Section 29-5109. REIMBURSEMENT

 

5109.1Each Provider shall be reimbursed seventeen dollars and thirty cents ($ 17.30) per hour for services rendered by a home health aide.

 

5109.2Reimbursement for services of a home health aide shall not exceed four (4) hours of service per day per patient, unless prior authorization is obtained from MAA.

 

5109.3Services provided by a home health agency and authorized in the plan of care may not exceed 36 visits per year per patient, unless prior authorization is obtained from MAA. The 36 visit limitation includes services performed by all disciplines included in the Medicare certification of a home health agency which are certified by a physician as medically necessary in the patient's treatment plan.

 

5109.4MAA may limit or deny services, if the cost of the services in addition to other home care services, exceed the estimated cost of institutional care over a six (6) month period.

 

5109.5Each Provider shall agree to accept as payment in full the amount determined by MAA as reimbursement for the authorized services provided to clients. Providers shall not bill the patient or any member of the patient's family for services.

 

5109.6Each Provider shall agree to bill any and all known third-party payers prior to billing Medicaid.

 

source

Final Rulemaking published at 50 DCR 3957 (May 23, 2003), as amended by Final Rulemaking published at 53 DCR 1696 (March 10, 2006).