PM 20-12-01-b.

Home Health Agency

  1. (FCRC) Tell provider to ask for prior approval within the first 39 days of service, if service will be longer than 60 days, so there will be no lapse in service.
  2. (BCHS) Approves services for clients who have exhausted home health benefits through Medicare or who are not eligible for Medicare paid benefits.
  3. (BCHS) At least every 2 months, reviews treatment plan and need for continuing home health services with client's physician.

Registered Professional Nurse

  1. (BCHS) Compares cost of RPN services with cost of long term care when service is needed for a long time.
  2. (BCHS) At least monthly, reviews need for service with client's physician.

Physical, Speech, or Occupational Therapist

  1. (Provider) Submits a request containing:
    • information identifying patient, including patient's age;
    • diagnosis of patient's condition, including a description of speech or communication problem when requesting speech therapy;
    • date condition began;
    • physician's statement of how long therapy will be needed;
    • physician's statement of goal of treatment;
    • type of therapy, length of each treatment, and frequency of treatment;
    • location of treatment;
    • name and qualifications of person or agency providing treatment; and
    • per visit charge for service.
  2. (BCHS) Decides if prior approval is given.

Community Health Agency

  1. (Provider) Submits same information as for independent therapists.
  2. (BCHS) Decides if prior approval is given.