The Home Health benefit is limited to 100 medically necessary visits per participant per calendar year. A visit is any combination of durable medical equipment or supplies, skilled nursing, home health aide services, physical, occupational or speech-language therapy services. Requests for services beyond 100-visits must be prior authorized by the Medical Care Unit.
Prior Authorization (PA) Requests
Agencies must fax documentation to the Medical Care Unit for prior authorization of visits over the 100-visit limitation and some durable medical equipment and supplies. The Department will accept timely retro supply requests.
The following documentation is required to determine the need for additional visits:
- Completed Home Health Prior Authorization Request Form
- Current physician’s order
- Current signed Home Health Certification and Plan of Care
- Treatment notes from the last 30 days
- Current history and physical from order physician or hospital discharge/admission paperwork
- MSRP or invoice for all CPT or HCPCS for codes with no price on the Medicaid Fee Schedule
- Any documentation that supports medical necessity
Requests for durable medical equipment and supplies should list each supply or piece of equipment separately using the appropriate CPT or HCPCS code and revenue code 270 for supplies and 291 for equipment. If items do not have a price on the fee schedule, include a copy of the manufacturer or wholesaler’s invoice or proof of the manufacturer’s suggested retail price (MSRP). See the Durable Medical Equipment and Supplies web page for prior authorizing equipment and supplies that always require a prior authorization or have exhausted that benefit’s limitation.
The status of a prior authorization request may be checked online at the DXC Technology Health PAS portal under “Authorization Status”, using your NPI, or by contacting DXC Technology at 1 (866) 686-4272.
The next Home Health provider meeting will be held June 2021. The date and time will appear in the May MedicAide newsletter. The meeting agenda will appear in the June MedicAide newsletter. Minutes from previous meetings are available on the right hand toolbar and published in the MedicAide newsletter.
If you would like to be added to the contact list for these meetings, or you have an issue you would like to appear on the next meeting’s agenda, e-mail your request to MCPT@dhw.idaho.gov.