Reimbursable Home Health Service Locations

The Home Health program reimburses for skilled nursing, skilled certified nurse aide, physical therapy, occupational therapy, and speech therapy services that are provided on an intermittent or per visit basis to Colorado Medical Assistance Program clients in their place of residence.

Colorado Medical Assistance Program pediatric clients may receive Home Health services outside of their place of residence when: 

 The Home Health services can be provided safely and adequately in a location other than the client’s residence; 

 Home Health service and interventions will be at least equally effective in a location other than the client’s residence; 

 It is clinically appropriate for the Home Health services to be provided in a location other than the client’s residence; 

 It is not primarily for the convenience of the client, client’s family, physician or other care provider; 

 It is not provided in a group home, nursing facility, hospital or other facility; and 

 It is not provided on public school grounds or as a part of an Individualized Education Program. 

Other Billing Information

 The Colorado Medical Assistance Program will reimburse two Home Health staff to care for a client when it is necessary to safely provide client care due to complexity of tasks, client weight, etc. and when it has been prior authorized. 

 Client’s Home Health Medical records must be retained by the agency for at least six (6) years unless State or Medicaid regulations require that the client’s records be maintained for more than six (6) years.

Non-Reimbursable Home Health Services

 Supplies used for routine Home Health are not reimbursed separately through the Home Health or Durable Medical Equipment (DME) benefit. Non-routine or client specific supplies must be reimbursed through the client’s DME benefit. 

 Nursing Visits for purpose of psychiatric counseling 

 Certified nurse aide visits for the purpose of providing only unskilled personal care and/or homemaking services. 

 Nursing or CNA visits provided in a shift (visits lasting more than 4½ consecutive hours) 

 Nursing visits for the sole purpose of providing supervision of the CNA or other Home Health staff 

 Nursing visits for the sole purpose of completing the Home Health plan of care/recertification 

 Long-Term Home Health nursing visits for the sole purpose of teaching the client or their family member 

 Long-Term Home Health nursing visits for the sole purpose of assessing a stable client where management, and reporting to physician of specific conditions and/or symptoms which are not stable 

Special Reimbursement Conditions for Home Health Services

 Acute Home Health services provided to Medicaid MCO clients shall be prior authorized (if required) and reimbursed under Medicaid MCO rules

 If a client is eligible for Medicare and Medicaid, Medicare is always the first payer when a client has skilled Home Health needs and the client is unable to leave their residence for non-medical programs and treatments (Homebound). All Medicare requirements shall be met and exhausted prior to billing Medicaid for Home Health services, except when:

o Medication box pre-filling is the only service provided; 

o Certified Home Health Aide Services are the only services provided; 

o Occupational Therapy Services when provided as the sole skilled service; 

o Routine Laboratory Draw Services are the only service provided; 

o If the client is (1) stable, (2) not experiencing an acute episode, and (3) routinely leaves the home unassisted for social, recreational, educational and/or employment purposes (not Homebound)