2013 Practitioner and Provider Manual - Presbyterian Healthcare ...

Home HealthThe condition of these patients should besuch that a normal inability to leave homeexists and, consequently, leaving home wouldrequire a considerable and taxing effort.Absences from the home are infrequent or forperiods of relatively short duration, or areattributable to the need to receive health caretreatment, including regular absences for thepurpose of participating in therapeutic,psychosocial, or medical treatment in an adultday care program. Attending a religiousservice shall be deemed to be an absence ofinfrequent or short duration.Occasional absences from the home for nonmedicalpurposes, such as an occasional tripto the barber, a walk around the block, a drive,attendance at a family reunion, funeral,graduation, or another infrequent or uniqueevent would not necessitate a finding that thepatient is not homebound if the absences areon an infrequent basis or are of relatively shortduration and do not indicate that the patienthas the capacity to obtain health care servicesoutside rather than in the home.The patient has a condition because of anillness or injury that restricts the patient’sability to leave their place of residence exceptwith the aid of supportive devices such ascrutches, canes, wheelchairs, or walkers; theuse of special transportation; the assistance ofanother person; or if leaving home ismedically contraindicated.of time. A patient may leave the home morefrequently during a short period when, forexample, the presence of visiting relativesprovides a unique opportunity for suchabsences than is normally the case.So long as the patient’s overall condition andexperience is such that he or she meets thesequalifications, he or she should be consideredconfined to the home.PHHSN may also review the referral or requestagainst the following qualifying criteria for homecare services:Ensuring requests for services are medicallynecessary requiring a skilled service (forexample, nursing, physical therapy,occupational therapy, and speech languagepathology)Ensuring that intermittent part-time serviceswill meet the patient’s needsEnsuring that all care is ordered and under aphysician’s direction through the course ofcareQualifying Home Care Criteria Policy – MedicaidPresbyterian Medicaid Intermittent Skilled Servicesadmission criteria are modeled as follows:Recipient must have documented medicalneed to receive care at homeServices are needed on an intermittent basisAll care must be ordered and under physiciandirection throughout the course of careWhen determining if a patient is homebound,their condition must be reviewed over a period11-32014 Practitioner and Provider Manual - Ver. 3