§ 40-18-4. Payment for long-term home healthcare programs.
(a) When a long-term home healthcare program as defined under this chapter is available,
the department of human services, before authorizing care in a nursing home or intermediate-care
facility for a person eligible to receive services under this title, shall notify
the person, in writing, of the provisions of this chapter.
(b)(1) If a hospitalized person eligible to receive services under the provisions of this
title who requires care, treatment, maintenance, nursing, or other services in a nursing
home desires to return to his or her own home or the home of a responsible relative
or other responsible adult if the necessary services are provided, that person or
his or her representative shall so inform the department of human services.
(2) If a home healthcare program as defined under this chapter is provided, the department
of human services shall authorize an assessment and if the results of the assessment
indicate that the person can receive the appropriate level of care at home, the official
shall prepare for that person a plan for the provision of services comparable to those
that would be rendered in a nursing home. In developing the plan, the department shall
consult with those persons performing the assessment. The services shall be provided
by certified home health agencies, home health aide/homemaker agencies, and adult
daycare centers.
(3)(i) At the time of the initial assessment, and at the time of each subsequent assessment,
the official shall establish a monthly budget in accordance with which he or she shall
authorize payment for the services provided under the plan. Total monthly expenditures
made under this title for that person shall not exceed a maximum of one hundred percent
(100%) of the average of the monthly rates payable for skilled nursing/intermediate-care
facility service as provided for in the department of human services.
(ii) Principles of reimbursement for skilled nursing/intermediate-care facility services
provided eligible receipts of the medical assistance program. If an assessment of
the person's needs demonstrates that he or she requires services the payment for which
would exceed the monthly maximum, but it can be reasonably anticipated that total
expenditures for required services for that person will not exceed the maximum calculated
over a one-year period, the department of human services may authorize payment for
those services.
(c) Notwithstanding any inconsistent provision of law, but subject to expenditure limitations
of this chapter, the director, subject to the approval of the state director of the
budget, may authorize the utilization of medical assistance funds to pay for services
provided by specified home healthcare persons in addition to those services included
in the medical assistance program under chapter 8 of this title, so long as federal
financial participation is available for those services. Expenditures made under this
subsection shall be deemed payments for medical assistance for needy persons.
(d) The department shall not make payments pursuant to Title XIX of the federal Social
Security Act, 42 U.S.C. § 1396 et seq., for benefits available under Title XVIII, 42 U.S.C. § 1395 et seq., of the act without documentation that Title XVIII claims have been filed
and denied.
(e) The department shall not make payment for a person receiving a long-term home healthcare
program while payments are being made for that person for inpatient care in a skilled
nursing and intermediate-care facility or hospital.