Home Health Aide Services
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Defines eligibility, duties, supervision, service limits, and prior authorization requirements for Home Health Aide services provided to Montana Medicaid members under the Home Health Policy 506.
No material clinical or coverage changes in this revision.
Coverage conditions and limits
Coverage Conditions
Covered when ALL of the following are met:
based on chunk 2
based on chunk 2
based on chunks 2 and 3
based on chunk 8
based on chunk 8
Visits by a registered nurse to a Medicaid member's home that are conducted solely to supervise a Home Health aide are not reimbursable by Medicaid. Providers should ensure RN home visits include billable skilled nursing services beyond mere supervision of aide activities.
What providers must do
Prior authorization required for all Home Health aide services
All Home Health aide services require prior authorization from the Department or the Utilization Review Contractor before services are provided.
Authorization requires inability to use State personal assistance programs
Authorization is contingent on demonstration that the member's medical needs cannot be met through the State's personal assistance programs; providers must document this when requesting authorization.
- Authorization will only be granted when needs cannot be met through State personal assistance programs.
Required physician order, plan of care, legal permission, and aide documentation
Services must be ordered by a physician, included in the plan of care, be permitted under state law, and be consistent with Home Health aide training; aides must complete appropriate records per the HHA's policies and procedures.
- Physician order and inclusion in the plan of care (chunk 2).
- Permitted under state law and consistent with Home Health aide training (chunk 2).
- Aides must complete appropriate records in compliance with the HHA's policies and procedures (chunk 3).
Authorization triggered only if State personal assistance programs cannot meet needs
Home Health aide services will only be authorized when the member's medical needs cannot be met through the State's personal assistance programs; this condition is the authorization trigger for coverage.
- Authorization granted only after demonstrating member needs cannot be met by State personal assistance programs.
RN supervisory visits solely to oversee aides are not reimbursable
Visits by a registered nurse to the home solely to supervise a Home Health aide are not reimbursable by Medicaid and present a reimbursement denial risk.
- RN supervisory-only visits to the member's home are not Medicaid reimbursable.
Background and context
A Home Health aide is a paraprofessional trained and certified under 42 CFR 484.80 to provide unskilled personal care and simple procedures under the direction of a registered nurse or other appropriate skilled professional. Aides provide part‑time or intermittent hands‑on personal care, assistance with ambulation and exercises, and may help with self‑administered medications as ordered and included in the plan of care. All Home Health aide services require prior authorization, and authorization is limited to situations where the member's needs cannot be met through State personal assistance programs.
Key definitions
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