§ 1249.54. Payment conditions for home health aide services.
(a) Home health aide service is a covered home health service and is reimbursable under the MA Program if the following conditions are met:
(1) The services of a home health aide are given in conjunction with skilled care or, when skilled care is not needed, when personal care services are medically necessary.
(2) The recipient record contains documentation that, at least every 2 weeks, there has been communication between the home health aide and a supervisory nurse regarding the recipient.
(Editor’s Note: Under section 2(5)(ii) of the act of October 28, 2022 (P.L. 1632, No. 98) and to the extent permitted under Federal law, § 1249.54(a)(3) is abrogated to the extent that home health aide service is only covered and reimbursable under the medical assistance program if a physician establishes the written plan of treatment and, if skilled care is not required, certifies that the personal care services are medically necessary.)
(3) The assignment of a home health aide to a case shall be made in accordance with a written plan of treatment established by the recipient’s attending physician. The plan shall indicate the recipient’s need for personal care services. The specific personal care services to be furnished by the home health aide shall be determined by a registered nurse and not by the home health aide. If skilled care is not required, the recipient’s attending physician shall certify that the personal care services furnished are medically necessary.
(b) Personal care services that may be performed by a home health aide include, but are not limited to, assisting the recipient with the following:
(1) Bathing and personal hygiene.
(2) Ambulation and transfer.
(3) Exercise.
(4) Administering medications specifically ordered by a physician that are ordinarily self-administered.
(5) Retraining the recipient in necessary self-help skills.
(c) Domestic and housekeeping services which are unrelated to recipient care are not covered home health services. For example, the services include the following:
(1) Vacuuming, dusting, floor mopping, kitchen and bathroom maintenance.
(2) Washing, ironing and mending clothes.
(3) Child care.
Authority The provisions of this § 1249.54 amended under sections 403(a) and (b), 443.2(2) and 509 of the Public Welfare Code (62 P. S. § § 403(a) and (b), 443.2(2) and 509).
Source The provisions of this § 1249.54 adopted December 6, 1980, effective December 1, 1980, 10 Pa.B. 4618; amended August 12, 1988, effective September 1, 1988, 18 Pa.B. 3571. Immediately preceding text appears at serial page (117531).
Cross References This section cited in 55 Pa. Code § 1249.51 (relating to general payment policy).
No part of the information on this site may be reproduced for profit or sold for profit.
This material has been drawn directly from the official Pennsylvania Code full text database. Due to the limitations of HTML or differences in display capabilities of different browsers, this version may differ slightly from the official printed version.
