§ 40-18-4. Payment for long term home health care programs. (a) When a long-term home health care 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 health care 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 day care 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 health care persons in addition to those services included in the medical assistance program under chapter 18 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 such 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 health care program while payments are being made for that person for inpatient care in a skilled nursing and intermediate care facility or hospital.

History of Section. (P.L. 1988, ch. 451, § 1; P.L. 2006, ch. 216, § 26.)