(Medicare Benefit Policy Manual)

If dieticians or nutritionists are used to furnish overall training or consultative advice to HHA staff and incidentally furnish dietetic or nutritional services to patients in their homes, the costs of these professional services are allowable only as administrative costs.  Visits by a dietician or nutritionist to a patient's home are not separately billable.   80.10 - Telecommunications Technology  (Rev. 10438, Issued: 11-06-20, Effective: 03-01-20, Implementation: 01- 11-21)   Telecommunications technology (other than audio-only telephone calls) can include: remote patient monitoring, defined as the collection of physiologic data (for example, ECG, blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient or caregiver or both to the home health agency; teletypewriter (TTY) technology; and 2- way audio-video telecommunications technology that allows for real- time interaction between the patient and clinician.  Telecommunications technology can be ordered as part of a home health plan of care but such services cannot be reported as a visit without the provision of another skilled service.  If telecommunications technologies are used by the home health agency, the costs of any equipment, set-up, and service related to the technology are allowable only as administrative costs. Visits to a beneficiary's home for the sole purpose of supplying, connecting, or training the patient on the technology, without the provision of a skilled service, are not separ ately billable.  However, HHAs may include the costs of telecommunications technology as an allowable administrative cost (that is, operating expense), if the technology is used by the HHA to augment the care planning process.  90 - Medical and Other Health Services Furnished by Home Health Agencies  (Rev. 10438, Issued: 11-06-20, Effective: 03-01-20, Implementation: 01- 11-21)   Payment may be made by Medicare contractors to a home health agency which furnishes either directly or under arrangements with others the following "medical and other health services" to beneficiaries with Part B coverage in accordance with Part B billing and payment rules other than when a home health plan of care is in effect .  1.  Surgical dressings (for a patient who is not under a home health plan of care), and splints, casts, and other devices used for reduction of fractures and dislocations;  2.  Prosthetic (Except for items excluded from the term "orthotics and prosthetics" in accordance with 1834(h)(4)(C) of the Act for patients who are under a home health plan of care);  3.  Leg, arm, back, and neck braces, trusses, and artificial legs, arms, and eyes and adjustments to these items when ordered by a physician or allowed practitioner.  (See Pub 100-02, Medicare Benefit Policy Manual, Chapter 15);  4.  Outpatient physical therapy, outpatient occupational therapy, and outpatient speech -language pathology services (for a patient not under a home health plan of care).  (See Pub 100-02, Medicare Benefit Policy Manual, Chapter 15); and  5.  Rental and purchase of durable medical equipment.  (See Pub 100- 02, Medicare Benefit Policy Manual, Chapter 15.)  If a beneficiary meets all of the criteria for coverage of home health services and the HHA is providing home health care under the Hospital Insurance Program (Part A), any DME provided and billed to the Medicare contractor by the HHA to that patient must also be provided under Part A.  Where the patient meets the criteria for coverage of home health services and the HHA is providing the hom e health care under the Supplementary Medical Insurance Program (Part B) because the patient is not eligible for Part A, the DME provided by the HHA may, at the beneficiary's option, be furnished under the Part B home health benefit or as a medical and other health service.  Irrespective of how the DME is furnished, the beneficiary is responsible for a 20 percent coinsurance.   6. Ambulance service. (See Pub 100- 02, Medicare Benefit Policy Manual, Chapter 10, Ambulance Services)   7. Hepatitis B Vaccine.  Hepatitis B vaccine and its administration are covered under Part B for patients who are at high or intermediate risk of contracting hepatitis B.  High risk groups currently identified include:  end -stage renal disease (ESRD) patie nts, hemophiliacs who receive factor VIII or IX concentrates, clients of institutions for the mentally retarded, persons who live in the same household as a hepatitis B virus carrier, homosexual men, illicit injectable drug users.  Intermediate risk groups  currently identified include staff in institutions for the mentally retarded, workers in health care professions who have frequent contact with blood or blood- derived body fluids during routine work.  Persons in the above listed groups would not be considered at high or intermediate risk of contracting hepatitis B, however, if there is laboratory evidence positive for antibodies to hepatitis B.  ESRD patients are routinely tested for hepatitis B antibodies as part of their continuing monitoring and therapy.  The vaccine may be administered, upon the order of a doctor of medicine or osteopathy, by home health agencies.   8. Hemophilia clotting factors.  Blood clotting factors for hemophilia patients competent to use such factors to control bleeding without medical or other supervision and items related to the administration of such factors are covered under Part B.   9. Pneumococcal and influenza vaccines.  See Pub 100- 02, Medicare Benefit Policy Manual, Chapter 15, Covered Medical and Other Health Services, 50.4.2 Immunizations.   10. Splints, casts.  See Pub 100- 02, Medicare Benefit Policy Manual, Chapter 15, Covered Medical and Other Health Services.   11. Antigens. See Pub 100- 02, Medicare Benefit Policy Manual, Chapter 15, Covered Medical and Other Health Services.   100 - Physician or Allowed Practitioner Certification for Medical and Other Health Services Furnished by Home Health Agency (HHA)     (Rev. 10438, Issued: 11- 06-20, Effective: 03 -01-20, Implementation: 01-  11-21)  A physician or allowed practitioner must certify that the medical and other health services covered by medical insurance, which were provided by (or under arrangements made by) the HHA, were medically required.  This certification needs to be made only once where the patient may require over a period of time the furnishing of the same item or service related to one diagnosis.  There is no requirement that the certification be entered on any specific form or handled in any specific way as long as the approac h adopted by the HHA permits the Medicare contractor to determine that the certification requirement is, in fact, met.  A written physician or allowed practitioner's order designating the services required would also be an acceptable certification.   110 - Use of Telehealth in Delivery of Home Health Services  (Rev. 10438, Issued: 11-06-20, Effective: 03-01-20, Implementation: 01- 11-21)   Section 1895(e) governs the home health prospective payment system (PPS) and provides that telehealth services are outside the scope of the Medicare home health benefit and home health PPS.  This provision does not provide coverage or payment for Medicare home health services provided via a telecommunications system.  The law does not permit the substitution or use of a telecommunications system to provide any covered home health services paid under the home health PPS, or any covered home health service paid outside of the home health PPS.  As stated in 42 CFR 409.48(c), a visit is an episode of personal contact with the beneficiary by staff of the home health agency (HHA), or others under arrangements with the HHA for the purposes of providing a covered service. The provision clarifies that there is nothing to preclude an HHA from adopting telemedicine or other technologies that they believe promote efficiencies, but there is no separate reimbursement for those technologies under the Medicare home health benefit. However, Medicare does recognize services furnished via telecommunications technology (see section 80.10) as an allowed administrative cost on Medicare cost reports if telecommunications technology is used by the HHA to augment the care planning process, and the technology is indicated on the plan of care.   This provision does not waive the current statutory requirement for a physician or allowed practitioner certification of a home health plan of care under current 1814(a)(2)(C)  or 1835(a)(2)(A) of the Act.              Transmittals Issued for this Chapter  Rev #  Issue Date  Subject  Impl Date  CR#  R12425BP  12/21/2023 Enforcing Billing Requirements for Intensive Outpatient Program (IOP) Services with New Condition Code 92 - Additional Publication Update 01/02/2024  13496  R12382BP  11/28/2023 Separate Payment for Disposable Negative Pressure Wound Therapy Devices on Home Health Prospective Payment System Claims    01/02/2024  13244  R12291BP  10/05/2023 Separate Payment for Disposable Negative Pressure Wound Therapy Devices on Home Health Prospective Payment System Claims   No Longer Sensitive - Rescinded and Replaced by Transmittal 12382 01/02/2024  13244