Idaho Medicaid Provider Handbook, Home Health and Hospice Services § 3.4.2

Home health agencies are responsible for providing durable medical equipment and supplies

(DME and DMS) to participants under a home health plan of care. DME and DMS must be

medically necessary and suitable for use in the home but may be provided for use anywhere

normal life activities take place. A physician, nurse practitioner, clinical nurse specialist,

certified nurse midwife, or physician assistant must provide Orders for DME and DMS and

reevaluate their necessity in the Plan of Care annually. DME and DMS must have a face-to-face visit within the six months preceding delivery. Home Health Agencies must adhere to the

Durable Medical Equipment, Prosthetics, Orthotics and Supplies, Idaho Medicaid Provider

Handbook for any dispensed DME or DMS.

The Department of Health and Welfare may arrange purchase agreements with providers to

purchase DME when the rental charges total more than the purchase price of the equipment.

All such purchases will be handled separately from the home health program as medical

vendor transactions.

Claims for DME and DMS must be billed with the correct revenue code and CPT®/HCPCS, one

combination per claim line. Routine supplies are included in the cost of the home health visit

and are not separately reimbursable. A routine supply is generally used in small supplies

during most home health visits and aren’t included in the plan of care. The items are part of

the staff’s supplies and aren’t designated for an individual participant. Routine supplies usually

include, but are not limited to:

•

Swabs, alcohol preps, and skin prep pads;

•

Tape removal pads;

•

Cotton balls;

•

Adhesive and paper tape;

•

Nonsterile applicators;

•

4 x 4 gauze dressings;

•

Nonsterile gloves;

•

Aprons;

•

Masks;

•

Gowns;

•

Specimen containers;

•

Thermometers; and

•

Tongue depressors.

(a)

References: Durable Medical Equipment and

Supplies

(i) Federal Regulations

Home Health Services, 42 CFR §440.70 (2020). Government Printing Office,

https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-440/subpart-A/section-

440.70.

(ii)

State Regulations

“Home Health Services: Coverage and Limitations.” IDAPA 16.03.26, “Medicaid Plan

Benefits,” Sec. 242. Department of Administration, State of Idaho,

https://adminrules.idaho.gov/rules/current/16/160326.pdf.

Medical Assistance Program – Services to be Provided, Idaho Code 56-255(5)(a)(x) (2018).

Idaho State Legislature,

https://legislature.idaho.gov/statutesrules/idstat/Title56/T56CH2/SECT56-255.

“Medical Necessity (Medically Necessary).” IDAPA 16.03.26, “Medicaid Plan Benefits,” Sec.

006.15. Department of Administration, State of Idaho,

https://adminrules.idaho.gov/rules/current/16/160326.pdf.