Home health benefits: A covered benefit for your Medicaid members

There may be times when a member requires a skilled home visit to assess their current status, instruct and reconcile medications, as well as instruct in early signs and symptoms of disease processes and complications to prevent hospitalization/re-hospitalization.

Skilled nursing (SN) and therapies such as physical therapy (PT), occupational therapy (OT), or speech therapy (ST) at home may be a needed option post a hospital or inpatient rehab stay. These service providers would keep you, the primary care provider, apprised of the member’s status.

We are working on two focus areas to assist members to get the care they need:

• Postpartum members
• Members with a sepsis diagnosis

Postpartum members

The State Department of Health has provided the guidance below regarding postpartum visits to Medicaid members as part of their benefit package. To attempt to improve New York State’s maternity morbidity and mortality rates, they provided the guidance below:¹

• All postpartum persons are eligible for one initial postpartum home visit after they give birth.
• Pregnant/postpartum persons are also eligible for home visits in pregnancy and/or additional postpartum visits if determined to be medically necessary by the principal maternal care provider.

Members with a sepsis diagnosis

Studies have shown that members with a sepsis diagnosis benefit from at least two post hospital home care skilled nursing visits:

• A National Institutes of Health (NIH) funded study showed that timely home health nursing visits and outpatient follow-up within seven days after hospital discharge, significantly reduced readmissions.
• 7 percentage point reduction in sepsis (41% relative reduction)².

We need your help

The first step in this process starts with you, the provider. We will need signed orders for the home health agency in the community to provide these home visits.

The process should begin while the member is still in the hospital as part of discharge planning. If the orders are not signed while the member is still in-patient, we will be reaching out to you to obtain the needed home health care orders.

Together, we can work towards improved outcomes.

Contact us

• Call the prior authorization at 212-563-5570, ext. 1062001261, option 3.