Medicaid Benefits: Home Health Services – Nursing Services, Home Health Aides, and Medical Supplies/Equipment
This data is presented as an interactive tool that allows users to: filter by timeframe/year, select specific data columns (distributions), filter by state or geography, and view the data as a table, map, or trend chart.
2018
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limits on Services | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 46 No - 0 NR - 5 | 2018 data limited to CN | Yes - 10 | Yes - 30 | Included in "Limits on Services" for 2018 | Not included in 2018 survey |
| Alabama | Yes | CN | No | 104 visits per year Home Health | - | - |
| Alaska | Yes | CN | Depends on income | Prior authorization required | - | - |
| Arizona | Yes | CN | No | Prior authorization required | - | - |
| Arkansas | Yes | CN | NR | NR | - | - |
| California | Yes | CN | No | No | - | - |
| Colorado | Yes | CN | No | Services subject to prior authorization and daily maximum reimbursement limits | - | - |
| Connecticut | Yes | CN | No | Nursing Services: Services beyond the initial evaluation and 2 nursing visits a week must be prior authorized. Home health aides services must be prior authorized if more than 14 hours weekly are needed. | - | - |
| Delaware | Yes | CN | No | Medically necessary | - | - |
| District of Columbia | Yes | CN | No | Requires PA for service to be reimbursable | - | - |
| Florida | Yes | CN | $2 per visit | Up to 3 intermittent visits per recipient, per day; and up to 4 intermittent visits per day for pregnant recipients. | - | - |
| Georgia | Yes | CN | $3 copay | More than 50 visits per year must be prior authorized. | - | - |
| Hawaii | Yes | CN | No | No | - | - |
| Idaho | Yes | CN | No | No | - | - |
| Illinois | NR | NR | NR | NR | - | - |
| Indiana | Yes | CN | No | Prior authorization. 120 hours of care within 30 days of hospital discharge if ordered by physician. | - | - |
| Iowa | NR | NR | NR | NR | - | - |
| Kansas | Yes | CN | $3.00 per skilled nursing visit | Frequency and quantity limits for medical equipment and supplies vary by product | - | - |
| Kentucky | Yes | CN | NR | NR | - | - |
| Louisiana | Yes | CN | No | NR | - | - |
| Maine | Yes | CN | $.50 to $3/day depending on payment amount, up to $30/month | No | - | - |
| Maryland | Yes | CN | No | Based on medical necessity for high cost cases | - | - |
| Massachusetts | Yes | CN | No | No | - | - |
| Michigan | Yes | CN | No | Medical necessity | - | - |
| Minnesota | Yes | CN | No | No | - | - |
| Mississippi | Yes | CN | $3 per visit | 25 visit max per state fiscal year. Services are prior authorized for medical necessity for waiver participants once the allowable State Plan benefit has been exhausted. | - | - |
| Missouri | Yes | CN | NR | NR | - | - |
| Montana | Yes | CN | $4 per visit | 180 combined skilled nursing, aide and therapy visits per year | - | - |
| Nebraska | Yes | CN | No | Aide services are limited to 56 hours/week | - | - |
| Nevada | Yes | CN | No | Prior authorization required | - | - |
| New Hampshire | NR | NR | NR | NR | - | - |
| New Jersey | Yes | CN | No | No | - | - |
| New Mexico | Yes | CN | No | No | - | - |
| New York | NR | NR | NR | NR | - | - |
| North Carolina | Yes | CN | No | 75 Nursing visits/yr 100 Nursing Aide visits/yr | - | - |
| North Dakota | Yes | CN | No | 50 visits per year | - | - |
| Ohio | Yes | CN | No | Four hours or less per visit, no more than eight hours a day combined, up to 14 hours a week. | - | - |
| Oklahoma | Yes | CN | $4 per visit | 36 visits annually without prior authorization when prescribed by a physician | - | - |
| Oregon | Yes | CN | No | All coverage is based upon the prioritized list of health services. Services are PA and based upon an individual plan of care | - | - |
| Pennsylvania | Yes | CN | No | Home Health Nursing/Aide Services are unlimited for first 28 days; then limited to 15 days every month thereafter, in combination with visits for therapy services. DME/Medical Supplies - no limits | - | - |
| Rhode Island | Yes | CN | No | No | - | - |
| South Carolina | NR | NR | NR | NR | - | - |
| South Dakota | Yes | CN | 5% of payment for DME or supply | Some equipment and supplies require a prior authorization. | - | - |
| Tennessee | Yes | CN | No | Limited to 27 hours/week of nursing services and 35 hours/week of combined nursing and home health aide services; persons who qualify for skilled nursing care may exceed these limits and receive up to 30 hours/week of nursing services and 40 hours/week of combined nursing and home health aide services. | - | - |
| Texas | Yes | CN | No | Requires prior authorization. | - | - |
| Utah | Yes | CN | No | No | - | - |
| Vermont | Yes | CN | No | Physician order and plan of care required for nursing; home health aide must be supervised by nurse or OT/PT/SLP | - | - |
| Virginia | Yes | CN | $3 per day; no cost sharing for DME | NR | - | - |
| Washington | Yes | CN | No | No | - | - |
| West Virginia | Yes | CN | No | PA required for services that exceed 60 visits in a calendar year | - | - |
| Wisconsin | Yes | CN | No | Prior approval required after 30 visits in a calendar year, regardless of the service or service provider | - | - |
| Wyoming | Yes | CN | No | Prior authorization required | - | - |
2012
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 55 No - 1 | Yes - 11 No - 44 | ||||
| Alabama | Yes | CN | 104 visits/year with no more than 2 home health aide visits/week, therapies not covered | Initiation of care and for medical equipment | Cost based payment for government providers, fee for service using time units for private providers, med equipment and supplies paid fee for service | |
| Alaska | Yes | CN | Specified med equipment | Percentage of charge | ||
| American Samoa | Yes | This service is not provided on-island but when necessary can be covered off-island; written plan of care required every 60 days; nursing care and home health aide services covered, along with medical supplies and PT; OT, SP, medical social services, homemaker and chore services not covered | ||||
| Arizona | Yes | CN & MN | Yes | Fee for service | ||
| Arkansas | Yes | CN & MN | 50 visits/year, only specified med equipment covered, med supplies covered up to $250/month and included in limitations with other providers | Specified med equipment | Fee for service, med supplies paid up to Medicare payment ceilings | |
| California | Yes | CN & MN | Initiation and continuation of care | Fee for service | ||
| Colorado | Yes | CN | Plan of care required | Care exceeding 60 days | Fee for service, using maximum daily rate | |
| Connecticut | Yes | CN & MN | 2 skilled nurse visits/week, 20 hours home health aide services/week | Therapies after first visit, continued nursing care after second visit | Fee for service, enhanced payment for complex care | |
| Delaware | Yes | CN | Fee for service | |||
| District of Columbia | Yes | CN & MN | Plan of care required, 36 visits/year, 8 hours/home health aide visits, only therapies in care plan are covered, only specified med equipment and supplies covered | Fee for service using Medicare cost ceilings | ||
| Florida | Yes | CN & MN | $2/day | 3 nursing or home health aide visits/day in combination for non-pregnant adults, therapies not covered, only specified med equipment and supplies covered | Yes | Fee for service |
| Georgia | Yes | CN & MN | $3/visit | 50 nursing, home health aide and therapy visits/year; med equipment rental needs physician order and has limit of 10 months | Therapies | Prospective cost based rate per visit |
| Guam | Yes | CN | Therapies not covered | Fee for service using Medicare fee schedule | ||
| Hawaii | Yes | CN & MN | Specified services | Fee for service | ||
| Idaho | Yes | CN | Basic and Enhanced Plan participants limited to 100 nursing, home health aide and therapy visits/year; oxygen and related equipment covered for specified conditions | Fee for service | ||
| Illinois | Yes | CN & MN | Therapies, more than 1 skilled nursing visit/day, skilled nursing care initiated after 14 days of hospital discharge | Fee for service | ||
| Indiana | Yes | CN | 120 hours of care within 30 days of hospital discharge if ordered by physician, 30 therapy sessions/month in combination with other therapy providers if ordered by physician prior to hospital discharge | Yes, unless ordered by physician prior to hospital discharge | Prospective cost based rates | |
| Iowa | Yes | CN & MN | Oxygen and related equipment covered for specified conditions | Cost based payment for most services with some paid on fee for service basis | ||
| Kansas | Yes | CN & MN | $3/skilled nurse visit | 2 home health aide visits/week, therapies limited to 6 months | Fee for service | |
| Kentucky | Yes | A, B & C - See state-specific FN | Fee for service, cost based payment for medical supplies and nutritional supplements included in plan of care | |||
| Louisiana | Yes | CN & MN | 50 nursing and home health aide visits/year; home health aide and therapy services are not covered for the MN population | Therapy services, med equipment and supplies | Fee for service | |
| Maine | Yes | CN & MN | $.50-$3/day, depending on payment, up to $30/month | Face-to-face encounter with physician or other designated provider certifying medical necessity required prior to commencing services | Yes | Fee for service |
| Maryland | Yes | CN & MN | Visit limits vary by type of service, 1 visit/type of service/day, home health aide visits require bi-weekly RN supervisory visits | Care cost exceeding that of average nursing facility | Fee for service with rates set geographically based on Medicare rates | |
| Massachusetts | Yes | CN & MN | Coverage limited by eligibility category | Fee for service using peer groups to set maximum payments | ||
| Michigan | Yes | CN & MN | Care requiring more than 60 days | Fee for service | ||
| Minnesota | Yes | A & B - See state-specific FN | 1 nursing or home health aide visit/day | After initial 9 skilled nurse visits | Fee for service | |
| Mississippi | Yes | CN | $3/visit | 25 skilled nursing and home health aide visits/year | Fee for service with nursing facility rate as upper limit or cost based payment | |
| Missouri | Yes | CN | 100 nursing and home health aide visits/year, adult coverage for therapies limited to those who are pregnant or blind, services limited to place of residence | Fee for service | ||
| Montana | Yes | A & B - See state-specific FN | $3/visit | 75 nursing visits/year; 100 visits/year including nursing, home health aide and therapy visits; services not covered at same time as personal care | Yes | Fee for service for nursing, aide and therapy services; medical equipment and supplies paid a percentage of Medicare allowable cost as ceiling |
| Nebraska | Yes | CN & MN | Daily cost limit for skilled nursing | Initiation of care | Fee for service | |
| Nevada | Yes | CN | Initiation of care and ongoing certification of need | Fee for service | ||
| New Hampshire | Yes | CN & MN | Fee for service | |||
| New Jersey | Yes | CN & MN | Plan of care required, cost of care for 6 months must be less than in nursing facility | Care after initial visit | Cost based payment per time unit, med supplies paid fee for service | |
| New Mexico | Yes | CN | A - $0-$7/visit depending on income, B - $7/visit - see state-specific FN | A - 25 days/year in combination with inpatient hospital care and inpatient physical rehab | Yes | Cost based payment with limits |
| New York | Yes | CN & MN | 40 visits/year and must be in lieu of hospitalization | Prospective cost based payment | ||
| North Carolina | Yes | CN & MN | Services must be ordered by physician and medically necessary, services not covered during same hours as personal care or private duty nursing | Prospective rate per visit based on Medicare methodology, medical supplies paid fee for service | ||
| North Dakota | Yes | CN & MN | Visits via telemonitoring allowed when appropriate | Prospective cost based rate per visit | ||
| Northern Mariana Islands | Yes | CN & MN - See territory-specific FN | Post-hospital care only, includes therapies | Yes | ||
| Ohio | Yes | CN | 8 hours/day nursing, aide and therapy services combined, up to 14 hours/week for nursing and aide services; up to 28 hours/week nursing and aide services combined for post-hospital care if criteria met | Fee for service for nursing, home health aide and therapies; med supplies paid 75% average list price if no payment limit available | ||
| Oklahoma | Yes | CN | $3/visit | 36 visits/year, therapies not covered | Fee for service | |
| Oregon | Yes | A - See state-specific FN | A - $3/visit | Services limited to funded conditions on the priority list | Med equipment and supplies over specified cost thresholds | Fee for service, using a percentage of Medicare rates |
| Pennsylvania | Yes | CN & MN | Multiple staff/visit counts as 1 visit, 15 visits/month after first 28 days of care, 2 postpartum visits/pregnancy | Specified services, medical equipment and supplies | Fee for service | |
| Puerto Rico | No - see territory-specific FN | |||||
| Rhode Island | Yes | See state-specific FN | Med equipment and supplies, therapies | Fee for service | ||
| South Carolina | Yes | CN | $3.30/visit, medical supplies are exempt from copayments | 50 nursing, home health aide and therapy visits/year | Cost based payment using Medicare upper limits for visits, med supplies paid at 50th percentile of Medicare allowable charge | |
| South Dakota | Yes | CN | Specified med equipment and supplies | Fee for service, med equipment paid at 75% of charge | ||
| Tennessee | Yes | A, B & C - See state-specific FN | 27 hours/week of nursing services or 35 hours/week of combined nursing and home health aide services, levels slightly higher for persons qualifying for skilled nursing facility care | See state-specific FN | ||
| Texas | Yes | CN & MN | Yes, every 6 months | Fee for service | ||
| Utah | Yes | A & B - See state-specific FN | Home health aide, OT and services for patient or family convenience not covered | Services after initial evaluation | Fee for service, payment for med equipment and supplies may be negotiated | |
| Vermont | Yes | A & B - See state-specific FN | Therapy services limited to 4 months/episode | Fee for service | ||
| U.S. Virgin Islands | Yes | CN | Medical equipment and supplies | Fee for service | ||
| Virginia | Yes | CN & MN | $3/visit including all therapy services | 32 home health aide visits/year | After initial 5 visits | Fee for service using geographic adjustments, health departments have special rates |
| Washington | Yes | CN & MN | 2 nurse visits/day, 1 home health aide visit/day, 3 nurse visits for high-risk pregnant women/pregnancy | Fee for service using prevailing charge as limit, rates vary geographically | ||
| West Virginia | Yes | A, B & C | Authorization required after 60 visits | Fee for service using a percentage of Medicare rates | ||
| Wisconsin | Yes | CN & MN | 30 visits/year | Fee for service using Medicare cost ceilings | ||
| Wyoming | Yes | CN | Visits paid fee for service, med supplies paid reasonable charge |
2010
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 54 No - 2 | Yes - 11 No - 43 | ||||
| Alabama | Yes | CN | 104 visits/year with no more than 2 home health aide visits/week, therapies not covered | Initiation of care and for medical equipment | Cost based payment for government providers, fee for service using time units for private providers, med equipment and supplies paid fee for service | |
| Alaska | Yes | CN | Specified med equipment | Percentage of charge | ||
| American Samoa | No | |||||
| Arizona | Yes | CN & MN | Yes | Fee for service | ||
| Arkansas | Yes | CN & MN | 50 visits/year, only specified med equipment covered, med supplies covered up to $250/month and included in limitations with other providers | Specified med equipment | Fee for service, med supplies paid up to Medicare payment ceilings | |
| California | Yes | CN & MN | Initiation and continuation of care | Fee for service | ||
| Colorado | Yes | CN | Plan of care required | Fee for service, using maximum daily rate | ||
| Connecticut | Yes | CN & MN | 2 skilled nurse visits/week, 20 hours home health aide services/week | Therapies after first visit, continued nursing care after second visit | Fee for service, enhanced payment for complex care | |
| Delaware | Yes | CN | Fee for service | |||
| District of Columbia | Yes | CN & MN | Plan of care required, 36 visits/year, 8 hours/home health aide visit, PT and OT must be in plan, SP not covered, only specified med equipment and supplies covered | Fee for service using Medicare cost ceilings | ||
| Florida | Yes | CN & MN | $2/day | 4 nursing or home health aide visits/day in combination, therapies not covered, only specified med equipment and supplies covered | Additional visits | Fee for service |
| Georgia | Yes | CN & MN | $3/visit | 50 nursing, home health aide and therapy visits/year; 2 months med equipment rental | Therapies | Prospective cost based rate per visit |
| Guam | Yes | CN | Therapies not covered | Negotiated rate/service | ||
| Hawaii | Yes | CN & MN | Specified services | Fee for service | ||
| Idaho | Yes | CN | Basic and Enhanced Plan participants limited to 100 nursing, home health aide and therapy visits/year; oxygen and related equipment covered for specified conditions | Fee for service | ||
| Illinois | Yes | CN & MN | Initiation of care | Fee for service | ||
| Indiana | Yes | CN | 120 hours of care within 30 days of hospital discharge if ordered by physician, 30 therapy sessions/month in combination with other therapy providers if ordered by physician prior to hospital discharge | Prospective cost based rates | ||
| Iowa | Yes | CN & MN | Oxygen and related equipment covered for specified conditions | Cost based payment for most services with some paid on fee for service basis | ||
| Kansas | Yes | CN & MN | $3/skilled nurse visit | 2 home health aide visits/week, therapies limited to 6 months | Fee for service | |
| Kentucky | Yes | A, B & C - See state-specific FN | Fee for service | |||
| Louisiana | Yes | CN & MN | 50 nursing and home health aide visits/year | Therapy services, med equipment and supplies | Fee for service | |
| Maine | Yes | CN & MN | $.50-$3/day, depending on payment, up to $30/month | Yes | Fee for service | |
| Maryland | Yes | CN & MN | Visit limits vary by type of service, 1 visit/type of service/day, home health aide visits require bi-weekly RN supervisory visits | Care cost exceeding that of average nursing facility | Fee for service with rates set geographically based on Medicare rates | |
| Massachusetts | Yes | CN & MN | Coverage limited by eligibility category | Fee for service using peer groups to set maximum payments | ||
| Michigan | Yes | CN & MN | Fee for service | |||
| Minnesota | Yes | A & B - See state-specific FN | 1 nursing or home health aide visit/day | After initial 9 skilled nurse visits | Fee for service | |
| Mississippi | Yes | CN | $3/visit | 25 skilled nursing and home health aide visits/year | Fee for service with nursing facility rate as upper limit or cost based payment | |
| Missouri | Yes | CN | 100 nursing and home health aide visits/year, adult coverage for therapies limited to those who are pregnant or blind, services limited to place of residence | Fee for service | ||
| Montana | Yes | A & B - See state-specific FN | $3/visit | 75 nursing visits/year; 100 visits/year including nursing, home health aide and therapy visits; services not covered at same time as personal care | Yes | Percentage of charge using a percentage of Medicare allowable cost as ceiling |
| Nebraska | Yes | CN & MN | Daily cost limit for skilled nursing | Initiation of care | Fee for service | |
| Nevada | Yes | CN | Initiation of care and ongoing certification of need | Fee for service | ||
| New Hampshire | Yes | CN & MN | Fee for service | |||
| New Jersey | Yes | CN & MN | Plan of care required, cost of care for 6 months must be less than in nursing facility | Care after initial visit | Cost based payment per time unit, med supplies paid fee for service | |
| New Mexico | Yes | CN | A - $0-$7/visit depending on income, B - $7/visit - see state-specific FN | A - 25 days/year in combination with inpatient hospital care and inpatient physical rehab | Yes | Cost based payment with limits |
| New York | Yes | CN & MN | 40 visits/year and must be in lieu of hospitalization | Prospective cost based payment | ||
| North Carolina | Yes | CN & MN | Services must be ordered by physician and medically necessary, services not covered during same hours as personal care or private duty nursing | Prospective rate per visit based on Medicare methodology, medical supplies paid fee for service | ||
| North Dakota | Yes | CN & MN | Prospective cost based rate per visit | |||
| Northern Mariana Islands | Yes | CN & MN - See territory-specific FN | Post-hospital care only, includes therapies | Yes | ||
| Ohio | Yes | CN | 8 hours/day nursing, aide and therapy services combined, up to 14 hours/week for nursing and aide services; up to 28 hours/week nursing and aide services combined for post-hospital care if criteria met | Fee for service for nursing, home health aide and therapies; med supplies paid 75% average list price if no payment limit available | ||
| Oklahoma | Yes | CN | $3/visit | 36 visits/year, therapies not covered | Fee for service | |
| Oregon | Yes | A - See state-specific FN | A - $3/visit | Services limited to funded conditions on the priority list | Med equipment and supplies over specified cost thresholds | Fee for service, using a percentage of Medicare rates |
| Pennsylvania | Yes | CN & MN | Multiple staff/visit counts as 1 visit, 15 visits/month after first 28 days of care, 2 postpartum visits/pregnancy | Specified services, medical equipment and supplies | Fee for service | |
| Puerto Rico | No - see territory-specific FN | |||||
| Rhode Island | Yes | See state-specific FN | Med equipment and supplies, therapies | Fee for service | ||
| South Carolina | Yes | CN | $2/visit, medical supplies are exempt from copayments | 75 nursing, home health aide and therapy visits/year | Cost based payment using Medicare upper limits for visits, med supplies paid at 50th percentile of Medicare allowable charge | |
| South Dakota | Yes | CN | Specified med equipment and supplies | Fee for service, med equipment paid at 75% of charge | ||
| Tennessee | Yes | A & B - See state-specific FN | 27 hours/week of nursing services or 35 hours/week of combined nursing and home health aide services, levels slightly higher for persons qualifying for skilled nursing facility care | See state-specific FN | ||
| Texas | Yes | CN | Yes, every 6 months | Fee for service | ||
| Utah | Yes | A & B - See state-specific FN | Home health aide, OT and services for patient or family convenience not covered | Services after initial evaluation | Fee for service, payment for med equipment and supplies may be negotiated | |
| Vermont | Yes | A & B - See state-specific FN | Therapy services limited to 4 months/episode | Fee for service | ||
| U.S. Virgin Islands | Yes | CN | Medical equipment and supplies | Fee for service | ||
| Virginia | Yes | CN & MN | $3/visit including all therapy services | 32 home health aide visits/year | After initial 5 visits | Fee for service using geographic adjustments, health departments have special rates |
| Washington | Yes | CN & MN | 2 nurse visits/day, 1 home health aide visit/day, 3 nurse visits for high-risk pregnant women/pregnancy | Fee for service using prevailing charge as limit, rates vary geographically | ||
| West Virginia | Yes | A, B & C | Authorization required after 60 visits | Fee for service using a percentage of Medicare rates | ||
| Wisconsin | Yes | CN & MN | 30 visits/year | Fee for service using Medicare cost ceilings | ||
| Wyoming | Yes | CN | Therapy must be restorative | Visits paid fee for service, med supplies paid reasonable charge |
2008
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 55 No - 1 | Yes - 11 No - 44 | ||||
| Alabama | Yes | CN | 104 visits/year with no more than 2 home health aide visits/week, therapies not covered | Initiation of care and for medical equipment | Cost based payment for government providers, fee for service using time units for private providers, med equipment and supplies paid fee for service | |
| Alaska | Yes | CN | Specified med equipment | Percentage of charge | ||
| American Samoa | Yes | See territory-specific FN | Post-hospital care only, includes therapies | |||
| Arizona | Yes | CN & MN | Yes | Fee for service | ||
| Arkansas | Yes | CN & MN | 50 visits/year, only specified med equipment covered, med supplies covered up to $250/month and included in limitations with other providers | Specified med equipment | Fee for service, med supplies paid up to Medicare payment ceilings | |
| California | Yes | CN & MN | Initiation and continuation of care | Fee for service | ||
| Colorado | Yes | CN | Plan of care required | Fee for service, using maximum daily rate | ||
| Connecticut | Yes | CN & MN | 2 skilled nurse visits/week, 20 hours home health aide services/week | Therapies after first visit, continued nursing care after second visit | Fee for service, enhanced payment for complex care | |
| Delaware | Yes | CN | Fee for service | |||
| District of Columbia | Yes | CN & MN | Plan of care required, 36 visits/year, 8 hours/home health aide visit, PT and OT must be in plan, SP not covered, only specified med equipment and supplies covered | Fee for service using Medicare cost ceilings | ||
| Florida | Yes | CN & MN | $2/day | 4 nursing or home health aide visits/day up to 60/lifetime, therapies not covered, only specified med equipment and supplies covered | Additional visits | Fee for service |
| Georgia | Yes | CN & MN | $3/visit | 50 nursing, home health aide and therapy visits/year; 2 months med equipment rental | Therapies | Prospective cost based rate per visit |
| Guam | Yes | CN | Therapies not covered | Negotiated rate/service | ||
| Hawaii | Yes | CN & MN | Specified services | Fee for service | ||
| Idaho | Yes | CN | 100 nursing, home health aide and therapy visits/year; oxygen and related equipment covered for specified conditions | Fee for service | ||
| Illinois | Yes | CN & MN | Initiation of care | Fee for service | ||
| Indiana | Yes | CN | 120 hours of care within 30 days of hospital discharge if ordered by physician, 30 therapy sessions/month in combination with other therapy providers if ordered by physician prior to hospital discharge | Prospective cost based rates | ||
| Iowa | Yes | CN & MN | Oxygen and related equipment covered for specified conditions | Cost based payment for most services with some paid on fee for service basis | ||
| Kansas | Yes | CN & MN | $3/skilled nurse visit | 1 home health aide visit/day, therapies limited to 6 months, psychiatric nursing covered if medically necessary | Fee for service | |
| Kentucky | Yes | A, B & C - See state-specific FN | Fee for service | |||
| Louisiana | Yes | CN & MN | 50 nursing and home health aide visits/year | Therapy services, med equipment and supplies | Prospective rates | |
| Maine | Yes | CN & MN | $.50-$3/day, depending on payment, up to $30/month | Yes | Fee for service using Medicare cost ceilings | |
| Maryland | Yes | CN & MN | Visit limits vary by type of service, 1 visit/type of service/day, home health aide visits require bi-weekly RN supervisory visits | Care cost exceeding that of average nursing facility | Fee for service with rates set geographically | |
| Massachusetts | Yes | CN & MN | Coverage limited by eligibility category | Fee for service using peer groups to set maximum payments | ||
| Michigan | Yes | CN & MN | Fee for service | |||
| Minnesota | Yes | A & B - See state-specific FN | A - 2 nursing or home health aide visits/day | After initial 9 skilled nurse visits | Fee for service | |
| Mississippi | Yes | CN | $3/visit | 25 skilled nursing and home health aide visits/year | Yes | Fee for service with nursing facility rate as upper limit or cost based payment |
| Missouri | Yes | CN | 100 nursing and home health aide visits/year, adult coverage for therapies limited to those who are pregnant or blind | Fee for service | ||
| Montana | Yes | A & B - See state-specific FN | $3/visit | 75 nursing visits/year; 100 visits/year including nursing, home health aide and therapy visits; services not covered at same time as personal care | Yes | Percentage of charge using a percentage of Medicare allowable cost as ceiling |
| Nebraska | Yes | CN & MN | 8 hours/day up to 40 hours/week | Initiation of care | Fee for service | |
| Nevada | Yes | CN | Initiation of care and ongoing certification of need | Fee for service | ||
| New Hampshire | Yes | CN & MN | Fee for service | |||
| New Jersey | Yes | CN & MN | Plan of care required, cost of care for 6 months must be less than in nursing facility | Care after initial visit | Cost based payment per time unit, med supplies paid fee for service | |
| New Mexico | Yes | CN | A - $5/visit, B - $7/visit - see state-specific FN | Yes | Cost based payment with limits | |
| New York | Yes | CN & MN | 40 visits/year and must be in lieu of hospitalization | Prospective cost based payment | ||
| North Carolina | Yes | CN & MN | Services must be ordered by physician and medically necessary, services not covered during same hours as personal care or private duty nursing | Fee for service based on Medicare rates | ||
| North Dakota | Yes | CN & MN | Prospective cost based rate per visit | |||
| Northern Mariana Islands | Yes | CN & MN - See territory-specific FN | Post-hospital care only, includes therapies | Yes | ||
| Ohio | Yes | CN | Fee for service for nursing, home health aide and therapies; med supplies paid 75% average list price if no payment limit available | |||
| Oklahoma | Yes | CN | $1/service | 36 visits/year, therapies not covered | Fee for service | |
| Oregon | Yes | A - See state-specific FN | A - $3/visit | Med equipment and supplies over specified cost thresholds | Fee for service | |
| Pennsylvania | Yes | CN & MN | Multiple staff/visit counts as 1 visit, 15 visits/month after first 28 days of care, 2 postpartum visits/pregnancy | Specified services, medical equipment and supplies | Fee for service | |
| Puerto Rico | No - see territory-specific FN | |||||
| Rhode Island | Yes | CN & MN - see state-specific FN | Med equipment and supplies, therapies | Fee for service | ||
| South Carolina | Yes | CN | $2/visit, medical supplies are exempt from copayments | 75 nursing, home health aide and therapy visits/year | Cost based payment using Medicare upper limits for visits, med supplies paid at 50th percentile of Medicare allowable charge | |
| South Dakota | Yes | CN | Specified med equipment and supplies | Fee for service, med equipment paid at 75% of charge | ||
| Tennessee | Yes | A & B - See state-specific FN | 27 hours/week of nursing services or 35 hours/week of combined nursing and home health aide services, levels slightly higher for persons qualifying for nursing facility care | |||
| Texas | Yes | CN | Yes | Cost based payment for visits, med equipment and supplies paid fee for service | ||
| Utah | Yes | A & B - See state-specific FN | Home health aide, OT and services for patient or family convenience not covered | Services after initial evaluation | Fee for service, payment for med equipment and supplies may be negotiated | |
| Vermont | Yes | A & B - See state-specific FN | Fee for service | |||
| U.S. Virgin Islands | Yes | CN | Medical equipment and supplies | Fee for service | ||
| Virginia | Yes | CN & MN | $3/day including all therapy services | 32 home health aide visits/year | After initial 5 visits | Fee for service using geographic adjustments, health departments have special rates |
| Washington | Yes | CN & MN | 2 nurse visits/day, 1 home health aide visit/day, 3 nurse visits for high-risk pregnant women/pregnancy | Fee for service using prevailing charge as limit, rates vary geographically | ||
| West Virginia | Yes | A, B & C | A - 25 visits/year | Yes | Fee for service using a percentage of Medicare rates | |
| Wisconsin | Yes | CN & MN | 30 visits/year | Fee for service using Medicare cost ceilings | ||
| Wyoming | Yes | CN | Therapy must be restorative | Visits paid fee for service, med supplies paid reasonable charge |
2006
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 55 No - 1 | Yes - 11 No - 44 | ||||
| Alabama | Yes | CN | 104 visits/year with no more than 2 home health aide visits/week, therapies not covered | Initiation of care and for medical equipment | Cost based payment for government providers, fee for service using time units for private providers, med equipment and supplies paid fee for service | |
| Alaska | Yes | CN | Specified med equipment | Percentage of charge | ||
| American Samoa | Yes | See territory-specific FN | Post-hospital care only, includes therapies | |||
| Arizona | Yes | CN & MN | Yes | Fee for service | ||
| Arkansas | Yes | CN & MN | 50 visits/year, only specified med equipment covered, med supplies covered up to $250/month and included in limitations with other providers | Specified med equipment | Fee for service, med supplies paid up to Medicare payment ceilings | |
| California | Yes | CN & MN | Initiation and continuation of care | Fee for service | ||
| Colorado | Yes | CN | Plan of care required | Fee for service, using maximum daily rate | ||
| Connecticut | Yes | CN & MN | 2 skilled nurse visits/week, 20 hours home health aide services/week | Therapies after first visit, continued nursing care after second visit | Fee for service, enhanced payment for complex care | |
| Delaware | Yes | CN | Fee for service | |||
| District of Columbia | Yes | CN & MN | Plan of care required, 36 visits/year, 8 hours/home health aide visit, PT and OT must be in plan, SP not covered, only specified med equipment and supplies covered | Fee for service using Medicare cost ceilings | ||
| Florida | Yes | CN & MN | $2/day | 4 nursing or home health aide visits/day up to 60/lifetime, therapies not covered, only specified med equipment and supplies covered | Fee for service | |
| Georgia | Yes | CN & MN | $3/visit | 50 nursing, home health aide and therapy visits/year; 2 months med equipment rental | Therapies | Prospective cost based rate per visit |
| Guam | Yes | CN | Therapies not covered | Negotiated rate/service | ||
| Hawaii | Yes | CN & MN | One 2 hour visit/day first 2 weeks, 3 visits/week next 5 weeks, 1 visit/week next 7 weeks, then 1 visit/2 months | Initiation of care and for med equipment and supplies costing more than $50 | Fee for service | |
| Idaho | Yes | CN | 100 nursing, home health aide and therapy visits/year; oxygen and related equipment covered for specified conditions | Med equipment costing more than $100 | Fee for service using Medicare cost ceilings, med equipment rental paid at 1/10 purchase price for 10 months | |
| Illinois | Yes | CN & MN | Initiation of care | Fee for service | ||
| Indiana | Yes | CN | 120 hours of care within 30 days of hospital discharge if ordered by physician, 30 therapy sessions/month in combination with other therapy providers if ordered by physician prior to hospital discharge | Prospective cost based rates | ||
| Iowa | Yes | CN & MN | Oxygen and related equipment covered for specified conditions | Cost based payment for most services with some paid on fee for service basis | ||
| Kansas | Yes | CN & MN | $3/skilled nurse visit | 1 home health aide visit/day, therapies limited to 6 months, psychiatric nursing for homebound only, med equipment must be rented | Med equipment and supplies | Fee for service |
| Kentucky | Yes | A, B & C - See state-specific FN | Med equipment costing more than $150 | Fee for service | ||
| Louisiana | Yes | CN & MN | 50 nursing and home health aide visits/year | Therapy services, med equipment and supplies | Prospective rates based on historical cost | |
| Maine | Yes | CN & MN | $.50-$3/day, depending on payment, up to $30/month | Yes | Fee for service using Medicare cost ceilings | |
| Maryland | Yes | CN & MN | Visit limits vary by type of service, 1 visit/type of service/day, home health aide visits require bi-weekly RN supervisory visits | Care cost exceeding that of average nursing facility | Fee for service with rates set geographically | |
| Massachusetts | Yes | CN & MN | Coverage limited by eligibility category | Fee for service using peer groups to set maximum payments | ||
| Michigan | Yes | CN & MN | Fee for service | |||
| Minnesota | Yes | A & B - See state-specific FN | 2 nursing or home health aide visits/day | After initial 9 skilled nurse visits | Fee for service | |
| Mississippi | Yes | CN | $3/visit | 25 skilled nursing and home health aide visits/year | Yes | Fee for service with nursing facility rate as upper limit or cost based payment |
| Missouri | Yes | CN | 100 nursing and home health aide visits/year, adult coverage for therapies limited to those who are pregnant or blind | Fee for service | ||
| Montana | Yes | A & B - See state-specific FN | $3/visit | 75 nursing visits/year; 100 visits/year including nursing, home health aide and therapy visits; services not covered at same time as personal care | Yes | Percentage of charge using a percentage of Medicare allowable cost as ceiling |
| Nebraska | Yes | CN & MN | 8 hours/day up to 40 hours/week | Initiation of care | Fee for service | |
| Nevada | Yes | CN | Initiation of care and ongoing certification of need | Fee for service | ||
| New Hampshire | Yes | CN & MN | Fee for service | |||
| New Jersey | Yes | CN & MN | Plan of care required, cost of care for 6 months must be less than in nursing facility | Care after initial visit | Cost based payment per time unit, med supplies paid fee for service | |
| New Mexico | Yes | CN | A - $5/visit, B - $7/visit - see state-specific FN | Yes | Cost based payment with limits | |
| New York | Yes | CN & MN | 40 visits/year and must be in lieu of hospitalization | Prospective cost based payment | ||
| North Carolina | Yes | CN & MN | Services must be restorative, services not covered during same hours as personal care or private duty nursing | Specified equipment, supplies, prosthetics and orthotics | Prospective cost based rates for nursing, home health aide and therapies; other services paid on reasonable charge basis using Medicare limits | |
| North Dakota | Yes | CN & MN | Prospective cost based rate per visit | |||
| Northern Mariana Islands | Yes | CN & MN - See territory-specific FN | Post-hospital care only, includes therapies | Yes | ||
| Ohio | Yes | CN | Fee for service for nursing, home health aide and therapies; med supplies paid 75% average list price if no payment limit available | |||
| Oklahoma | Yes | CN | $1/service | 36 visits/year, therapies not covered | Fee for service | |
| Oregon | Yes | A - See state-specific FN | A - $3/visit | Med equipment and supplies over specified cost thresholds | Fee for service | |
| Pennsylvania | Yes | CN & MN | Multiple staff/visit counts as 1 visit, 15 visits/month after first 28 days of care, 2 postpartum visits/pregnancy, 3 months rental of med equipment | Med equipment and supplies costing more than $100 | Fee for service | |
| Puerto Rico | No - see territory-specific FN | |||||
| Rhode Island | Yes | CN & MN - see state-specific FN | Med equipment and supplies, therapies | Fee for service | ||
| South Carolina | Yes | CN | $2/visit, medical supplies are exempt from copayments | 75 nursing, home health aide and therapy visits/year | Med equipment and supplies | Cost based payment using Medicare upper limits for visits, med equipment paid at 50th percentile of Medicare allowable charge |
| South Dakota | Yes | CN | Specified med equipment and supplies | Fee for service, med equipment paid at 75% of charge | ||
| Tennessee | Yes | A & B - See state-specific FN | ||||
| Texas | Yes | CN | Yes | Cost based payment for visits, med equipment and supplies paid fee for service | ||
| Utah | Yes | A & B - See state-specific FN | Home health aide, OT and services for patient or family convenience not covered | Services after initial evaluation | Fee for service, payment for med equipment and supplies may be negotiated | |
| Vermont | Yes | A & B - See state-specific FN | Fee for service | |||
| U.S. Virgin Islands | Yes | CN | Medical equipment and supplies | Fee for service | ||
| Virginia | Yes | CN & MN | $3/visit including all therapy services | Specified med equipment and supplies not covered | After initial 5 visits | Fee for service using geographic adjustments |
| Washington | Yes | CN & MN | 2 nurse visits/day, 1 home health aide visit/day, 3 nurse visits for high-risk pregnant women/pregnancy | Rental or purchase of med equipment and supplies, therapies provided by med rehab facility on agency order | Fee for service using prevailing charge as limit, rates vary geographically | |
| West Virginia | Yes | CN & MN | 124 nursing, home health aide, MSW and therapy visits/year | Specified med equipment and supplies | Fee for service using a percentage of Medicare rates | |
| Wisconsin | Yes | CN & MN | 30 visits/year | Fee for service using Medicare cost ceilings | ||
| Wyoming | Yes | CN | Therapy must be restorative | Visits paid fee for service, med supplies paid reasonable charge |
2004
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 56 No - 0 | Yes - 11 No - 45 | ||||
| Alabama | Yes | CN | 2 home health aide visits/week up to 104/year, therapies not covered | Cost based payment for government providers, fee for service using time units for private providers, med equipment and supplies paid fee for service | ||
| Alaska | Yes | CN | Specified med equipment | Percentage of charge | ||
| American Samoa | Yes | See territory-specific FN | Post-hospital care only, includes therapies | |||
| Arizona | Yes | CN & MN | Yes | Fee for service | ||
| Arkansas | Yes | CN & MN | 50 visits/year, only specified med equipment covered, med supplies covered up to $250/month and included in limitations with other providers | Specified med equipment | Fee for service, med supplies paid up to Medicare payment ceilings | |
| California | Yes | CN & MN | Initiation and continuation of care | Fee for service | ||
| Colorado | Yes | CN | Plan of care required | Fee for service, using maximum daily rate | ||
| Connecticut | Yes | CN & MN | 20 hours home health aide services/week | Therapies after first visit, continued nursing care after second visit | Fee for service, enhanced payment for complex care | |
| Delaware | Yes | CN | Fee for service | |||
| District of Columbia | Yes | CN & MN | Plan of care required, 36 visits/year, 8 hours/home health aide visit, PT and OT must be in plan, SP not covered, only specified med equipment and supplies covered | Fee for service using Medicare cost ceilings | ||
| Florida | Yes | CN & MN | $2/day | 4 nursing or home health aide visits/day up to 60/lifetime, therapies not covered, only specified med equipment and supplies covered | Fee for service | |
| Georgia | Yes | CN & MN | $3/visit | 50 nursing, home health aide and therapy visits/year; 2 months med equipment rental | Therapies | Prospective cost based rate per visit |
| Guam | Yes | CN | Therapies not covered | Negotiated rate/service | ||
| Hawaii | Yes | CN & MN | One 2 hour visit/day first 2 weeks, 3 visits/week next 5 weeks, 1 visit/week next 7 weeks, then 1 visit/2 months | Initiation of care and for med equipment and supplies costing more than $50 | Fee for service | |
| Idaho | Yes | CN | 100 nursing, home health aide and therapy visits/year; oxygen and related equipment covered for specified conditions | Med equipment costing more than $100 | Fee for service using Medicare cost ceilings, med equipment rental paid at 1/10 purchase price for 10 months | |
| Illinois | Yes | CN & MN | Initiation of care | Fee for service | ||
| Indiana | Yes | CN | 120 hours of care within 30 days of hospital discharge if ordered by physician, 30 therapy sessions/month in combination with other therapy providers if ordered by physician prior to hospital discharge | Prospective cost based rates | ||
| Iowa | Yes | CN & MN | Oxygen and related equipment covered for specified conditions | Cost based payment for most services with some paid on fee for service basis | ||
| Kansas | Yes | CN & MN | $3/skilled nurse visit | 1 home health aide visit/day, therapies limited to 6 months, psychiatric nursing for homebound only, med equipment must be rented | Med equipment and supplies | Fee for service |
| Kentucky | Yes | CN & MN | Med equipment costing more than $150 | Fee for service | ||
| Louisiana | Yes | CN & MN | 50 nursing and home health aide visits/year | Therapy services, med equipment and supplies | Prospective rates based on historical cost | |
| Maine | Yes | CN & MN | $.50-$3/day, depending on payment, up to $30/month | Fee for service using Medicare cost ceilings | ||
| Maryland | Yes | CN & MN | Visit limits vary by type of service, 1 visit/type of service/day, home health aide visits require bi-weekly RN supervisory visits | Fee for service with rates set geographically | ||
| Massachusetts | Yes | CN & MN | Coverage limited by eligibility category | Fee for service using peer groups to set maximum payments | ||
| Michigan | Yes | CN & MN | Fee for service | |||
| Minnesota | Yes | A & B - See state-specific FN | 2 nursing or home health aide visits/day | After initial 9 skilled nurse visits | Fee for service | |
| Mississippi | Yes | CN | $3/visit | 60 nursing, home health aide and therapy visits/year | Yes | Fee for service with nursing facility rate as upper limit or cost based payment |
| Missouri | Yes | CN | 100 nursing and home health aide visits/year | Fee for service | ||
| Montana | Yes | A & B - See state-specific FN | $3/visit | 75 nursing visits/year; 100 visits/year including nursing, home health aide and therapy visits; services not covered at same time as personal care | Yes | Percentage of charge using a percentage of Medicare allowable cost as ceiling |
| Nebraska | Yes | CN & MN | 8 hours/day up to 40 hours/week | Initiation of care | Fee for service | |
| Nevada | Yes | CN | Initiation of care and ongoing certification of need | Fee for service | ||
| New Hampshire | Yes | CN & MN | Fee for service | |||
| New Jersey | Yes | CN & MN | Plan of care required, cost of care for 6 months must be less than in nursing facility | Care after initial visit | Cost based payment per time unit, med supplies paid fee for service | |
| New Mexico | Yes | CN | B - $7/visit - see state-specific FN | Yes | Cost based payment using Medicare upper limits | |
| New York | Yes | CN & MN | 40 visits/year and must be in lieu of hospitalization | Prospective cost based payment | ||
| North Carolina | Yes | CN & MN | Services must be restorative, services not covered during same hours as personal care or private duty nursing | Specified equipment, supplies, prosthetics and orthotics | Prospective cost based rates for nursing, home health aide and therapies; other services paid on reasonable charge basis using Medicare limits | |
| North Dakota | Yes | CN & MN | Prospective cost based rate per visit | |||
| Northern Mariana Islands | Yes | CN & MN - See territory-specific FN | Post-hospital care only, includes therapies | Yes | ||
| Ohio | Yes | CN | Fee for service for nursing, home health aide and therapies; med supplies paid 75% average list price if no payment limit available | |||
| Oklahoma | Yes | CN | $1/service | 36 visits/year, therapies not covered | Fee for service | |
| Oregon | Yes | A - See state-specific FN | A - $3/visit | Med equipment and supplies over specified cost thresholds | Fee for service | |
| Pennsylvania | Yes | CN & MN | Multiple staff/visit counts as 1 visit, 15 visits/month after first 28 days of care, 2 postpartum visits/pregnancy, 3 months rental of med equipment | Med equipment and supplies costing more than $100 | Fee for service | |
| Puerto Rico | Yes | CN & MN | Primary care physician referral required | Yes | Cost based all-inclusive payment | |
| Rhode Island | Yes | CN & MN - see state-specific FN | 8 visits/month | Med equipment and supplies, therapies | Fee for service | |
| South Carolina | Yes | CN | $2/visit, medical supplies are exempt from copayments | 75 nursing, home health aide and therapy visits/year | Med equipment and supplies | Cost based payment using Medicare upper limits for visits, med equipment paid at 50th percentile of Medicare allowable charge |
| South Dakota | Yes | CN | Specified med equipment and supplies | Fee for service, med equipment paid at 75% of charge | ||
| Tennessee | Yes | A & B - See state-specific FN | ||||
| Texas | Yes | CN & MN | Yes | Cost based payment for visits, med equipment and supplies paid fee for service | ||
| Utah | Yes | A & B - See state-specific FN | Home health aide, OT and services for patient or family convenience not covered | Services after initial evaluation | Fee for service, payment for med equipment and supplies may be negotiated | |
| Vermont | Yes | A & B - See state-specific FN | Fee for service | |||
| U.S. Virgin Islands | Yes | CN | Medical equipment and supplies | Fee for service | ||
| Virginia | Yes | CN & MN | $3/visit including all therapy services | Specified med equipment and supplies not covered | After initial 5 visits | Fee for service using geographic adjustments |
| Washington | Yes | CN & MN | 2 nurse visits/day, 1 home health aide visit/day, 3 nurse visits for high-risk pregnant women/pregnancy | Rental or purchase of med equipment and supplies, therapies provided by med rehab facility on agency order | Fee for service using prevailing charge as limit, rates vary geographically | |
| West Virginia | Yes | CN & MN | 124 nursing, home health aide, MSW and therapy visits/year | Specified med equipment and supplies | Fee for service using a percentage of Medicare rates | |
| Wisconsin | Yes | CN & MN | 30 visits/year | Fee for service using Medicare cost ceilings | ||
| Wyoming | Yes | CN | Therapy must be restorative | Visits paid fee for service, med supplies paid reasonable charge |
2003
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 56 No - 0 | Yes - 11 No - 45 | ||||
| Alabama | Yes | CN | 2 home health aide visits/week up to 104/year, therapies not covered | Cost based payment for government providers, fee for service using time units for private providers, med equipment and supplies paid fee for service | ||
| Alaska | Yes | CN | Specified med equipment | Percentage of charge | ||
| American Samoa | Yes | See territory-specific FN | Post-hospital care only, includes therapies | |||
| Arizona | Yes | CN & MN | Yes | Fee for service | ||
| Arkansas | Yes | CN & MN | 50 PT visits/year, only specified med equipment covered, med supplies covered up to $250/month | Specified med equipment | Fee for service | |
| California | Yes | CN & MN | $1/visit | 30 visits/4 months, 1 evaluation visit/6 months | Initiation and continuation of care | Fee for service |
| Colorado | Yes | CN | Plan of care required | Fee for service, using maximum daily rate | ||
| Connecticut | Yes | CN & MN | 20 hours home health aide services/week | Therapies after first visit, continued nursing care after second visit | Fee for service | |
| Delaware | Yes | CN | Fee for service | |||
| District of Columbia | Yes | CN & MN | Plan of care required, 36 visits/year, 8 hours/home health aide visit, PT and OT must be in plan, SP not covered, only specified med equipment and supplies covered | Fee for service using Medicare cost ceilings | ||
| Florida | Yes | CN & MN | $2/day | 4 nursing or home health aide visits/day up to 60/lifetime, therapies not covered, only specified med equipment and supplies covered | Fee for service | |
| Georgia | Yes | CN & MN | $3/visit | 75 nursing, home health aide and therapy visits/year; 2 months med equipment rental | Prospective cost based rate per visit | |
| Guam | Yes | CN | Therapies not covered | Negotiated rate/service | ||
| Hawaii | Yes | CN & MN | One 2 hour visit/day first 2 weeks, 3 visits/week next 5 weeks, 1 visit/week next 7 weeks, then 1 visit/2 months | Initiation of care and for med equipment and supplies costing more than $50 | Fee for service | |
| Idaho | Yes | CN | 100 nursing, home health aide and therapy visits/year; oxygen and related equipment covered for specified conditions | Med equipment costing more than $100 | Fee for service using Medicare cost ceilings, med equipment rental paid at 1/10 purchase price for 10 months | |
| Illinois | Yes | CN & MN | Initiation of care | Fee for service | ||
| Indiana | Yes | CN | 120 hours of care within 30 days of hospital discharge if ordered by physician, 30 therapy sessions/month in combination with other therapy providers if ordered by physician prior to hospital discharge | Prospective cost based rates | ||
| Iowa | Yes | CN & MN | Oxygen and related equipment covered for specified conditions | Cost based payment for most services with some paid on fee for service basis | ||
| Kansas | Yes | CN & MN | $3/skilled nurse visit | 1 home health aide visit/day, therapies limited to 6 months, psychiatric nursing for homebound only, med equipment must be rented | Med equipment and supplies | Fee for service |
| Kentucky | Yes | CN & MN | Med equipment costing more than $300 | Fee for service | ||
| Louisiana | Yes | CN & MN | 50 nursing and home health aide visits/year | Therapy services, med equipment and supplies | Prospective rates based on historical cost | |
| Maine | Yes | CN & MN | $.50-$3/day, depending on payment, up to $30/month | Fee for service using Medicare cost ceilings | ||
| Maryland | Yes | CN & MN | Visit limits vary by type of service, 1 visit/type of service/day, home health aide visits require bi-weekly RN supervisory visits | Fee for service with rates set geographically | ||
| Massachusetts | Yes | CN & MN | Coverage limited by eligibility category | Fee for service using peer groups to set maximum payments | ||
| Michigan | Yes | CN & MN | Fee for service | |||
| Minnesota | Yes | A & B - See state-specific FN | 2 nursing or home health aide visits/day | After initial 9 skilled nurse visits | Fee for service | |
| Mississippi | Yes | CN | $3/visit | 60 nursing, home health aide and therapy visits/year | Yes | Fee for service with nursing facility rate as upper limit or cost based payment |
| Missouri | Yes | CN | 100 nursing and home health aide visits/year | Fee for service | ||
| Montana | Yes | CN & MN | $3/visit | 75 nursing visits/year; 100 visits/year including nursing, home health aide and therapy visits; services not covered at same time as personal care | Yes | Percentage of charge using a percentage of Medicare allowable cost as ceiling |
| Nebraska | Yes | CN & MN | 8 hours/day up to 40 hours/week | Initiation of care | Fee for service | |
| Nevada | Yes | CN | Private duty nursing covered if specified criteria are met | Initiation of care and ongoing certification of need | Fee for service | |
| New Hampshire | Yes | CN & MN | Fee for service | |||
| New Jersey | Yes | CN & MN | Plan of care required, cost of care for 6 months must be less than in nursing facility | Care after initial visit | Cost based payment per time unit, med supplies paid fee for service | |
| New Mexico | Yes | CN | B - $5/visit - see state-specific FN | Yes | Cost based payment using Medicare upper limits | |
| New York | Yes | CN & MN | 40 visits and must be in lieu of hospitalization | Prospective cost based payment | ||
| North Carolina | Yes | CN & MN | Services must be restorative, services not covered during same hours as personal care or private duty nursing | Specified equipment, supplies, prosthetics and orthotics | Prospective cost based rates for nursing, home health aide and therapies; other services paid on reasonable charge basis using Medicare limits | |
| North Dakota | Yes | CN & MN | Prospective cost based rate per visit | |||
| Northern Mariana Islands | Yes | CN & MN - See territory-specific FN | Post-hospital care only, includes therapies | Yes | ||
| Ohio | Yes | CN | Fee for service for nursing, home health aide and therapies; med supplies paid 75% average list price if no payment limit available | |||
| Oklahoma | Yes | CN | $1/service | 36 visits/year, therapies not covered | Fee for service | |
| Oregon | Yes | CN & MN | $3/visit | Med equipment and supplies over specified cost thresholds | Fee for service | |
| Pennsylvania | Yes | CN & MN | Multiple staff/visit counts as 1 visit, 15 visits/month after first 28 days of care, 2 postpartum visits/pregnancy, 3 months rental of med equipment | Med equipment and supplies costing more than $100 | Fee for service | |
| Puerto Rico | Yes | CN & MN | Primary care physician referral required | Yes | Cost based all-inclusive payment | |
| Rhode Island | Yes | CN & MN - see state-specific FN | 8 visits/month | Med equipment and supplies, therapies | Fee for service | |
| South Carolina | Yes | CN | 75 nursing, home health aide and therapy visits/year | Med equipment and supplies | Cost based payment using Medicare upper limits for visits, med equipment paid at 50th percentile of Medicare allowable charge | |
| South Dakota | Yes | CN | Beneficiary must make an election statement | Specified med equipment and supplies | Fee for service, med equipment paid at 75% of charge | |
| Tennessee | Yes | A & B - See state-specific FN | ||||
| Texas | Yes | CN & MN | Yes | Cost based payment for visits, med equipment and supplies paid fee for service | ||
| Utah | Yes | A & B - See state specific FN | Home health aide, OT and services for patient or family convenience not covered | Services after initial evaluation | Fee for service, payment for med equipment and supplies may be negotiated | |
| Vermont | Yes | A & B - See state-specific FN | Fee for service | |||
| U.S. Virgin Islands | Yes | CN | Medical equipment and supplies | Fee for service | ||
| Virginia | Yes | CN & MN | $3/visit | Specified med equipment and supplies not covered | After initial 5 visits | Fee for service using geographic adjustments |
| Washington | Yes | CN & MN | Rental or purchase of med equipment and supplies, therapies provided by med rehab facility on agency order | Fee for service using prevailing charge as limit, rates vary geographically | ||
| West Virginia | Yes | CN & MN | 124 nursing, home health aide, MSW and therapy visits/year | Specified med equipment and supplies | Visits paid at Medicare rates, med equipment and supplies paid 90% of Medicare rates | |
| Wisconsin | Yes | CN & MN | 30 visits/year | Fee for service using Medicare cost ceilings | ||
| Wyoming | Yes | CN | Therapy must be restorative | Visits paid fee for service, med supplies paid reasonable charge |