Sec. 10.09.04.03. Conditions for Participation

A. To be a provider, a home health agency shall be a participating home health agency under Medicare.

B. To participate in the Program, the home health agency shall:

(1) Apply for participation in the Program using the form designated by the Department;

(2) Be approved for participation by the Department;

(3) Have in effect a provider agreement with the Department;

(4) Accept payment by the Department as payment in full for covered services rendered and make no additional charge to any person for covered services;

(5) Provide verification to the Department, in the manner prescribed by the Department, of all changes in the provider's charges within 10 days of the occurrence of the changes;

(6) Maintain all patient care, medical supply, timesheets, official agency recipient or witness signature records, and billing records for a minimum of 6 years after completion of an audit by the Department and make them available, upon request, to the appropriate State and federal personnel or their designees during office hours;

(7) Secure from the recipient's attending physician a written plan of treatment which relates the items and services to the recipient's medical condition;

(8) Maintain a patient plan of care based on the attending physician's plan of treatment for the recipient;

(9) Provide services without regard to race, color, age, sex, national origin, marital status, or physical or mental handicap;

(10) Verify the recipient's eligibility;

(11) Place no restriction on a recipient's right to select his choice of providers under all chapters of this subtitle;

(12) Agree that if the Program denies payment or requests repayment on the basis that an otherwise covered service was not medically necessary, the provider may not seek payment for that service from the recipient; and

(13) Agree that if the Program denies payment due to late billing, the provider may not seek payment from the recipient.

C. Plan of Treatment.

(1) The plan of treatment under §C(8) shall include:

(a) Prognosis;

(b) Diagnoses;

(c) Treatment goals;

(d) Frequency of visits for each type of service ordered;

(e) Duration of treatment of each type of service ordered;

(f) Rehabilitation potential;

(g) Functional limitations;

(h) Permitted and prohibited activities;

(i) Diet;

(j) Medications;

(k) Treatments;

(l) Mental status;

(m) Medical supplies;

(n) Durable medical equipment;

(o) Safety measures to protect against injury; and

(p) Other appropriate items.

(2) The plan of treatment shall be reviewed, updated and signed at least every 60 days by the attending physician, in consultation with the registered nurse or the case coordinator.

(3) The attending physician shall:

(a) Sign and date the initial plan of treatment; and

(b) Document that the attending physician or nonphysician practitioner, who is not employed by the home health agency, has had a face-to-face encounter with the recipient no more than 90 days before the home health start of care date or within 30 days of the start of the home health care, including the date of the encounter.

(4) For recipients admitted to home health upon discharge from a hospital or post-acute setting, the attending acute or post-acute physician or nonphysician practitioner shall document the clinical findings of the face-to-face encounter.

(5) The plan of treatment shall be part of the provider's permanent record for the recipient.

D. Plan of Care.

(1) For each type of service ordered, the plan of care under §C(9) shall, at a minimum, include:

(a) Goals of treatment;

(b) Actions or procedures needed to meet the goals;

(c) Dates the goals are expected to be achieved;

(d) Problems encountered, if any;

(e) Revision of goals and actions or procedures, whenever necessary; and

(f) Appropriate discharge activities.

(2) The plan of care shall be reviewed, dated, and signed at least every 60 days by the registered nurse or the case coordinator upon consultation with the appropriate health team.

(3) The plan of care is a part of the provider's permanent record for the recipient.