Medication set-up, when it is the only skilled need, is not covered. Services must be provided on an intermittent basis. Private duty services are not covered. Skilled services covered as in Medicare. A recipient may qualify for personal care worker or home health aide services without being homebound and without a skilled need.
Medication set-up is covered when there is no other alternative.
Qualifying conditions must be met. Any additional services and all private duty require prior authorization. Medical supplies and equipment are covered according to Medicare guidelines based on diagnosis and criteria. IV medications administered at home are generally not covered except for a few specific agents that are given as prolonged infusions. Disposable, consumable, expandable or nondurable medically necessary supplies are covered if necessary to carry out the plan of care.