Home Health visits — eligible services, limitations, and exclusions
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Defines where Home Health services may be provided, the composition of Home Health visits, annual visit limits, authorization periods, and prior authorization requirements for Montana Medicaid beneficiaries.
No material clinical or coverage changes in this revision.
Home Health Coverage Criteria and Limits
Home Health coverage criteria and limits
Covered when ALL of the following are met:
ALL of the following
- Home Health visits may be any combination of skilled nursing, therapy, and/or Home Health aide services.
- Home Health services cannot be limited to beneficiaries who are homebound.
ALL of the following
- Combined limit of 180 Home Health visits annually for skilled nursing, therapy, and Home Health aide services (counting from the initial visit up to and including the 365th day).
- Requests for additional Home Health services after the annual 180-visit limit will be reviewed by the Department and/or the Utilization Review Contractor.
ALL of the following
- All Home Health services require prior authorization through the Department or the Department’s Utilization Review Contractor.
- Extended authorizations are issued for 60-day service periods; a new authorization is required for each 60-day period over the 180-day limit.
Visit Limits, Counting, and Coding Notes
| No codes listed |
Authorization and Provider Requirements
Prior authorization required; extended authorizations issued in 60‑day increments
All Home Health services must be prior authorized through the Department or the Department's Utilization Review Contractor. Extended authorizations are issued for 60‑day service periods; a new authorization is required for each 60‑day period over the 180‑day limit. Requests for additional Home Health services after the annual 180‑visit limit will be reviewed by the Department and/or the Utilization Review Contractor.
- Prior authorization required for all Home Health services.
- Extended authorizations cover 60‑day service periods.
- A new authorization is required for each 60‑day period beyond the 180‑day limit.
- Requests for services after the annual 180‑visit limit are subject to review by the Department and/or the Utilization Review Contractor.
Definitions Used in This Policy
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