100-02 Medicare Benefit Policy Manual: Chapter 7 Crosswalk

Medicare Benefit Policy Manual
Chapter 7 - Home Health Services
Crosswalk
New
Chap.
New
Sect.
Int.
Pub. 13
HHA
Pub. 11
PMs 	Description
7 	10 	HH-201 	Home Health Prospective Payment System
7 	10.1 	HH-201.1 	National 60-Day Episode Rate
7 	10.2 	HH-201.2 	Adjustments to the 60-Day Episode Rates
7 	10.3 	HH-201.3 	Continuous 60-Day Episode Recertification
7 	10.4 	HH-201.4 	Counting 60-Day Episodes
7 	10.5 	HH-201.5 	Split Percentage Payment Approach to the 60-Day Episode
7 	10.6 	HH-201.6 	Physician Signature Requirements for the Split Percentage Payments
7 	10.7 	HH-201.7 	Low Utilization Payment Adjustment
7 	10.8 	HH-201.8 	Partial Episode Payment Adjustment
7 	10.9 	HH-201.9 	Significant Change in Condition Payment Adjustment (SCIC)
7 	10.10 	HH-201.10 	Outlier Payments
7 	10.11 	HH-201.11 	Discharge Issues
7 	10.12 	HH-201.12 	Consolidated Billing

New
Chap.
New
Sect.
Int.
Pub. 13
HHA
Pub. 11
PMs 	Description
7 	10.13 	HH-201.14 	Change of Ownership Relationship to Episodes Under PPS
7 	20 	A3-3116 	HHA-203 	Conditions to Be Met for Coverage of Home Health Services
7 	20.1 	A3-3116.1 	HHA-203.1 	Reasonable and Necessary Services
7 	20.1.1 	A3-3116.1A 	HHA-203.1A 	Background
7 	20.1.2 	A3-3113.1B 	HHA-203.1B 	Determination of Coverage
7 	20.2 	A3-3116.2 	HHA-203.2 	Impact of Other Available Caregivers and Other Available Coverage
on Medicare Coverage of Home Health Services
7 	20.3 	A3-3116.3 	HHA-203.3 	Use of Utilization Screens and "Rules of Thumb"
7 	30 	A3-3117 	HHA-204 	A-98-49 	Conditions Patient Must Meet to Qualify for Coverage of Home Health
Services
7 	30.1 	A3-3117.1 	HHA-204.1 	Confined to the Home
7 	30.1.1 	A3-3117.1A 	HHA-204.1A 	A-01-21 	Patient Confined to the Home
7 	30.1.2 	A3-3117.1B 	HHA-204.1B 	Patient's Place of Residence
7 	30.2 	A3-3117.2 	HHA-204.2 	Services Are Provided Under a Plan of Care Established and Approved
by a Physician
7 	30.2.1 	A3-3117.2A 	HHA-204.2A 	Content of the Plan of Care
7 	30.2.2 	A3-3117.2B 	HHA-204.2B 	Specificity of Orders
7 	30.2.3 	A3-3117.2C 	HHA-204-2C 	Who Signs the Plan of Care

New
Chap.
New
Sect.
Int.
Pub. 13
HHA
Pub. 11
PMs 	Description
7 	30.2.4 	A3-3117.2D 	HHA-204-2D 	Timeliness of Signature
7 	30.2.5 	A3-3117.2E 	HHA-204-2E 	Use of Oral (Verbal) Orders
7 	30.2.6 	A3-3117.2F 	HHA-204.2F 	Frequency of Review of the Plan of Care
7 	30.2.7 	A3-3117.2G 	HHA-204.2G 	Facsimile Signatures
7 	30.2.8 	A3-3117.2H 	HHA-204.2H 	Alternative Signatures
7 	30.2.9 	A3-3117.2I 	HHA-204.2I 	Termination of the Plan of Care
7 	30.2.10 	A3-3117.2J 	HHA-204.2J 	Sequence of Qualifying Services and Other Medicare Covered Home
Health Services
7 	30.3 	A3-3117.3 	HHA-204.3 	Under the Care of a Physician
7 	30.4 	A3-3117.4 	HHA-204.4 	Needs Skilled Nursing Care on an Intermittent Basis (Other than Solely
Venipuncture for the Purposes of Obtaining a Blood Sample), or
Physical Therapy or Speech-Language Pathology Services or Has
Continued Need for Occupational Therapy
7 	30.5 	A3-3117.5 	HHA-204.5 	Physician Certification
7 	30.5.1 	A3-3117.5A 	HHA-204.5A 	Content of the Physician Certification
7 	30.5.2 	A3-3117.5B 	HHA-204.5B 	Periodic Recertification
7 	30.5.3 	A3-3117.5C 	HHA-204.5C 	Who May Sign the Certification

New
Chap.
New
Sect.
Int.
Pub. 13
HHA
Pub. 11
PMs 	Description
7 	40 	A3-3118 	HHA-205 	Covered Services Under a Qualifying Home Health Plan of Care
7 	40.1 	A3-3118.1 	HHA-205.1 	Skilled Nursing Care
7 	40.1.1 	A3-3118.1 	HHA-205.1 	General Principles Governing Reasonable and Necessary Skilled
Nursing Care
7 	40.1.2 	A3-3118.1B 	HHA-205.1B 	Application of the Principles to Skilled Nursing Services
7 	40.1.2.1 	A3-3118.1B1 	HHA-205.1B1 	Observation and Assessment of the Patient's Condition When Only the
Specialized Skills of a Medical Professional Can Determine Patient's
Status
7 	40.1.2.2 	A3-3118.1B2 	HHA-205.1B2 	Management and Evaluation of a Patient Care Plan
7 	40.1.2.3 	A3-3118.1B3 	HHA-205.1B3 	Teaching and Training Activities
7 	40.1.2.4 	A3-3118.1B4 	HHA-205.1B4 	Administration of Medications
7 	40.1.2.5 	A3-3118.1B5 	HHA-205.1B5 	Tube Feedings
7 	40.1.2.6 	A3-4118.1B6 	HHA-205.1B6 	Nasopharyngeal and Tracheostomy Aspiration
7 	40.1.2.7 	A3-3118.1B7 	HHA-205.1B7 	Catheters
7 	40.1.2.8 	A3-3118.1B8 	HHA-205.1B8 	Wound Care
7 	40.1.2.9 	A3-3118.1B9 	HHA-205.1B9 	Ostomy Care
7 	40.1.2.10 	A3-3118.1B10 	HHA-205.1B10 	Heat Treatments
7 	40.1.2.11 	A3-3118.1B11 	HHA-205.1B11 	Medical Gasses

New
Chap.
New
Sect.
Int.
Pub. 13
HHA
Pub. 11
PMs 	Description
7 	40.1.2.12 	A3-3118.1B12 	HHA-205.1B12 	Rehabilitation Nursing
7 	40.1.2.13 	A3-3118.1B13 	HHA-205.1B13 	Venipuncture
7 	40.1.2.14 	A3-3118.1B14 	HHA-205.1B14 	Student Nurse Visits
7 	40.1.2.15 	A3-3118.1B15 	HHA-205.1B15 	Psychiatric Evaluation, Therapy, and Teaching
7 	40.1.3 	A3.3118.1C 	HHA-205.1C 	Intermittent Skilled Nursing Care
7 	40.2 	A3-3118.2 	HHA-205.2 	Skilled Therapy Services
7 	40.2.1 	A3-3118.2A 	HHA-205.2A 	General Principles Governing Reasonable and Necessary Physical
Therapy, Speech-Language Pathology services, and Occupational
Therapy
7 	40.2.2 	A3-3118.2B 	HHA-205.2B 	Application of the Principles to Physical Therapy Services
7 	40.2.3 	A3-3118.2C 	HHA-205.2C 	Application of the General Principles to Speech-Language Pathology
Services
7 	40.2.4 	A3-3118.2D 	HHA-205.2D 	Application of the General Principles to Occupational Therapy
7 	40.2.4.1 	A3-3118.2D1 	HHA-205.2D1 	Assessment
7 	40.2.4.2 	A3-3118.2D2 	HHA-205.2D2 	Planning, Implementing, and Supervision of Therapeutic Programs
7 	40.2.4.3 	A3-3118.2D3 	HHA-205.2D3 	Illustration of Covered Services
7 	50 	A3-3119 	HHA-206 	Coverage of Other Home Health Services

New
Chap.
New
Sect.
Int.
Pub. 13
HHA
Pub. 11
PMs 	Description
7 	50.1 	A3-3119.1 	HHA-206.1 	Skilled Nursing Physical Therapy, Speech-Language Pathology
Services, and Occupational Therapy
7 	50.2 	A3-3119.2 	HHA-206.2 	Home Health Aide Services
7 	50.3 	A3-3119.3 	HHA-206.3 	Medical Social Services
7 	50.4 	A3-3119.4 	HHA-206.4 	Medical Supplies (Except for Drugs and Biologicals) and the Use of
Durable Medical Equipment
7 	50.4.1 	A3-3119.4A 	HHA-206.4A 	Medical Supplies
7 	50.4.1.1 	A3-3119.4A2 	HHA-206.4A3,
4, 5
The Law, Routine and Non Routine Medical Supplies, and the Patient's
Plan of Care
7 	50.4.1.2 	A3-3119.4A1 	HHA-206.4A.1 	Routine Supplies (Nonbillable)
7 	50.4.1.3 	A3-3119.4A2 	HHA-206.4A.2 	Nonroutine Supplies (Billable)
7 	50.4.2 	A3-3119.4B 	HHA-206.4B 	Durable Medical Equipment
7 	50.5 	A3-3119.5 	HHA-206.5 	Services of Interns and Residents
7 	50.6 	A3-3119.6 	HHA-206.6 	Outpatient Services
7 	50.7 	A3-3119.7 	HHA-206.7 	Part-Time or Intermittent Home Health Aide and Skilled Nursing
Services
7 	50.7.1 	A3-3119.7A 	HHA-206.7A 	Definition of "Part-Time"
7 	50.7.2 	A3-3119.7B 	HHA-206.7B 	Definition of "Intermittent"

New
Chap.
New
Sect.
Int.
Pub. 13
HHA
Pub. 11
PMs 	Description
7 	60 	A3-3122 	HHA-212 	Special Conditions for Coverage of Home Health Services Under
Hospital Insurance (Part A) and Supplementary Medical Insurance
(Part B)
7 	60.1 	A3-3122.1 	HHA-212.1 	Post-Institutional Home Health Services Furnished During A Home
Health Benefit Period - Beneficiaries Enrolled in Part A and Part B
7 	60.2 	A3-3122.1 	HHA-212.2 	Beneficiaries Enrolled in Parts A and B and Meet the Institutional Care
Threshold
7 	60.3 	A3-3122.1 	HHA-212.3 	Beneficiaries Who Are Enrolled In Part A and Part B, But Do Not
Meet Threshold For Post-Institutional Home Health Services
7 	60.4 	A3-3122.1 	HHA-212.4 	Beneficiaries Who Are Part A Only Or Part B Only
7 	70 	A3-3123 	HHA-215 	Duration of Home Health Services
7 	70.1 	A3-3123.1 	HHA-215.1 	Number of Home Health Visits Under Hospital Insurance (Part A)
7 	70.2 	A3-3123.2 	HHA-215.2 	Number of Home Health Visits Under Supplementary Medical
Insurance (Part B)
7 	80 	A3-3125 	HHA-230A 	Specific Exclusions From Coverage as Home Health Services
7 	80.1 	A3-3125A 	HHA-230A 	Drugs and Biologicals
7 	80.2 	A3-3125B 	HHA-230B 	Transportation
7 	80.3 	A3-3125C 	HHA-230C 	Services That Would Not Be Covered As Inpatient Services
7 	80.4 	A3-3125D 	HHA-230D 	Housekeeping Services

New
Chap.
New
Sect.
Int.
Pub. 13
HHA
Pub. 11
PMs 	Description
7 	80.5 	A3-3125E 	HHA-230E 	Services Covered Under End Stage Renal Disease (ESRD) Program
7 	80.6 	A3-3125F 	HHA-230F 	Prosthetic Devices
7 	80.7 	A3-3125G 	HHA-230G 	Medical Social Services Furnished to Family Members
7 	80.8 	A3-3125H 	HHA-230H 	Respiratory Care Services
7 	80.9 	A3-3125I 	HHA-230I 	Dietary and Nutrition Personnel
7 	90 	A3-3127,
A3-3661
HHA-219 	Medical and Other Health Services Furnished by Home Health
Agencies
7 	100 	A3-3128 	HHA-224 	Physician Certification for Medical and Other Health Services
Furnished by Home Health Agency
7 	110 	HHA-201.13 	A-01-02 	Use of Telehealth in Delivery of Home Health Services