Idaho Medicaid Provider Handbook, Home Health and Hospice Services, introduction

This chapter of the Idaho Medicaid Provider Handbook covers home health and hospice

services as deemed appropriate by the Department of Health and Welfare.

Should the handbook ever appear to contradict relevant provisions of Idaho or federal

regulations, the regulations prevail. Any paper or digital copy of these documents is

considered out of date except the version appearing on Gainwell Technologies’ Idaho Medicaid

website. Sections of the Idaho Medicaid Provider Handbook applicable in specific situations

are listed throughout the handbook for provider convenience. Handbook chapters which

always apply include the following:

•

General Billing Instructions;

•

General Information and Requirements for Providers; and

•

Glossary.

Handbooks can only be used properly in context. Providers must be familiar with the

handbooks that affect them and their services. The numbering in handbooks is also important

to make note of as subsections rely on the content of the sections above them.

Example

Section 1.2.3.a The Answer requires the reader to have also read Section 1,

Section 1.2 and Section 1.2.3 to be able to properly apply Section 1.2.3.a.

References are included throughout the handbook for provider and staff convenience. Not all

applicable references have been incorporated into the handbook. Not all references provided

are equal in weight.

•

Case Law: Includes references to court cases that established interpretations of law

that states and providers would be required to follow.

•

CMS Guidance: These references reflect various Centers for Medicare and Medicaid

Services (CMS) publications that Idaho Medicaid reviewed in the formulation of

policies. The publications themselves are not required to be followed for Idaho Medicaid

services unless otherwise specified.

•

Federal Regulations: These references are regulations from the federal level that

affected policy development. Usually these include the Code of Federal Regulations,

the Social Security Act and other statutes. Providers are required to follow these.

•

Idaho Medicaid Publications: These are communications from Idaho Medicaid to

providers that were required to be followed when published. These are included in the

handbook for historical reference. The provider handbook supersedes other

communications unless the documents are listed in the Rules, Policies, Procedures,

and Waivers webpage under policies in the Medicaid Policies library in the Policies &

Standards Library.

•

Idaho State Plan: The State Plan is the agreement between the State of Idaho and

the Centers for Medicare and Medicaid Services (CMS) on how the State will administer

its medical assistance program. Unless otherwise stated, services can only be

reimbursed when in compliance with the agreement.

•

Idaho Waivers: A waiver is a deviation, or an expansion of benefits, of federal

requirements approved by the Centers for Medicare and Medicaid Services. Waiver

services can only be reimbursed as detailed in an approved waiver.

•

Professional Organizations: These references reflect various publications of

professional organizations that Idaho Medicaid reviewed in the formulation of policies.

Providers may or may not be required to follow these references, depending on the

individual reference and its application to a provider’s certification, licensure or scope

of practice.

•

Scholarly Work: These references are publications that Idaho Medicaid reviewed in

the formulation of policies. The publications themselves are not required to be followed

for Idaho Medicaid services.

•

State Regulations: These references are regulations from the state level that

affected policy development. They usually include statute and IDAPA. They are

required to be followed.

Some citations may not be available on the internet. Copies of the documents may be

requested with a public records request. Guidance for public records requests is available on

the department’s website.