Idaho Medicaid Provider Handbook, Home Health and Hospice Services § 3.3

Home health services must be medically necessary for the participant to receive services in

their place of residence or where normal life activities take place. Participants are eligible even

if they don’t need institutional care, nursing or therapy services, or aren’t homebound.

A face-to-face visit with a physician, nurse practitioner, clinical nurse specialist, certified nurse

midwife, or physician assistant is required to establish coverage. The visit must be primarily

for the condition requiring home health services. The visit can be conducted via virtual care

services so long as it meets all requirements for telehealth services found in the General

Information and Requirements for Providers, Idaho Medicaid Provider Handbook. The ordering

provider does not have to be the provider that performed the face-to-face visit but must

document when the visit occurred, and the name and credentials of the professional that

conducted the encounter. The face-to-face visit must occur either 90 days before, or within

30 days after home health services begin.

Not all participants are eligible for all services. Home health isn’t covered in a hospital, nursing

facility, intermediate care facility for individuals with intellectual disabilities (ICF/IID) or any

setting where Medicaid covers inpatient services including room and board. Services can be

provided in an ICF/IID when otherwise not provided by the facility. Services are available

based on the participant’s enrollment eligibility. Incarcerated individuals or otherwise

ineligible non-citizens with Medicaid coverage are not eligible for these services.

Before delivery of services, providers must check eligibility on the date of the service to

validate coverage. Providers must maintain documentation of the eligibility check. Eligibility

can be checked by calling Idaho Medicaid Automated Customer Service (MACS) at 1 (866)

686-4272; or through the Trading Partner Account on Gainwell Technologies Idaho Medicaid

website.

See the General Information and Requirements for Providers, Idaho Medicaid Provider

Handbook, for more detail on eligibility checks.