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|
Angus S. King, Jr. |
State of Maine |
Kevin W. Concannon |
| October 14, 1999 |
Dear Doctor:
The Maine Medicaid program has changed the eligibility standards for receiving home health benefits.
Under the new rules, which were effective September 18, the physician must certify, on the HCFA-485 form, that the patient is homebound. Medicaid is using the same definition as Medicare. This definition is set forth in Appendix 1 of the Section 40, Home Health Services rules. There can be an exemption if the physician signs a statement that the patient’s medical condition prevents the safe use of outpatient services and is contraindicated for specific reasons. The reasons must be listed and the likelihood of a bad result must be probable or definite. This is a change from past practice whereby the home health agency documented the need for in-home services.
We know that home health services can be critical to avoiding unnecessary hospitalizations, or nursing facility placement. Home Health is one of six different home care programs available to Medicaid patients. Since Maine pays among the highest reimbursement rates in New England under the Home Health benefit, Medicaid wants to make sure this benefit is targeted to those who cannot obtain services effectively through another program, or on an out-patient basis.
If you have questions, please contact Pam Cobb, Provider Relations Specialist, Bureau of Medical Services, 249 Western Ave., 11 SHS, Augusta, ME 04333-0011. Telephone: 287-3094 or 1-800-321-5557, Option 1. FAX: 287-2675.
Sincerely,
Tim Clifford, M.D.
Medical Director
Bureau of Medical Services
