Family and Children's Medicaid MA-3540 Medicaid Covered Services

Xix. In-Home Care for Adults (IHCA) and In-Home Care for Children (IHCC).

Beginning June 1, 2011 the North Carolina Department of Health and Human Services Division of Medical Assistance (DMA) discontinued the Medicaid Personal Care Services Program and implemented two new programs: In-Home Care for Adults (IHCA) age 21 and over and In-Home Care for Children (IHCC) under age 21.

The In-Home Care (IHC) Programs provide person-to-person, hands-on assistance with common Activities of Daily Living (ADL). This assistance is delivered by a paraprofessional aide in the recipient’s home. The program is for recipients who need assistance to supplement care provided by family members and other caregivers.

IHC is non-skilled care is not considered as a substitute for skilled home health care services (e.g., nursing, physical therapy, occupational therapy, speech therapy, etc.), which may be indicated to improve the patient’s function/condition.

Refer to, https://www.thecarolinascenter.org/default.aspx?pageid=176

for specific coverage criteria, prior approval requirements, and service limitations regarding In Home Care for Adults (IHCA) and In-Home Care for Children (IHCC).

NOTE: For recipients under the age of 21 relative to EPSDT requirements, see I. and XXXVIII. of this manual section.

REVISED 08/01/11 – CHANGE NO. 14-11

(XIX)

A. In Home Care (IHC) Covered Services

In Home Care (IHC) tasks may include assistance with such activities as bathing, toileting, positioning, ambulation, and taking and recording vital signs, etc. Housekeeping and home management tasks that are essential, although secondary, to the in home care tasks necessary for maintaining the recipient’s health are also covered.

B. Non-Covered Services

1. Skilled medical care performed by licensed professionals, such as a registered nurse or licensed practical nurse

2. IHC provided by the recipient’s spouse, child, parent, sibling, grandparent, grandchild, or equivalent step or in-law relationship to the recipient or willing/able family members or other informal caregivers available on a regular basis adequate to meet the recipient’s need for personal assistance

3. Housekeeping and home management tasks not directly related to maintaining the recipient's health status

4. Medical transportation

C. Restrictions

1. IHCA and IHCC services do not count towards a recipient’s professional services visit limit.

2. IHC must be authorized by recipient's attending physician.

3. The recipient must have a medical condition that requires the direct ongoing care of the physician prescribing IHC.

4. The recipient must need help with personal care tasks because of the medical condition.

5. The recipient must be medically stable at maintenance level.

6. IHC must be the most cost-effective and appropriate form of care.

7. Medicaid covers IHC only for recipients in a private residence.

8. The recipient may not receive both IHC and another substantially equivalent service, such as Home Health Aide Services, In-Home Aide Level II, or In-Home Aide Level III-Personal Care, on the same day.

REVISED 08/01/11 – CHANGE NO. 14-11

(XIX. C.)

NOTE: Relative to number 9 above and for recipients under the age of 21 in regard to EPSDT requirements, see I. and XXXVIII. of this manual section.

D. Copayments

There are no copayments for IHCA or IHCC.

E. Prior Approval

1. Prior approval is required for IHCA or IHCC services.

Refer to, https://www.thecarolinascenter.org/default.aspx?pageid=176

for specific coverage criteria, prior approval requirements, and service limitations regarding In Home Care for Adults (IHCA) and In-Home Care for Children (IHCC).

2. Prior approval is required for MPW recipients.