§ 40-18-4 - Payment for long term home health care programs.
SECTION 40-18-4
§ 40-18-4 Payment for long term homehealth care programs. – (a) When a long-term home health care program as defined under this chapter isavailable, the department of human services, before authorizing care in anursing home or intermediate care facility for a person eligible to receiveservices under this title, shall notify the person, in writing, of theprovisions of this chapter.
(b) If a hospitalized person eligible to receive servicesunder the provisions of this title who requires care, treatment, maintenance,nursing, or other services in a nursing home desires to return to his or herown home or the home of a responsible relative or other responsible adult ifthe necessary services are provided, that person or his or her representativeshall so inform the department of human services.
(2) If a home health care program as defined under thischapter is provided, the department of human services shall authorize anassessment and if the results of the assessment indicate that the person canreceive the appropriate level of care at home, the official shall prepare forthat person a plan for the provision of services comparable to those that wouldbe rendered in a nursing home. In developing the plan, the department shallconsult with those persons performing the assessment. The services shall beprovided by certified home health agencies, home health aide/homemakeragencies, and adult day care centers.
(3) At the time of the initial assessment, and at the time ofeach subsequent assessment, the official shall establish a monthly budget inaccordance with which he or she shall authorize payment for the servicesprovided under the plan. Total monthly expenditures made under this title forthat person shall not exceed a maximum of one hundred percent (100%), of theaverage of the monthly rates payable for skilled nursing/intermediate carefacility service as provided for in the department of human services.
(ii) Principles of reimbursement for skillednursing/intermediate care facility services provided eligible receipts of themedical assistance program. If an assessment of the person's needs demonstratesthat he or she requires services the payment for which would exceed the monthlymaximum, but it can be reasonably anticipated that total expenditures forrequired services for that person will not exceed the maximum calculated over aone year period, the department of human services may authorize payment forthose services.
(c) Notwithstanding any inconsistent provision of law butsubject to expenditure limitations of this chapter, the director, subject tothe approval of the state director of the budget, may authorize the utilizationof medical assistance funds to pay for services provided by specified homehealth care persons in addition to those services included in the medicalassistance program under chapter 18 of this title, so long as federal financialparticipation is available for those services. Expenditures made under thissubsection shall be deemed payments for medical assistance for needy persons.
(d) The department shall not make payments pursuant to TitleXIX of the federal Social Security Act, 42 U.S.C. § 1396 et seq., forbenefits available under Title XVIII, 42 U.S.C. § 1395 et seq., of suchact without documentation that Title XVIII claims have been filed and denied.
(e) The department shall not make payment for a personreceiving a long term home health care program while payments are being madefor that person for inpatient care in a skilled nursing and intermediate carefacility or hospital.