Home Health visits are limited to 100 medically necessary visits per participant per calendar year (January to December). A combination of skilled nursing, home health aide services, physical, occupational or speech-language therapy services are combined when calculating the 100 visits. Requests for services beyond 100 visits must be prior authorized by the Medical Care Unit.
Prior Authorization (PA) Requests
If the participant requires visits over the 100-visit limit, the agency must fax documentation to the Medical Care Unit for prior authorization. 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
Completing the PA Request Form for Supplies
Enter each individual supply or piece of equipment separately using the appropriate CPT or HCPCS code.
If the CPT or HCPCS code is listed on the Idaho Medical Fee Schedule, enter the rev code (270 supplies or 291 DME), service code and price from the fee schedule. For items not priced on the fee schedule, enter the cost from the invoice or MSRP.
Line 1: Rev code 270 Service code A5051 Cost $2.05
Line 2: Rev code 291 Service code K0008 Cost $500.00 (cost from invoice)
The status of a prior authorization request may be checked online at the Molina Health PAS portal under “Authorization Status”, using your NPI, or by contacting Molina at 1 (866) 686-4272