N.H. Admin. Code § He-W 553.06

Current through Register No. 36, September 5, 2024

Section He-W 553.06 - Covered Services

(a) Services shall be covered when:

(1) A physician orders services as part of a written plan of care; and

(2) A face-to-face encounter with the recipient, which may occur within 90 days before the initial start of the home health services or within 30 days after the start of services, is documented in compliance with He-W 553.05(d) (2) above, and is performed by one of the following medicaid enrolled providers:

a. The recipient's physician; or

b. The following non-physician practitioners when the requirements in (b) below are met:

(i) A nurse practitioner or clinical nurse specialist working in collaboration with the recipient's physician;

(ii) A certified nurse midwife; or

(iii) A physician assistant under the supervision of the recipient's physician.

(b) Non-physician practitioners in (a) (2) b. above who perform the face-to-face encounter shall communicate the clinical findings of the face-to-face encounter to the recipient's physician who shall incorporate the clinical findings into the recipient's medical record.

(c) Covered services shall be those home health services, regardless of diagnosis, the need for which is consistent with the nature of the recipient's condition and accepted standards of medical and nursing practice.

(d) Covered home health services shall include:

(1) Skilled nursing services in accordance with the written plan of care including:

a. Skilled observation and assessment of the recipient's status, including available support system and physical environment;

b. Administration of medications, including intramuscular and intravenous medications;

c. Insertion and irrigation of indwelling urinary catheters;

d. Administration of enemas, providing ostomy care, and other related procedures to provide assistance with bowel evacuation;

e. Skilled respiratory care including suctioning, tracheostomy care, administration of inhalation therapies, and chest physiotherapy;

f. Wound care, care of decubitus ulcers, and treatment of other extensive skin disorders;

g. Administration of enteral feedings;

h. Rehabilitative nursing procedures such as the initiation and supervision of bowel and bladder training programs;

i. Education, specific to the recipient's condition, provided to the recipient and significant others involved with the recipient;

j. Pre-filling of medication administration devices such as pill planners;

k. Medication reconciliation; and

l. Education about medication therapeutic effects, side effects, and adherence to prescribed regimen;

(2) Home health aide services, in accordance with the written plan of care, including assistance provided to a recipient for the following:

a. Personal hygiene, including bathing, grooming, dressing, and changing bed linens, when there is a medical need and it is documented in the care plan;

b. Ambulation and movement, including range of motion exercises, turning, positioning, and transferring;

c. Nutritional care, including feeding and hydration;

d. Elimination, including toileting and bowel or bladder training;

e. Assistance with the use of adaptive prosthetic and orthotic devices;

f. Assistance with self-administering medications, when the assistance provided by the aide does not require the skill of a licensed nurse;

g. Administration of medications by a medication LNA or by an LNA if delegated by a RN in accordance with RSA 326-B:14, II-a;

h. Activities that are directly supportive of skilled therapy services;

i. Other medically related activities which can safely and effectively be provided by a LNA, including simple dressing changes;

j. Light housekeeping when there is documentation that no other support in the home exists at the time of the visit, and when such services are directly related to the recipient's medical condition and care needs and is documented in the written plan of care; and

k. Tasks properly delegated to the LNA by the supervising RN pursuant to RSA 326-B:28;

(3) Physical therapy, speech therapy, occupational therapy, speech pathology and audiology services provided a licensed therapy provider and subject to the limits specified in He-W 530;

(4) Durable medical equipment, medical supplies, prosthetics, and orthotic devices, when prescribed by the attending physician and in accordance with the requirements in He-W 571; and

(5) Office visits, when the recipient receives services provided by an advanced practice registered nurse (APRN) at the location of the home health care provider as an alternative to visiting a physician's office for treatment.

N.H. Admin. Code § He-W 553.06

#8972, eff 9-11-07

Amended by Volume XXXVI Number 28, Filed July 14, 2016, Proposed by #11127, Effective 7/1/2016, Expires 7/1/2026.