Name of Manual - Blue Cross and Blue Shield of Minnesota

Coding Policies and Guidelines (Home Health, Home Infusion, Hospice)
Elderly Waiver
Program
11-4
The statewide Elderly Waiver Program (EW) is available to
members of Blue Advantage MSC+ and SecureBlue SM (HMO
SNP). Blue Plus will review all Medicaid and Medicare home care
requests and determine the number of visits based upon medical
necessity, Medicare, and state plan guidelines. This is applicable to
all members receiving Medicaid and Medicare home care services
including those on Elderly Waiver.
Home care agencies contact the member’s care coordinator for
consultation regarding the member’s plan of care. The care
coordinator will need to fax in the 6.04.01 Recommendation for
Authorization of MA Home Care Services for members open to a
home and community based disability or form 6.04.03 Home Care
Services Recommendation-Non Disability to request Blue Plus to
review the services.
Blue Plus will obtain medical necessity information from the home
care agency and will review the information submitted and make a
coverage determination within 10 days of receipt of the request.
When a determination is made, Blue Plus will notify the member
and the home care provider via a letter of the outcome.
Blue Plus will fax the 6.04.01 or 6.04.03 form back to the care
coordinator for their records and case mix cap management.
PCA Services
Blue Cross and Blue Plus contracts with Personal Care Provider
Organizations (PCPO) and PCA (Personal Care Assistant) Choice
providers as part of our Government Programs Specialty Network.
PCA services are eligible only for reimbursement under certain
Public Program contracts. PCA services may also be furnished
through a contracted home health agency. The following
information describes the programs, eligible services and claims
submission requirements.
Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (07/12/12)