Idaho Medicaid Provider Handbook, Home Health and Hospice Services § 3.6.2

All home health services must have an individualized home health plan of care before

beginning treatment. The participant’s plan of care must be reviewed, signed and dated by

the attending physician, nurse practitioner, clinical nurse specialist or physician assistant, who

established the plan, every 60 days for services and annually for durable medical equipment

and supplies. The home health agency must maintain a copy in their records and provide a

copy to the participant. The plan must include at a minimum:

•

All pertinent diagnoses;

•

The participant’s mental status;

•

The services, equipment and supplies required;

•

The frequency of visits;

•

Functional limitations;

•

Ability to perform activities of daily living;

•

Activities permitted;

•

Nutritional requirements;

•

Medication and treatment orders;

•

Any safety measures implemented to prevent injury;

•

Any environmental factors that may impact the home health agency’s ability to provide

safe and effective care;

•

The participant’s support system’s ability to provide care;

•

The participant and support system’s teaching needs;

•

A plan for discharge; and

•

Any other appropriate items.

(a)

References: Plan of Care

(i) Federal Regulations

“Conditions of and Limitations on Payment for Services” Social Security Act, Sec. 1814(a)(7)

(1935). Social Security Administration,

https://www.ssa.gov/OP_Home/ssact/title18/1814.htm.

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 Plan of Care.” IDAPA 16.03.26, “Medicaid Plan Benefits,” Sec. 243.02

Department of Administration, State of Idaho,

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