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Sarah C. Massengale Files (Ford Administration)
Sarah Massengale's Health, Social Security and Welfare Files
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Legislation
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The original documents are located in Box 12, folder "Health - Home Health Care (3)" of
the Sarah C. Massengale Files at the Gerald R. Ford Presidential Library.
Copyright Notice
The copyright law of the United States (Title 17, United States Code) governs the making of
photocopies or other reproductions of copyrighted material. Gerald R. Ford donated to the
United States of America her copyrights in all of her husband's unpublished writings in National
Archives collections. Works prepared by U.S. Government employees as part of their official
duties are in the public domain. The copyrights to materials written by other individuals or
organizations are presumed to remain with them. If you think any of the information displayed
in the PDF is subject to a valid copyright claim, please contact the Gerald R. Ford Presidential
Library.
MEMORANDUM
DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE
OFFICE OF THE SECRETARY
TO:
See Below
DATE: JAN 15 1976
FROM:
SEQUENCE No.
SRS - 13
Executive Secretary
DOCUMENT No.
1
of
1
(FINALS ONLY)
SUBJECT: SRS - Final Regulations -- Home Health Services - Part 249--Services and
Payment in Medical Assistance Programs - Title XIX of the Social Security
Act - Chapter II, Title 45
Attached is a copy of SRS' Action Memorandum dated January 14, 1976,
with accompanying Federal Register document. Please indicate your
conconcurrence by signing the Action Memorandum in the space provided
within 5 working days. If additional time is needed for review of
this document, please notify Miss Howell by telephone (extension 57770).
Please discuss questions you have about these proposed regulations
with operating agency personnel before submitting memoranda of comment.
If issues cannot be resolved, nonconcurrence memoranda addressed to the
Secretary are then appropriate.
Please return your concurrence (or nonconcurrence memorandum) to
Miss Howell, Room 5139-B, North Building, for association with the
docket file.
Simultaneous routing of this Federal Register document submitted
to the Secretary is being made to expedite clearance and approval
in the Office of the Secretary.
Attachments
Addressees:
General Counsel
Assistant Secretary, Comptroller
Assistant Secretary (Planning and Evaluation)
Mssistant Secretary (Legislation)
Assistant Secretary for Administration and Management
Commissioner of Social Security
GERALD LIBRARY R. FORD
Assistant Secretary (Health)
Assistant Secretary (Public Affairs)
Assistant Secretary (Human Development)
Mr. 'Peter Franklin, Special Assistant to the Secretary
MEMORANDUM
DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE
SOCIAL AND REHABILITATION SERVICE
Office of the Administrator
TO
:
The Secretary
DATE:
JAN 14 1976
Through: U
ES
FROM
:
Acting Administrator
Social and Rehabilitation Service
SUBJECT: Final Medicaid Regulations on Home Health Services - ACTION
PURPOSE
To revise regulations in order to increase use of home health services
under the Medicaid program where home care is appropriate and necessary
with respect to the recipient's condition. The revisions broaden the
types of agencies eligible to provide services and clarify the required
and optional services made available by States.
BACKGROUND
Under existing Medicaid home health services regulations:
(1) Provider participation has been restricted to those which meet
Medicare requirements. One such requirement is that they must
provide skilled nursing services and one other service such as
physical therapy. This has meant that some agencies, such as
small public health departments and visiting nurse associations,
have been unable to participate if they cannot offer the second
service. Also, the requirement has served as a deterrent to
creation of new agencies.
Another requirement under Medicare (by statute) is that
proprietary agencies must be licensed under State law and,
if the State has not enacted such a law, a proprietary agency
cannot be a provider for Medicare in that State. This restric-
tion has been carried over into Medicaid by regulation.
(2) There is ambiguity as to the minimum set of home health
services which States must provide. under a State plan.
It has been interpreted that the States are required to
provide only one of the specified services (nursing, home
health aide, supplies and equipment), when in fact it was
intended that all of these were required to be available.
Page 2 - The Secretary
Another problem has been that some States have adopted the Medicare
requirement that a patient must be in need of "skilled" nursing or
other professional services. Thus, a person who does not require
"skilled" services but for example, only home health aide services,
was regarded as not eligible for home health services. Some States
also limited eligibility by applying inappropriate requirements of
post-hospitalization or pre-institutionalization.
A GAO report on home health services recommended that SRS clarify
the services for which FFP is available and encourage States to
make greater use of them. In line with these recommendatio: s and
as part of the Department's effort to develop alternatives to
institutional care, SRS published proposed regulations on August 21,
1975, containing the following revisions:
(1) Clarification of required and optional services. The
proposal specified that States must make available nursing
services, home health aide services, and medical supplies,
equipment and appliances suitable for use in the home.
At State option, physical, occupational, or spe ch therapy
may be provided to home health care patients e: though
not generally provided to all recipients under the State
plan.
(2) Expansion of the types of agencies qualified to provide
services and specification of standards they must meet:
(a) Instead of the limitation to agencies providing
primarily skilled nursing plus a therapeutic service,
the proposal permitted agencies offering only nursing
or only home health aide services to qualify if they
meet the prescribed standards. (The latter are
basically the Medicare standards adapted to permit
these agencies to qualify).
(b) The proposal also permitted proprietary agencies
to participate if they meet the standards, not
restricting their participation to States which
have enacted a licensing law.
Page 3 - The Secretary
(3) Clarification of recipient eligibility. As indicated
above, there has been some confusion as to whether recipients
must be determined to need skilled care or to require admit-
tance to institutions.
COMMENTS
Almost 1300 comments were received, covering both the major issues
of types of agencies to be included and different standards for
Medicaid and Medicare, and virtually every provision of the proposed
regulations. There were also hearings held by the subcommit ees of
the Senate and House Committees on Aging, and a meeting convened by
SRS with State, Congressional, consumer and provider representatives.
TYPES OF AGENCIES
The major controversy arose over the proposal to permit proprietary
agencies to be Medicaid providers if they meet the Federal standards,
whether or not the State has a licensing law.
Comments indicated primarily (a) a misunderstanding that ates could
not continue to regulate home health agencies, and (b) a strong concern
that proprietary agencies would not provide quality services, since
their overriding interest is in returning a profit to their owners or
stockholders; that they would employ inadequately trained and supervised
staff, which might lead to patient abuse; and that they would "corner
the market" of paying patients, thus driving out of business voluntary
agencies which depend on payment from some percentage of patients.
Also, some of those basically in favor of allowing for-profit agencies
to participate expressed concern about the Federal and State capacity
for monitoring and standards enforcement.
With respect to State licensing laws, the regulations do not limit
State action in any way--States are free to require licensing and to
establish standards higher than the Federal requirements. The
regulations establish Federal standards which all agencies must meet.
Additional requirements are then properly a matter for State legis-
lative and regulatory action. This is appropriate in light of the
silence on this subject in the Medicaid statute as contrasted with
the specific provisions enacted for Medicare.
Page 4 - The Secretary
The Department also believes that home health services should not be
subject to a restriction which is not applied in the case of any other
Medicaid service, and that there should not be discrimination against
one type of provider-rather, the same standards should be used for all.
With respect to the second comment, SRS recognizes a legitimate concern.
However, it is regarded as inappropriate to bar all proprietary agencies
(in States which do not enact licensing laws) because of the possible
abuse by some. To lessen the potential that these results will ensue,
SRS will make home health services one of its four top priorities for
monitoring against fraud and abuse and will assist States in estab-
lishing effective systems for this purpose.
Another issue centered on the proposal to allow single-service agencies
to become Medicaid providers. Comments expressed concern that use of a
single-service agency would lead to fragmentation of care and poor
quality service.
NURSING
ONLY
In the final regulation, the "single-service" agency provision has
SERVICE
been changed to allow only nursing service agencies to qualify, since
AGENCIES
SRS believes that these agencies are best qualified to provide the
coordination of services that may be needed by many recipients. Home
health aide agencies have been eliminated from the regulation as
single-service providers since they are usually not equipped to per-
form such coordination.
DIFFERING STANDARDS FOR MEDICARE AND MEDICAID
The proposal contained a standard for Medicaid agencies not participating
in Medicare--that is, proprietary and single-service agencies which the
Department wishes to include in Medicaid in order to increase availability
of services. The proposed standard was the Medicare rule, modified to
allow such agencies to participate.
There was much misunderstanding of the extent of the differences and
of the need for a separate Medicaid standard. In the final regulations
the Medicare standards have been adopted by cross-reference and the
necessary exceptions (for proprietary and single-service agencies, etc.,)
have been listed. This should clarify that the Medicare-Medicaid
standards are the same wherever possible.
FORD is LIBRARY 939330
Page 5 - The Secretary
Other comments have been considered and appropriate changes made,
as explained in the preamble.
PRESS RELEASE
A draft press release is attached (Tab B).
INFLATIONARY IMPACT STATEMENT
It has been determined that an inflationary impact statement is
not necessary.
RECOMMENDATION
That you approve the final regulations (Tab A) for publication in
the Federal Register.
JOHN A. SVAHN
John A. Svahn
Enclosure
Tab A - - Final Regulations
Tab B - - Press Release
Tab C - Previous Action Memo
Prepared by: SRS/MSA, MOSchnoor x50397, 1/13/76
(Contact: Ilse C. Sandmann, x58822)
CONCUR
Asst. Secretary (Legislation)
DATE
TITLE 45 - PUBLIC WELFARE
CHAPTER II - SOCIAL AND REHABILITATION SERVICE
(ASSISTANCE PROGRAMS)
DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE
PART 249 - SERVICES AND PAYMENT IN MEDICAL ASSISTANCE PROGRAMS
Home Health Services
Notice of proposed rule making was published August 21, 1975
(40 FR 36702) revising existing regulations on the provision of home
health services under State plans for medical assistance (title XIX,
Social Security Act). The purpose of the proposed revisions was to
remove certain restrictions and ambiguities which prevented full
realization of the benefits of such services. The basis for the
proposal was the Department's desire to increase the availability of
home health services to Medicaid recipients and to encourage their
use in appropriate cases as one alternative to institutionalization.
In the summary, the proposed revisions would:
- permit certain types of qualified health service agencies, in
addition to those which meet Medicare standards, to provide home
health services under Medicaid programs;
- prescribe the standards which those agencies must meet, which
parallel those for Medicare but are appropriately adjusted for
differing needs under Medicaid;
-. permit proprietary agencies to participate if they meet the
standards, subject to any licensing law of the State;
- clarify that States must make available under the State plan
the three main types of services needed in home care: nursing, home
FORD LIBRARY Y GERVID
health aide, and supplies and equipment, and also permit them to
provide various therapies as home health services;
any clarify the Medicaid recipients to whom home health services
must be available, specify the requirements for a physician's
determination of medical needs recorded in a plan of care and
periodically reviewed, and clarify that Medicare requirements
relating to need for "skilled" care or to post-hospitalization do
not apply under Medicaid.
Nearly 1300 comments were received from a broad range Cf
interested parties: members of Congress, private citizens,
na Dional health and welfare organizations, consumer and senior
citizen groups, public and private providers and provider organi-
zations, State and local agencies, etc. The comments themselves
represented a broad range of opinion from approval of the hanges
to strong objections in whole or in part. Evidence of widespread
interest was also presented by the holding of public hearings on
October 28, 1975 by subcommittees of the Senate and House Committees
on Aging, and by the convening of an all-day session on the major
issues to which the Department invited State, congressional, consumer
and provider representatives.
The greatest controversy arose over the proposal to drop from Medicaid
the restrictions on proprietary agency participation applied by
statute under Medicare, thus allowing their participation in the
Medicaid program on the same basis and under the same standards as
nonprofit agencies. Another major issue was the establishment of
standards differing in some respects from Medicare's, including the
provision for single service agencies to participate in Medicaid
ii
(those offering only nursing or only home health aide services).
Inaddition, however, there were questions and suggestions on
virtually every detail of the proposed regulations. All comments
have been analyzed and given careful consideration in developing
the final regulations, and numerous clarifications have been made.
The major comments and the Department's responses are listed below:
1. Participation of proprietary agencies.
Under Medicare, for-profit agencies may qualify a home
health providers only if licensed by the State; if the
State does not have a licensing law, they may not be
certified under the program. This provision, statutory
for Medicare, had been adopted by regulation for Medicaid.
The Department's proposal would allow proprieta y agencies
to qualify as Medicaid providers if they met the standards
prescribed in the regulations; however, States could still
require licensing if they wished. Comments indicated
primarily (a) a misunderstanding that States could not
continue to regulate home health agencies, and (b) a strong
concern that proprietary agencies would not provide quality
services, since their overriding interest is in returning
a profit to their owners or stockholders; that they would
employ inadequately trained and supervised staff, which
might lead to patient abuse; and that they would "corner
the market" of paying patients, thus driving out of business
voluntary agencies which depend on payment from some percent-
iii
age of patients--the net result leaving poor persons refused
service by the profit-making agencies and deprived of any
other source of help. Also, some of those basically in
favor of allowing for-profit agencies to participate
expressed concern about the Federal and State capacity for
monitoring and standards enforcement.
With respect to State licensing laws, the regulations do
not limit State action in any way--States are free to require
licensing and to establish standards higher than the Federal
requirements. States may also impose certificate-ôf-need
requirements and other procedures designed to control the
establishment and operation of home health agencies. What
the regulations do is to establish Federal standards which
all agencies must meet.
Additional requirements are then
properly a matter for State legislative and regulatory action.
This is appropriate in light of the silence on this subject
in the Medicaid statute as contrasted with the specific
provisions enacted for Medicare.
The Department also believes that home health services should
not be subject to a restriction which is not applied in
the case of any other Medicaid service, and that there should
not be discrimination against one type of provider-rather,
the same standards should be used for all.
iv
With respect to the second comment, the Department
recognizes a very legitimate concern among a number of
interested parties, particularly in light of the
abuses perpetrated by some profitmaking agencies in
the nursing home field. However, it is regarded
as inappropriate, to bar all proprietary agencies
(in States which do not enact licensing laws) because
of the possible abuse by some. To lessen the potential
that these results will ensue, the Social and Rehabilitation
Service willmake home health services one of its
four top priorities for monitoring against fraud and
abuse and will assist States in establishing effective
systems for this purpose.
iv-a
2.
Establishment of separate standards for Medicare and Medicaid.
Again, some comments reflected misunderstanding of the extent
of the differences and of the need for a separate Medicaid
standard. As explained in the Notice of Proposed Rule Making,
using Medicare standards in total has restricted the partici-
pation of a number of agencies which can offer quality
singh
services to Medicaid recipients, for example, agencies which
Cervice
offer only a single service. In cases where a recipient. needs
only one type of home health service, he should be ble to
receive it from such an agency (provided it meets all other
prescribed standards) and to have reimbursement provided to the
agency by the Medicaid program. Although Medicare restrictions
such as the requirement for providing skilled nursing plus one
other service are imposed by statute, no similar estriction
appears in the Medicaid statute and thus regulatory changes
can be made as appropriate.
In the final regulation, the "single-service" agency provision
has been changed to allow only nursing service agencies to
qualify, since the Department believes that these agencies are
best qualified to provide the coordination of services that
may be needed by many recipients. Home health aide agencies
have been eliminated from the regulation as single--service
providers since they are usually not equipped to perform such
coordination and since the regulation requires supervision of
home health aides by qualified nursing personnel; therefore
V
the agency should be able to offer nursing service in a home
health program.
To clarify that the only variations from Medicare
'standards are those necessary to permit additional types
of agencies to participate in Medicaid, the final regulation
has adopted the Medicare standards in 20 CFR 405.1201-1230
with certain exceptions.
3. Definition of home health services (6249.10(b)(7)).
This paragraph specifies the required and optional services
to be provided under State Medicaid plans. Comments included
the following:
(a) Clarify when services may be provided in an intermediate
care facility.
This has been done by giving an example. Guidelines
will also elaborate on this provision.
(b) Change the 90-day physician's review to the Medicare
requirement of 60 days.
This has been done by adopting the Medicare standard.
(c) With respect to use of a "solo" nurse in the absence
of a qualified agency: drop the requirement, make it
optional, clarify when no agency is considered "available",
require public hearings prior to such a finding, clarify
"direction" by a physician.
vi
The requirement has been retained since it is necessary
for the provision of services in certain areas, primarily
rural, where no agency meeting the standard is available
to give home health services. Approximately 23 States
now make use of this provision and the Department considers
it essential for all States to have such arrangements in
effect. However, the requirement has been strengthened
by restricting its applicability to use of registered
nurses.
The non-availability of an agency has been clarified by
changing the wording to "no such agency exists in the area".
The Department considers that holding of public hearings
would be an undue administrative burden on State agencies
and unnecessary as a control. The wording on 'direction"
by a physician has been deleted and replaced by more
specific language.
(a) Clarify whether the home health agency itself must
furnish the medical supplies, equipment and appliances
required by #249.10(b)(7)(i)(c).
It is intended that these items be supplied by direct
prescription of the physician and not necessarily by
the home health agency. It is the State's responsibility
to make payment for any such item. Guidelines will
elaborate on this provision.
vii
(e) Many commenters suggested that a variety of other
services--nutrition, homemaker, social services--
should be required and that the therapy services listed
as optional should be mandated.
The Department recognizes that many of these services
would enhance the benefits gained from home health
services. However, with respect to some of the suggested
services, there is no statutory basis for mandating
them under State Medicaid programs, or for authorizing
payment for them whether mandated or optional. The
therapy services have been retained as optional since
it is felt that in the light of current fiscal restraints,
this should be a State decision. Such ser ces are
optional in State Medicaid programs for provison to
any recipient as well as under home health programs.
4. Definition of a medical rehabilitation facility (3249.150
(a)(3))
Comments pointed out an inconsistency between the specifica-
tion that the major portion of services be provided in the
facility and the fact that home health services are provided
in the patient's residence.
The inconsistent wording has been deleted.
viii
FORD is LIBRARY GERALD
5. Subcontracting provisions (8249.150(c)(2); now 20 CFR 405.1221(h))
Suggestions included: require licensing of subcontractors;
require liability coverage for them; require contracting with
Medicare agencies.
The Department believes the first is a State prerogative;
the second is a responsibility of the provider agency; and
the third is impractical and inappropriate for Federal
regulations.
6. Disclosure of ownership of agency (8249.150(b) (2) (vii))
Respondents suggested that all ownership interests be dis-
closed, rather than limiting the requirement to interests
of 10 percent or more.
The Department believes that the additional reporting and
review requirements for ownership interests of 10 3 than
10 percent would not be justified by any benefit gained.
Ownership of less than this amount does not present strong
stock manipulation possibilities leading to fraudulent
activities, which the disclosure requirement is designed
to inhibit.
7. Administrator or director (s 249.150(c) (4) ; now 20 CFR
405.1221(c))
Question was raised about the difficulty of recruiting
such a person in rural areas or for small agencies;
clarification of the qualifications required was requested.
ix
The Medicare standards specify that the administrator or
director may also perform the function of the supervising
physician or nurse, thus eliminating the need for two
persons to perform these functions separately in a small
agency. Guidelines will explain more fully the types of
acceptable qualifications.
8. Supervising physician or nurse (§249.150(c) (5); now 20
CFR 405.1221(d))
Clarification was requested relating to the "supervision"
exercised over members of other disciplines and as to when
professionals other than the M.D. or R.N. would be
supervising.
This will be clarified in guidelines.
9. Personnel policies (⁸249.150(b) (2) (iii))
It was requested that minimum qualifications be prescribed
and that staffing requirements be set.
Minimum qualifications were included in the proposed rule
making and have been retained. It is not appropriate to
prescribe staffing ratios for all home health agencies
at the Federal level. Suggested patterns will be in-
cluded in guides.
GERALD FORD LIBRARY
X
10. Advisory committee ($249.150(d))
Suggestions were to drop the requirement as ineffective;
to strengthen it by requiring entirely outside composition,
increasing the number of consumers, or adding social workers;
to eliminate the requirement for a physician; and to leave
monitoring up to the State.
The requirement has now been replaced by adopting the Medi-
care provision for review, by a group of professional per-
sons, of the agency's policies and program (20 CFR 405.1222).
11. Review of drug program (§249.150(a) (2) (viii))
The wording "agency staff" should be changed; only a physi-
cian or R.N. should perform review of the patient's medica-
tion. The wording now requires review by the R.N., who
reports problems to the physician.
12. Initial evaluation visits (§249.150(e) and (f); now 20 CFR
405.1224(a))
Respondents pointed out an apparent contradiction between
the requirement for such a visit, and the wording "as
appropriate Ia visit is made⁷".
The Medicare standard clarifies that an initial evaluation
visit is required.
It was also suggested that the R.N. could not make this
visit where therapy services are involved.
The R.N. can and should make the initial visit, for over-
xi
all evaluation of the patient's needs, and development
with the physician and other disciplines of the total
plan of care. This in no way interferes with the per-
formance of treatment procedures by another discipline.
13. Licensed practical nurse services (§249.150; CFR
405.1224(b))
"Under supervision" should be defined--does it mean
on the premises? How often is the LPN's performance
reviewed? On-premises supervision is not required; this
and other questions on supervision will be clarified in guides.
14. Therapy services ($249.150.(h); now 20 CFR 405.1225))
Suggestions included changes in terminology, specifications
as to what the orders shall include, and provision for
therapists to act as single-service providers.
The terminology change has been made in $249.10(b) (7) (i) (D)).
Specifications for therapy orders are contained in 20 CFR 1223(a).
The Department believes that single-service providers should
be restricted to nursing agencies, since this appears to be
the best way of assuring coordination of care to meet
the total needs of the patient, and of avoiding fragmentation.
xii
15. Home health aide services $249.10(b)(7) and $249.150(a) (2) (ix))
Comments were:
(a) Such services should not be mandated.
The Department believes it essential to include these
in a truly effective home health program.
(b) Require certification of agencies by the National
Council of Homemaker- Home Health Aide Agencies or
require that the Council's standards be met.
The Department believes that the Federal regulations
should contain the minimum standards and that it would
be inappropriate to require certification by an out-
side organization. However, a number of the Council's
standards with respect to training aides have been
adopted in the regulations.
(c) Aides should be required to complete a State-approved
medication administration course.
Since the aide's duties involve assisting the patient
with medication that is ordinarily self-administered,
completion of such a course is not considered necessary.
However, the content of the required home health aide
xiii
training has been amended to include training in providing
such assistance.
(d) Supervision should be changed from monthly to biweekly
or to every two weeks for the first two months of care
and then monthly.
The first suggestion has been adopted by using the
Medicare standards.
(e) Training should be strengthened by increasing the hours
or enlarging the content, specifying the qualifications
of the trainer, requiring State approval of the course,
and requiring in-service training on a quarterly basis.
One commenter suggested substitution of experience for
training.
The content of the required course has been trengthened
with respect to additional subject matter. Trainer
qualifications have been specified. It is not felt
appropriate for the Federal regulations to specify State
approval, although States may wish to impose this. The
suggestion regarding in-service training has been accepted.
Substitution of experience is not acceptable since it
would be extremely difficult to determine whether the
specific experience provided the knowledge and skill
intended to be gained from the training.
16. Records ($249.150(a) (2) (x))
(a) Require 5-year retention as in Medicare.
For Federal grant-in-aid programs including Medicaid,
the Department must follow the general regulations in
xiv
45 CFR Part 74, Administration of Grants. The rule in
Part 74 is 3 years' retention; however States may set longer
retention periods.
(b)
The requirement should specify review of records closed
within the quarter.
Medicare standards require quarterly review of both active
and closed records.
(c) A requ: ement for review of 10 per cent of records is
too burdensome for large agencies.
Medicare standards do not specify a percentage.
(a) For hospital-based agencies, the regulations should
recognize that some of the requirements, including
record review, may be otherwise met as part of the
hospital's administrative functioning.
The regulations do not preclude meeting some of the
requirements in this manner provided all of the
specifications are fulfilled.
17. Utilization control (8249.150 (a) (2) (xi))
Comments ranged from approval to objections as impractical,
costly or vague. There was some misunderstanding that the
two specified procedures (record review and evaluation
studies) had to be performed by home health agency--
established teams.
There were suggestions to have the State appoint teams or to
let each provider design its own control procedures.
XV.
Finally, it was suggested that a copy of the recommendations
resulting from evaluation studies be sent to the governing
body.
Under 45 CFR 250.18, State title XIX agencies must have a
utilization control program covering each item of service
provided under the State plan, including home health services.
They must also provide for evaluation of the necessity for and
quality and timeliness of services, and for a post-payment
review system which includes development of provider and
recipient profiles and exceptions criteria. The specific
provisions in the home health regulations are intended as
partial amplification of these requirements. In the final
regulations, changes have been made to specify that the State
agency must provide for establishing the teams (in any
appropriate manner), to change the record review requirement
to one performed on a sampling basis, to require in- home
visits as a safeguard in detecting fraud, abuse or over-
utilization, to delete the requirement for a physician on
the team in view of the difficulty of securing their partici-
pation in certain areas, to clarify the conflict-of-interest
requirements, and to incorporate the suggestion concerning
copies of the recommendations.
18. Certification procedures (8249.151)
(a) Concern was expressed about the lack of capacity to en-
force the requirements and monitor agencies, and about
xvi
the need for a cost control mechanism. It was
suggested that a certificate of need provision
be required.
It is recognized that there are fiscal constraints
on States' ability to enforce and monitor; however,
it is essential that this be made a priority in
Medicaid programs both to realize the full benefits
of home health services and to avoid fraud and over-
utilization. The utilization control requirement
represents one cost control mechanism; the Depart-
ment will assist in developing others. As indicated
above, States may impose certificate of need require-
ments.
(b) Many respondents suggested clarifying the terminology
used; this has been done.
(c) It was suggested that a requirement for prompt
transfer of patients when an agency loses certification
be added; this has been accepted.
(a) Concern was expressed that the requirements are too
loose and give unlimited time to agencies to comply.
The survey agency is responsible for specifying the
time considered appropriate for an agency to correct
its deficiencies. Ordinarily this will not exceed
60 days.
xvii
In addition, provider agreements between the State
Medicaid agency and the home health agency are time-
limited under the regulation to one year, or less if
the latter is found deficient in meeting standards;
therefore home health agencies cannot have unlimited
time to meet requirements.
xviii
Chapter II, Title 45, Code of Federal
Regulations, is amended as follows:
1. Section 249.10 is amended by revis-
ing paragraphs (a) (4) and (b) (7) to
read as set forth below:
§ 249.10 Amount, duration, and scope
of medical assistance.
(a)
(4) Provide for the inclusion of home
health services which, as a minimum,
shall include nursing services, home
health aide services, and medical sup-
plies, equipment and appliances as speci-
fied in paragraph (b) (7) of this section.
Under this requirement, home health
services must be provided to all categori-
cally needy individuals 21 years of age
or over; to all categorically needy indi-
viduals under 21 years of age if the State
plan provides for skilled nursing facility
services for such individuals: and to all
corresponding groups of medically needy
individuals to whom skilled nursing fa-
cility services are available under the
plan. Eligibility of any individual to re-
ceive home health services available un-
der the plan shall not depend upon his
need for, or discharge from, institutional
care.
(b)
(7) Home health services. (i) This
term means the following services and
items provided to a recipient in his place
of residence. Such residence does not in-
clude a hospital, skilled nursing facility
or intermediate care facility, except that
required to be
these services and items may be fur-
nished as home health services to a re-
cipient in an intermediate care facility
(for example, short-term
if they are not/furnished by the facility
registered nurse service during
as intermediate care services/Any such
service or item provided to a recipient of
an acute illness to avoid transfer
home health services must be ordered by
to a skilled nursing facility).
his physician as part of a written plan
of care which is reviewed by his physician
at least every/90 days. Those services
60
listed in paragraphs (A), (B) and (C)
are required to be made available by the
State as home health services; those
on a part-time or intermittent
listed in paragraph (D) may be provided-
basis
as home health services at State option.
(A) Nursing service, as defined in
the State Nurse Practice Act, provided
exists in the area
by a qualified agency or in the case
where no such agency / is ave lable to
provide nursing services. by a registered
receives written orders from the
,
nurse or licensed practical nurse who is
currently licensed to practice in the
patient's physician, documents
State/ and who is under the direction of
the care and services provided and
the patient physician
(B) Home healthjaid services provided
has had orientation to home care
by a qualified agency.
and record keeping from a health
department nurse.
aide
- 2 -
(C) Medical supplies, equipment and
appliances suitable for use in the home.
(D) Physical therapy, occupational
therapy or speech therapy provided by a
pathology and audiology
qualified agency or by a facility licensed
services
by the State to provide medical rehabili-
tation services.
(ii) In order to participate under a
State title XIX plan as an agency quali-
fied to provide home health services, such
agency must meet the conditions and
standards set forth in § 249.150 of this
chapter, as determined in accordance
with the applicable provisions for the
certification and execution of valid pro-
vider agreements under § 249.151 of this
chapter.
2. A new § 249.150 is added to Part 249,
as set forth below:
§ 249.150 Standards for agencies qual-
ified to provide home health services.
(a) Type of agencies qualified to pro-
vide home health services. The require-
ment to provide home health services un-
der State plans for medical assistance is
specified in § 249.10(a) (4) of this chap-
ter: the services included are defined in
§ 249.10(b) (7) This section describes the
agencies which qualify to provide the
nursing, home health aide and therapy
services specified in § 249.10(b) (7).
(1) Home health services may be pro-
vided under the title XIX State plan by
any. agency which is certified under title
XVIII of the Act to provide such serv-
ices and which executes a valid provider
agreement with the title XIX State
agency.
(2) Home health services may also be
provided under the title XIX State plan
by an agency which meets the
bya public or private agency or subdivi-
requirements set forth in 20
sion thereof the home care unit of a
hospital) which is primoril in
CFR 405.1201-1230 except as
providing medical or health care
described in this paragraph; and
of which one must be nursing, or home
health aide services, and which meets the
standards set forth in this section: and
which executes a valid provided agree-
provider
ment with the title XIX agency.
Exceptions to the requirements of 20 CFR 405.1201-1230 are:
(i) The definition of a home health agency contained in section
1861(o) of the Act, which is cited in $405.1201(a), is revised in
the following respects for purposes of this paragraph (a)
(2):
- 3 -
(A) A home health agency may be a public or private
agency or organization or subdivision thereof;
(B) The agency is one primarily engaged in providing
medical or health care services, of which one must
be nursing, and which executes a valid provider
agreement with the State title XIX agency;
(c) Private organizations which are nonprofit
organizations exempt from Federal income taxation
under section 501 of the Internal Revenue Code of
1954 are eligible to participate under title XIX
if they meet the remaining requirements of $405.1201-
1230, subject to the revisions herein.
(ii) The definition of "nonprofit agency" in ฿405.1202(e) is not
applicable under this paragraph.
(iii) The definitions of occupational therapist, occupational
therapy assistant, physical therapist, physical therapy
assistant, social worker, and speech pathologist or
audiologist, in $405.1202(f), (g), (i),(j), (t), and (u)
are replaced by those in 20 CFR 405.1101(m)(n), (q), (r)
(s) and (t).
(iv) The exclusion of proprietary organizations appearing in
$405. 1220 is deleted in that section and wherever else
it appears.
- 4 -
(v)
The requirements that agencies must provide "skilled"
nursing services and that they must provide at least
one other therapeutic service, which appear in
$405.1221(a), are deleted in that paragraph and
wherever else they appear.
(vi) The reference in $405.1221(a) to a "place of residence"
is amplified as described in $249.10(b)(7)(i) of this
chapter.
(vii) The requirement for disclosure of ownership information in
$405.1221(b) is replaced by a requirement that the governing
body or designated person so functioning shall supply to the
State survey agency full and complete information as to the
identity:
(A) Of each person who has any di-
rect or indirect ownership interest of 10
percentum or more in the agency or who
is the owner (in whole or in part) of any
mortgage, deed of trust, note or other
obligation secured (in whole or in part)
by the agency or by any of the property
or assets of the agency;
(B) Of each officer and director of the
corporation if the agency is organized
as a corporation;
(C) Of each partner if the agency is shall
organized as a partnership; and/prompt-
ly report any changes to the State sur-
vey agency which would affect the
current accuracy of the information sup-
plied under this paragraph.
(viii) The statement in 8405.1223(c) that "agency staff" shall
check a patient's medication is changed to require review
by a licensed nurse.
- 5 -
(ix) The statement in 20 CFR 405.1227 relating to training
of home health aides is replaced by the following require-
ments:
(3) Training. All home health aides
(A)
shall receive basic orientation and train-
ing consisting of not less than 40 hours.
The training will include as a minimum
content in each of the following areas:
(1)
(i) Basic techniques of personal care
and rehabilitation;
(2)
such 0.3 the activities of daily living;
,
(ii) Health/and hygiene
, and household tasks essential to
(3)
(iii) Food preparation and nutrition;
health;
(4)
(iv) Interpersonal relationships meet-
ing the social, emotional, and physical
(5)
needs of patients:
(v) Basic household management;
The ill, disabled and aging adult;
(6)
Mental health and mental illness;
(7)
(vi) Child care.
(8)
(viii) Accident prevention;
(9)
(ix) Assisting patients to take own medications.
/ (4) In service education. There shall
(B)
be continuing in-service programs on a
, but at least quarterly
regularly scheduled basis/with on-the-
job training during supervisory visits and
more often as needed.
(C) Only persons with teaching experience and
knowledge of the subject shall be responsible for training and
in-service education.
(x) The retention period for clinical records specified in
$405.1228 (a) is changed to 3 years for purposes of this
paragraph.
FORD is LIBRARY GERALD
- 6 -
(xi) The evaluation requirements in $405.1229 are replaced by
the following requirement for utilization control:
(k) Utilication control. The agency
shall participate in a program of utiliza-
tion control of services as prescribed
by the title XIX State agency pursuant
to § 250.18 of this chapter which GS a
minimum shall include provisions for:
As a minimum, the utilization
control program shall include establishment by the State title
XIX agency of a team or teams of professional persons to perform
the functions of patient record review and home health evaluation
studies as specified in this paragraph.
(A)
1(1) Review of patient records by a
on a sampling basis shall be
team of professional persons (at least a
physician, public health nurse and one
performed
additional health professional) not in
No reviewer may participate
in the review of the records for patients in wh e care he is
directly involved. The team shall also make in-home visits on
a sampling basis. The purpose of the review and visits is
volved in the direct care of the individ
ual patient, for each 90 day period of
service with respect to any patient re-
eeiving continued services during such
period, in -order to make recommenda-
tions to the agency providing service as
to the necessity for continued service,
the adequacy of the plan of care and the
appropriateness of continued service
and
(B)
1 (8) A continuing program of home
shall be carried out
health evaluation studies by a team of
professional persons (which may be the
subparagraph ix (A) of this
same team as specified in 7 paragraph
(k) (1) of this section). which shall iden-
paragraph (a) (2)
tify and analyze trends, problems and
patterns of care and make recommenda-
tions to the State title XIX agency/ for
and to the governing body of the
improvement of the quality of home
health care.
home health agency
- 7 -
(xii) The special standards set forth in the appendix to
Subpart L of Part 405 are not applicable under this
paragraph unless so specified by the State title XIX
agency.
(3) Therapy services may be provided
as home health services by an agency
specified in paragraph (a) (1) or (2) of
this section, or by a facility licensed by
the State to provide medical rehabilita-
tion services, and which meets the other
conditions set forth in this paragraph.
Such a rehabilitation facility must be op-
erated under competent medical super-
vision and is one which provides therapy
services for the primary purpose of as-
sisting in the rehabilitation of disabled
persons through an integrated program
of (i) medical evaluation and services,
and (ii) psychological, social, or voca-
tional evaluation and services. The major
portions of the required evaluation and
services must be furnished within the
facility and the facility must be operated
The
either in connection with a hospital or as
a facility in which all medical and re-
lated health services are prescribed by, or
are under the general direction of, per-
sons licensed to practice medicine or sur-
gery in the State.
(b)
(1) Determination of qualifications.
The determination that an agency pro-
viding home health services meets the
conditions and standards for participa-
tion shall be made in accordance with
the applicable provisions for certifica-
tion and the execution of valid provider
agreements set forth in § 249.151 of this
chapter.
- 8 -
3. A new $ 249.151 is added to Part 249
set forth below:
$ 249.151 Home health agencies: Re-
quirements for agencies qualifying
as home health service providers.
(a) Certification of agencies not par-
ticipating under title XVIII. Prior to the
execution of a provider agreement/and
with the State title XIX agency
participation in the title XIX program as
a provider of home health services, the
State survey agency designated under
§ 250.100 of this chapter shall survey the
home health agency and certify as to
whether it is found to be in compliance
with the conditions and standards set
forth in § 249.150 (a) (2), and-(i))
(1) The findings of the State survey
agency with respect to each of the stand-
ards shall be adequately documented.
Where the State survey agency certifies
that a provider agency is not in compli-
ance with the standards, such documen-
tation shall include, in addition to the
description of the specific deficiencies
which resulted in the/agencys finding,
State survey
a report of all consultation which has
been undertaken in an effort to assist the
provider to comply with the standards,
a report of the provider's responses with
respect to the consultation, and the State
survey
agency's assessment of the prospects for
such improvements as to enable the pro-
vider to achieve compliance with the
standards within a reasonable period of
time.
(2) If a provider is certified by the
State survey agency to be in compliance
with the standards or to be in compliance
except for deficiencies not adversely af-
fecting the health and safety of patients
,
the following information will be incor-
porated into the finding:
(i) A statement of the deficiencies
and submitted to the State survey
which were found, and
(ii) A description of further action
agency within 10 days of the
which is required to remove the defi-
provider's receipt of the deficiency
ciencies, and
(iii) A time-phased plan of correction
report
developed by the provider/and concurred
in by the State survey agency, and
follow-up visit or
(iv) A scheduled time for a resurvey
of the agency/to be conducted by the
State survey agency within 90 days fol-
provider
lowing the completion of the survey.
(3) If, on the basis of the State/cer-
tification that an agency meets stand-
survey agency
ards, and such other information as it
possesses, the State title XIX agency ex-
ecutes a provider agreement with the
a provider
provider agency. the information de-
scribed in paragraph (a) (2) of this sec-
tion will be incorporated into a notice
to the provider.
9
(4) Initial certifications and recerti-
fications by the State survey agency to
the effect that a provider is in compliance
with all the standards will be for a pe-
riod of 12 months. State survey agencies
may visit or resurvey providers more fre-
quently where necessary to evaluate cor-
rection of deficiencies, ascertain con-
tinued compliance, or accommodate to
periodic or cyclical survey programs. The
State survey agency shall evaluate such
reports as may pertain to the health and
safety requirements and, as necessary,
take appropriate action to achieve com-
pliance or certify to the State title XIX
agency that compliance has not been
survey agency
achieved. A State/finding and certifica-
tion that a provider is no longer in com-
pliance will supersede the State's pre-
vious certification.
(5) The State survey agency will cer-
tify that a provider is not or is no longer
in compliance with the standards where
the deficiencies are of such character as
to substantially limit the provider's ca-
pacity to render adequate care or which
adversely affect the health and safety of
patients.
(6) If a provider is found to be defi-
cient with respect to one or more of the
standards, it may participate in the State
title XIX program only if the provider
has submitted an acceptable plan of cor-
rection for achieving compliance within
a reasonable period of time acceptable to
the State survey agency. The existing
deficiencies noted either individually or
in combination must neither jeopardize
the health and safety of patients nor be
of such character as to seriously limit
the provider's capacity to render ade-
quate care.
(7) If it is determined during a survey
that a provider is not in compliance with
one or more of the standards in accord-
ance with paragraph (a) (6), it will be
granted a reasonable time to achieve
compliance. The amount of time will de-
pend upon the nature of the deficiency
and the State survey agency's judgment
as to the provider's capabilities to pro-
vide adequate and safe care. Ordinarily
a. provider will be expected to take the
steps needed to achieve compliance with-
in 60 days of being notified of the defi-
ciencies but the State survey agency may
grant additional time in individual situa-
tions, if in its judgment it is not reason-
able to expect compliance within 60 days,
e.g., a provider must obtain the approval
of its governing body, or engage in com-
petitive bidding.
be 10 -
(b) Execution of provider agreements
with all agencies providing home health
services. (1) The State/agency shall not
title XIX
execute a provider agreement, under this
section, with an agency providing home
health services unless the agency is cer-
tified to provide such services under title
XVIII of the Act, or is certified as meet-
ing the standards specified in § 249.150
of this chapter in accordance with the
applicable provisions of this section.
(2) (i) The term of an agreement may
not exceed a period of one year and the
effective date of such agreement may not
be earlier than the date of certification.
(ii) Execution of a provider agreement
shall be for the term and in accordance
with the provisions of certification de-
State
termined by the/survey agency, except
that the single State/agency for good
cause based on adequate and documented
title XIX
evidence may elect to execute a provider
agreement for a term less than the full
period of certification, or may elect not
to execute a provider agreement, or may
cancel a provider agreement for partici-
pation by an/agency certified under the
home health
Statel plan. (iii) Notwithstanding the
provisions of this paragraph the shagle
State/agency may extend such term for
,
a period not exceeding two months
where the|survey agency has notified the
single State agency in writing prior to
title XIX
the expiration of a provider agreement
that the health and safety of the pa-
the term of an agreement
tients will not be jeopardized thereby,
and that such extension is necessary to
prevent irreparable harm to such agency
State
or hardship to the individuals being fur-
nished items or services or that it is im-
practicable within such provider agree-
the home health
ment period to determine whether such
agency is complying with the provisions
and requirements under the program.
the home health
An extension of the provider agreement
for more than two months may be
granted if it is necessary to implement
the State survey agency's. determination
under paragraph (a) (7) of this section
to allow the provider additional time to
correct deficiencies.
(iv) Any agency/whose agreement has
provider
been cancelled or otherwise terminated
- 11 -
may not be issued another agreement
until the reasons which caused the can-
cellation or termination have been re-
moved and reasonable assurance pro-
vided the /survey agency that they will
State
not recur.
(3) With respect to home health agen-
cies certified to participate under title
When an agreement is cancelled or
XVIII of the Act, the term of a provider
otherwise terminated, the State
agreement between such agency and the
State title XIX agency shall be subject
title XIX agency must take prompt
to the same terms and conditions and be
action to provide alternate
coterminous with the period of partici-
pation specified by the Secretary under
sources of care.
title XVIII. Upon notification that an
agreement with an-ageney/under title
XVIII has been terminated or cancelled,
a provider
the State title XIX agency will take the
same action under title XIX as of the
effective date of the title XVIII action.
(c) Disallowance of Federal financial
participation when agency is found not
to meet all requirements for certification.
A provider agreement between the title
XIX State agency and an agency speci-
fied in § 249.150(a) (2) of this chapter
shall not be considered valid evidence
that such agency meets all requirements
for certification pursuant to § 249.150, if
the Secretary establishes on the basis of
on-site validation surveys, other Federal
reviews, State certification records, or
such other reports as he may prescribe,
that:
(1) The survey agency failed to apply
the Federal standards for the certifica-
tion of such agency as required under
249.150 of this chapter;
(2) The survey agency failed to follow
the rules and procedures for certification
set forth under § 249.151 of this chapter;
(3) The survey agency failed to use the
Federal standards and such forms, meth-
ods and procedures as are established
under § 250.100(c) (1) of this chapter; or
(4) The terms and conditions of a
provider agreement do not meet the
requirements of this section.
States upon request shall receive a re-
consideration of any disallowances of
Federal financial participation resulting
from the Secretary's determination un-
der these provisions, in accordance with
section 1116(d) of the Act, and § 201.14
of this chapter.
(Sec. 1102, 49 Stat. 647 (42 U.S.C. 1302))
GERACE FORD LIBRAGE
- 12 -
Effective Date: The regulations in this section shall be
effective 90 days following date of publication in the
Federal Register.
(Catalog of Federal Domestic Assistance Program No. 13.714,
Medical Assistance Program)
DATED: JAN 14 1976
JOHN A. SVAHN
Acting Administrator, Social
and Rehabilitation Service
APPROVED:
Secretary
GERALD FOND LIDRARY
MEMORANDUM
SOCIAL AND REHAMLITATION SERVICE
Office of the Administrator
TO
The Secretary
Through: U
ES
AUG 4 1975
FROM :
Acting Administrator
Social and Rehabilitation Service
SUBJECT:
Proposed Medicaid Regulations on Home Health Services - ACTION
Purpose
To revise regulations in order to increase use
one health
services under the Medicaid program where home
is appropriate
and necessary with respect to the recipient's 01
tion. The
revisions broaden the types of agencies eligibl
provide services
and clarify the required and optional services
available by
States.
Background
Under existing Medicaid home health services tions (Tab E) ;
(i) Provider participation has been restric
1 to those
which meet Medicare requirements, i.e.
hey must provide
skilled nursing services and one other
vice such as
physical therapy. This has meant that
encies, such as
visiting nurse associations, have been
able to participate
if they cannot offer the second servic
Also, the require-
ment has served as a deterrent to cream
on of new agencies.
(2) There is ambiguity as to the minimum ELL of home health
services which States must provide under a State plan.
It has been interpreted that the Stat are required to
provide only one of the specified services (nursing,
home health aide, supplies and equipment), when in fact
it was intended that all of these were equired to be
available.
Another problem has been that some States have pted the Medicare
definition of home health services as those who can be performed
only by an R.N. or L.P.N. This has resulted in person who did
not require "skilled" services but for example, ily home health
side services, not being eligible for home health services. Some
States also limited eligibility by applying inc opriate require-
ments of post-hospitalization or pre-institution lization.
Page 2 - The Secretary
A GAO report on home health services recommended that SRS clarify
the services for which FFP is available and encourage States to
make greater use of them. In line with these recommendations and
as part of the Department's effort to develop alternatives to
institutional care, SRS has developed a proposed revision of the
regulations as outlined below.
Proposed Revisions
(1) Clarification of required and optional services. The
proposal now specifies that States must make available,
as determined necessary by the recipient's physician and
included in the plan of care, nursing services, home health
aide services, and medical supplies, equipment and appliances
suitable for use in the home. At State option, physical,
or occupational or speech therapy may be provided to home
health care patients even though not generally provided to
all recipients under the State plan (s249.10(b)( (7), page 2).
(2) Expansion of the types of agencies qualified to provide
services and specification of standards they must meet.
Instead of the limitation to agencies providing primarily
skilled nursing plus a therapeutic service, the regulations
would permit agencies offering nursing or home health aide
services to qualify if they meet the prescribed standards.
The latter are basically the Medicare standards for home
health agencies, appropriately adapted to reflect inclusion
of additional provider types ($249.150, page 3).
(3) Clarification of recipient eligibility. As indicated
above, there has been some confusion as to whether
recipients must be determined to need skilled care or to
require admittance to long-term care. The revision
incorporates into regulations an explanation of entitle-
ment previously issued as policy interpretation. $249.10
(a) (4), page 1)
(4) Specification of certification procedures for agencies
offering home health services. These are based on Medicare
procedures. (8249.151, page 18)
Discussion of Issues
An earlier version of these regulations was circulated by OS/ES to
appropriate offices and agencies in the Department and was also
reviewed by a committee of State representatives through APWA.
Discussions and written comments have indicated that a variety of
rage J - the secretary
opinions exist on what revisions should be made, although there is
general agreement on the value of increasing the use of these
services. The regulations at Tab A reflects most of the suggestions
received on the detail of the provisions; it also contains the
SRS position on the two major issues involved in revising the
current rules. Those issues concern participation by proprietary
agencies on the same basis as voluntary and non-profit agencies, and
eligibility of single-service agencies to provide home health
services. They are discussed at Tab B.
Recommendation
That you decide the issues described under Tab B, and approve the
Notice of Proposed Rule Making at Tab A for publication in the
Federal Register. We believe that, in the light of the GAO report
and Congressional interest in expanding home health services it
is urgent to publish a Notice for comment by States, provider and
recipient groups, and others, and that additional comments from
DHEW staff should be considered during the public notice period.
JOHN A. SVAHN
John A. Svahn
Enclosures
Tab A - Notice of Proposed Rule Making
Tab B - Discussion of Issues
Tab C - Inflationary Impact Statement
Tab D - Press Release
Tab E - Current Medicaid Regulations
Prepared by: SRS/MSA, MOSchnoor, 5/02/75, x50397
Fim
L- H
DEPARTMENT OF
HEALTH, EDUCATION, AND WELFARE
OFFICE OF THE SECRETARY
EXECUTIVE SECRETARIAT
January 16, 1976
TO:
GC, C, P, L, A, SSA, H, HD and Mr. Peter Franklin
SUBJECT: Press Release for SRS' Regulations----
Home Health Services (Sequence No.
SRS-13, 1 of 1 Staffed by ES 1/15/76
Attached is SRS' press release for the subject
regulations routed to you yesterday.
Please associate with regulations file now in
your offices.
may Frances Howell
Mary Frances Howell
Regulations Coordinator
Attachment
cc: ESW, Room 5614 North Building
GLRAUG FORD
HEW
TRANS
NEWS
USA
U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE
Social and Rehabilitation Service
KELSO--(202)--245-0620
KAPLAN--(202)--245-0347
More health care organizations can provide home health services
for Medicaid patients under a regulation issued by HEW's Social
and Rehabilitation Service.
The regulation, published today in the Federa 1 Register, permits
profit-making agencies which meet Federal and State : Standards to
provide home health services under Medicaid. It also permits small
visiting nurses associations, providing only nursing services, to
participate.
Further, the regulation clarifies who is eligible for me health
care as well as the kinds of services States are I quired to make
available under the title of home health services.
Among them are nursing services, home health side services, and the
furnishing of suitable medical supplies, equipment, and appliances
(in accordance with a patient's needs as determined by his physician.)
Physical and occupational therapy, as well as speech therapy, can be
offered as home health services at a State option whether or not they
are available to all Medicaid recipients under a State plan.
The regulation adopts the Medicare standards for home health
agencies, with appropriate modifications, as standards for health
care organizations and profit-making agencies participating in Medicaid.
(more)
Under the regulation, profit-making agencies will be able to
participate in Medicaid home health services programs if they meet
those standards, subject to State licensing laws.
In proposing the regulation last August, HEW said that many
Medicaid patients would prefer to be taken care of at home rather than
in an institution, if possible. HEW also noted that home health care
for some patients can be provided at lower cost, to the benefit of
both patient and taxpayer.
# # #