1. A system of periodic interpretive guidance letters to inform providers regarding reimbursement policies and procedures;

2. A system to provide timely responses to inquiries regarding the rules of reimbursement; and

3. A process for appeals of payment claims. The process must provide for payment to the provider if a patient is found to be eligible and the claim is otherwise appropriate.

The rules must require the department to estimate the administrative cost to providers of each rule change proposed by the department; and be it further

Sec. 2. Report. Resolved: That by January 15, 2002 the Department of Human Services, Bureau of Elder and Adult Services shall report to the joint standing committee having jurisdiction over health and human services matters regarding implementation of a prospective payment system for Medicaid home health care benefits, based on the Medicare system; and be it further

Sec. 3. Data publication. Resolved: That the Department of Human Services, Bureau of Elder and Adult Services shall annually publish data on home health care provided under the Medicaid program. The data must include information on the number of persons provided benefits, the types and volume of services, the geographic distribution of services, the number of persons determined to be qualified and awaiting services, the number of persons determined to be ineligible and the reasons for ineligibility, the cost of preauthorization for services and the total of expenditures.

SUMMARY

This resolve requires action by the Department of Human Services with regard to the home health care benefit provided under the Medicaid program. It requires interpretive guidance letters, an appeals process for payments and an estimate of administrative costs to providers. It requires a report on a home health care prospective payment system in Medicaid. It requires an annual report of data with regard to home health care benefits.