Section 366-E. Certified home health agency medicare billing  


Latest version.
  • (a) Certified
      home health agencies shall bill under title XVIII of the federal  social
      security  act  for  services  provided to all patients eligible for such
      program who, as  defined  by  federal  law  and  regulations,  are:  (i)
      homebound; (ii) receiving skilled services; and (iii) are receiving such
      services  on an intermittent basis. The department, in consultation with
      the department of health and representatives of  certified  home  health
      agencies  with  demonstrated  ability  to maximize medicare revenue, may
      promulgate regulations to implement this subdivision. Nothing  contained
      herein  shall be construed to prohibit agencies from billing for medical
      assistance reimbursement for eligible services provided to such patients
      which are not covered under title XVIII of the federal  social  security
      act meeting the standards established by the department pursuant to this
      section.    Patient cases that meet the criteria established pursuant to
      this subdivision, where coverage has been denied under  title  XVIII  of
      the  federal  social  security  act  for  the cost of care provided by a
      certified home health agency shall be referred  by  such  agency  to  an
      organization pursuant to subdivision (b) of this section.
        (b)  The  commissioner  shall  enter  into  agreements with persons or
      entities to provide for representation of persons meeting  the  criteria
      specified  in  subdivision  (a)  of  this  section  who have been denied
      reimbursement, under title XVIII of the federal social security act, for
      services provided by a certified home health agency.