WAG 20-12-01-b.

The need for prior approval for home health care depends on the provider and the type of service provided.

Home Health Agency

The first 60 days of services from a Home Health Agency do not require prior approval. The provider must tell the Family Community Resource Center when services begin. The Bureau of Comprehensive Health Services handles prior approval for services lasting over 60 days. Tell the provider to ask for prior approval within the first 39 days of service, so there will not be a lapse in service. The decision on the request for prior approval must be made within 21 calendar days.

Registered Professional Nurse

The Bureau of Comprehensive Health Services handles prior approval for occasional part-time nursing services at home, when a Home Health Agency is not available. The decision on the request for prior approval must be made within 21 calendar days.

Physical, Speech, or Occupational Therapist

If the client has just been released from the hospital where they were getting therapy, the first 30 days of services from a therapist do not require prior approval. If more than 30 days are needed or the client was not in the hospital, the Bureau of Comprehensive Health Services handles prior approval. Tell the provider to ask for prior approval immediately. The decision on the request for prior approval must be made within 30 days.

Community Health Agency

If the client has just been released from the hospital where they were getting therapy, the first 30 days of services from a community health agency do not require prior approval. If more than 30 days are needed or the client was not in the hospital, the Bureau of Comprehensive Health Services handles prior approval. Tell the provider to ask for prior approval immediately. The decision on the request for prior approval must be made within 30 days.