Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart D - PAYMENT FOR NON-INSTITUTIONAL SERVICES › Section 140.471 - Description of Home Health Care Services

Current through Register Vol. 48, No. 28, July 12, 2024
a) Home health services are services provided
				for participants in their places of residence and are aimed at facilitating the
				transition from a more acute level of care to the home.
b) Services provided shall be of a curative
				or rehabilitative nature and demonstrate progress toward goals outlined in a
				plan of care. Services shall be provided for individuals upon direct order of a
				physician and in accordance with a plan of care established by the physician
				and reviewed at least every 60 days.
c) For purposes of this Section, "residence"
				includes any setting in which normal life activities take place and does not
				include a hospital, a skilled nursing facility, an intermediate care facility,
				a specialized mental health rehabilitation facility,or any setting in which
				payment is or could be made under Medical Assistance programs for inpatient
				services that include room and board. The term "residence" includes an
				intermediate care facility for the mentally retarded only to the extent that
				home health services are not required to be provided under 89 Ill. Adm. Code
				144.
d) Effective July 1, 2012, to
				be eligible for reimbursement by the Department, initial certification of
				intermittent skilled nursing services, home health aide or therapy services
				must have documentation that a face-to-face encounter was conducted by the
				practitioner requesting services. The following conditions must be met for the
				face-to-face encounter:
1) The physician
				responsible for performing the initial certification must document that the
				face-to-face patient encounter, which is related to the primary reason the
				patient requires home health services, has occurred no more than 90 days prior
				to the home health start of care date or within 30 days after the start of the
				home health care by including the date of the encounter and including an
				explanation of why the clinical findings of the encounter support that the
				patient is in need of either intermittent skilled nursing, home health aide or
				therapy services as defined in Section
				140.472.
2) The face-to-face encounter must be
				performed by the certifying physician, a nurse practitioner, a clinical nurse
				specialist who is working in collaboration with the physician in accordance
				with State law, a certified nurse midwife as authorized by State law, a
				physician assistant under the supervision of the physician, or, for patients
				admitted to home health immediately after an acute or post-acute stay, the
				physician who cared for the patient in an acute or post-acute facility and who
				has privileges at the facility.
A) If the
				certifying physician does not perform the face-to-face encounter personally,
				the non-physician practitioner or the physician who cared for the patient in an
				acute or post-acute facility performing the face-to-face encounter must
				communicate the clinical findings of that face-to-face patient encounter to the
				certifying physician. The clinical findings must be incorporated into a written
				or electronic document in the patient's medical record.
B) If a face-to-face patient encounter
				occurred within 90 days prior to the start of care but is not related to the
				primary reason the patient requires home health services, or the patient has
				not seen the certifying physician or allowed non-physician practitioner within
				the 90 days prior to the start of the home health episode, the certifying
				physician or non-physician practitioner must have a face-to-face encounter with
				the patient within 30 days after the start of the home health care.
C) The face-to-face patient encounter may
				occur through telehealth, in compliance with Section
				140.403.
D) The physician responsible for certifying
				the patient for home care must document that the face-to-face encounter is
				related to the primary reason the patient requires home health services, and
				occurred within the timeframes described in subsection (d)(1). The
				documentation must indicate the practitioner who conducted the encounter and
				the date of the encounter.