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)
