OAR 410-127-0040: Coverage

(1) Medically appropriate home health services may be covered on a visiting basis to eligible clients as ordered by a physician and part of a written plan of care. Coverage of home health services is not contingent on the client needing nursing, nursing facility or therapy services. (2) Home health services may be provided in the client’s home or any setting in which normal life activities take place other than a hospital, nursing facility, intermediate care facility for individuals with intellectual disabilities, any setting that exists primarily for the purpose of providing medical/nursing care, or any setting in which payment is or could be made under Medicaid for inpatient services that include room and board. (3) Home health services require a face-to-face encounter as described in OAR 410-127-0045 consistent with federal Medicaid regulations at 42 CFR 440.70. (4) Home health services must be prescribed by a physician, and the signed order must be on file at the home health agency. The prescription must include the ICD-10-CM diagnosis code indicating the reason the home health services are requested. The orders on the plan of care must specify the type of services to be provided to the client with respect to the professional who will provide them, the nature of the individual services, specific frequency, and specific duration. The orders must clearly indicate how many times per day, each week or each month the services are to be provided. The plan of care must include the client’s condition, the rationale for the care plan including justification for the required skill level of care, and the summary of care for additional certification periods. (5) The plan of care must be reviewed and signed by the physician who established the plan of care at least every 60 days to continue services. (6) The following services or items are covered, if diagnoses are on the portion of the prioritized list above the line funded by the legislature: (a) Skilled nursing services; (b) Skilled nursing evaluation (includes Outcome and Assessment Information Set (OASIS) assessment); (c) Home health aide services; (d) Occupational therapy services; (e) Occupational therapy evaluation, which may include OASIS assessment; (f) Physical therapy services; (g) Physical therapy evaluation, which may include OASIS assessment; (h) Speech-language pathology services, which may include OASIS assessment; (i) Speech-language pathology evaluation, which may include OASIS assessment; (j) Medical and surgical supplies.