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Home Health Prescribing by Non-Physicians

As a reminder, the Pennsylvania Department of Human Services (DHS) requires all home health services provided under the state’s Medicaid Program/HealthChoices — including certain durable medical equipment (DME), appliances and medical supply items — to be prescribed by a physician.

Effective October 15, 2018, Health Partners Plans (HPP) will be implementing system updates that will operationalize and monitor this regulation. Going forward, non-physicians will be prohibited from prescribing home health services for Health Partners (Medicaid) Members, and all claims for home health, DME, and medical supplies submitted by non-physicians will be denied by HPP.

Examples of non-physicians that frequently submit such claims include Podiatrists, Physician Assistants (PAs), Certified Registered Nurse Practitioners (CRNPs), Certified Nurse Midwives (CNMs) and Clinical Nurse Specialists (CNSs).

FOR MORE INFORMATION

This update is consistent with both Federal and State requirements, and aligns with the Centers for Medicare & Medicaid Services (CMS) Federal Regulation 42.CFR.440.70. For more information, please review the following federal documents:

HPP will be hosting a one hour webinar in late September that will address this topic from both a Medicaid and Medicare perspective. Registration links will be available on the Provider Webinars web page in the coming weeks.