Notification for Home Health Providers

Date: 10/21/16

Magnolia Health is committed to ensuring all our members receive quality care at the right time and the right location. Home health is an essential benefit for our members when provided under the care of a physician. In accordance with the Division of Medicaid’s Administrative Code, Magnolia Health requires home health agencies to maintain auditable records that at a minimum include:

• a physician referral
• appropriate identifying information
• name of the referring physician
• original signed copy of the initial certification
• original signed copies of all recertifications
• original signed copy of any new orders
• change in orders, medications, medical supplies or other treatment changes
• original copy of case conference report(s) covering all disciplines
• original copy of all lab results and other diagnostic test results
• original copy of discharge summary to include transfers and hospital stays
• documentation of all verbal communications between the home health agency and the physician
• signed copy of drug, dietary, treatment and activity orders including any new changes.

Magnolia Health requires prior authorization for all home health services performed after the initial evaluation. We must receive proper documentation to support the medical need for home health as well as evidence that home health is being provided under the direction of a physician. In order to meet that requirement, we accept:

• signed physician orders
• prescriptions
• signed plan of care documents
• hospital discharge summaries or orders that contain a reference to or an order for home health.

We will accept verbal orders with the understanding that the verbal order will be signed by the provider in a timely fashion.

Magnolia Health reserves the right to audit all records, refer to the Division of Medicaid’s Program Integrity Unit all instances of missing required documentation including a lack of signed physician certifications/recertifications, and to recoup any claims paid for services not properly documented.