) A registered nurse shall be available for consultation in person or by telephone; (B) In-person home visits by a registered nurse: (1.) At least once every two weeks if the client is receiving skilled nursing care; or (2.) At least every sixty days if the client only receives home health aide services. The supervisory visits must occur while the aide is furnishing services. Supervisory visits are not a covered service; (C) Each home health aide encounter must include at least one of the following personal care services in addition to all ordered services that can be provided in one encounter unless medically indicated otherwise: (1.) Bath (bed, sponge, tub, shower, or shampooing hair); (2.) Nail or skin care (applying lotion to a client does not constitute personal care); (3.) Oral hygiene; (4.) Toileting and elimination; (5.) Safe transfers and assisted ambulation; (6.) Assisted dressing; (7.) Assisted range of motion and positioning; or (8.) Assisted nutrition or fluid intake (such as meal set-up, meal preparation, feeding assistance, and meal supervision); (D) Each LPN encounter must include at least one of the following: (1.) direct patient care; (2.) monitoring; (3.) some assessments focus or patient history; (4.) medication management; (5.) wound care; (6.) patient and family education; or (7.) supervision of home health aides; (iii) Physical therapy services provided by a licensed physical therapist; (iv) Speech, hearing, and language services provided by a licensed speech therapist; (v) Occupational therapy services provided by a licensed occupational therapist; (vi) Medical social services provided by a licensed social worker; and (vii) Disposable medical supplies provided by a provider in accordance with a plan of treatment.