Ala. Admin. Code r. 560-X-12-.08

Current through Register Vol. 43, No. 1, October 31, 2024

Section 560-X-12-.08 - Certification And Recertification

(1) An eligible Medicaid recipient may be considered for home health services (i.e., nursing services and home health aide services) upon the initial written prescription or order signed and place by a physician licensed in the State of Alabama or an authorized non-physician practitioner (NPP).

(2) The ordering physician or NPP must sign and place the initial prescription or order for home health services only after the required face-to-face visit with the recipient is conducted.

(3) Subsequent written prescriptions or orders for refills, ancillary supplies, repairs or services, or re-certifications do not require the ordering physician's or NPP's signature or an additional face-to-face visit.

(4) Either an authorized physician or one of the following authorized non-physician practitioners working under a collaborative agreement under Alabama law must conduct the required face-to-face visit and write the initial prescription or order for home health services:

(a) Certified registered nurse practitioners or clinical nurse specialists;

(b) Certified nurse midwifes;

(c) Physician assistants (PA) under the supervision of the physician; or

(d) Attending acute or post-acute physicians, if recipients are admitted to home health services immediately after discharge from an acute or post-acute stay.

(5) The physician or NPP must document the clinical findings of the required face-to-face visit for the initial written prescription or order for home health services in the recipient's medical record.

(6) The required face-to-face visit for the initial written prescription or order for home health services must be conducted no more than 90 days before or 30 days after the start of service. The face-to-face visit must be related to the primary reason why the recipient requires home health services. The ordering physician or NPP must provide written documentation to the home health provider regarding the recipient's condition, which justify that the recipient meets home health criteria. The ordering physician or NPP must be an active Medicaid provider licensed in the State of Alabama. The required face-to-face visit may be conducted using telehealth systems.

(7) The ordering physician or NPP must recertify care every sixty (60) days if home health services continue to be necessary.

(8) For more information on the requirements for placing the initial written prescription or order for certain medical supplies, equipment, and appliances, please refer to Chapter 13-Durable Medical Equipment (DME), Supplies, Appliances, Prosthetics, Orthotics and Pedorthics (POP).

Ala. Admin. Code r. 560-X-12-.08

Rule effective October 1, 1982. Amended: Filed February 5, 2001; effective March 12, 2001.

Amended by Alabama Administrative Monthly Volume XXXV, Issue No. 05, February 28, 2017, eff. 3/27/2017.

Amended by Alabama Administrative Monthly Volume XXXVI, Issue No. 11, August 31, 2018, eff. 9/24/2018.

Amended by Alabama Administrative Monthly Volume XXXIX, Issue No. 01, October 30, 2020, eff. 12/14/2020.

Author: Renee R. Adams, Program Manager, Home Health, Long Term Care Division

Statutory Authority: Title XIX, Social Security Act; 42 C.F.R. § 440.70; State Plan.