Eligibility, Certification, Face-to-Face Encounter, Homebound Status, and Medicaid Prior Authorization
Sets out how the Agency confirms, documents and keeps current each patient's eligibility for home health care: for Medicare patients, the beneficiary qualifications in 42 CFR §409.42, homebound status, the physician or allowed practitioner certification and recertification, and the face-to-face encounter under 42 CFR §424.22; for Michigan Medicaid patients, the written order and plan of care, the face-to-face encounter, medical necessity and setting, and prior authorization of home health aide services by the MDHHS Program Review Division after the first 90 days, with renewals received at least 15 business days before the end of each authorization.
- Policy number
- MI-HH-ADM-03
- Version
- 1.0
- Main rule
- 42 CFR §424.22
- Library
- Michigan home health · 57 policies
- Category
- Service delivery
- Sections
- 24
In short
- Medicare patients must be homebound and need skilled care. Write specific facts, not just the word "homebound".
- The practitioner’s face-to-face encounter (in person or by allowed telehealth) must happen within 90 days before or 30 days after the start of care.
- Tell the clinical manager the same day if a patient may no longer be homebound.
- Michigan Medicaid aide services need prior authorization after the first 90 days.
- Renewal requests must reach MDHHS at least 15 business days before the authorization ends. Never schedule aide visits past the end date.
What's inside
24 sections. The full text comes with the One-time Policy Pack.
- Terms of Reference
- 1. Purpose
- 2. Scope
- 3. Definitions
- 4. Policy Statement (42 CFR §424.22)
- 5. Medicare: Who Qualifies
- 6. Medicare: Homebound Status
- 7. Medicare: Certification and Recertification
- 7.1 Content of the Certification
- 7.2 Timing and Signature
- 7.3 Supporting Documentation
- 7.4 Practitioners Who May Not Certify
- 8. Face-to-Face Encounter
- 9. Michigan Medicaid: Orders, Medical Necessity and Setting
- 10. Michigan Medicaid: Home Health Aide Prior Authorization
- 11. Tracking and Notices
- 12. Other Payers
- 13. Responsibilities
- 14. Records and Compliance Monitoring
- 15. Staff Training
- 16. References
- 17. Related Policies and Forms
- 18. Approval
- 19. Revision History
An inspector may ask
- Show me the face-to-face encounter documentation for this Medicare patient. Who performed it and when, compared with the start of care?
- How did the clinician document that this patient was homebound at the initial and comprehensive assessments?
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