Requirements for Medicaid PA Coverage
You may qualify for Adaptive home healthcare if you are eligible to receive Medicaid or Medicaid Waiver. Once a referral is made, one of our RN Clinical Managers (CM) will contact your primary care physician to obtain a written order to assess for homecare services. Once this is received, our CM will conduct a full, hands on, nursing assessment to determine each clients specific healthcare needs, as well as evaluating the home to ensure that it will be a safe working environment for our greatest asset, our caregivers. In addition to medical condition of the client, all potential caregivers must be accounted for. The state requires written documentation for able caregivers that could exclude them from providing care for their loved one. Generally this means a work letter, school schedule, or in some circumstances disability papers that document why a family member is unable to fully care for the client. Once these documents are received, the CM will draft a client specific plan of care, which is then signed by the client’s primary physician, ensuring that the services are necessary and appropriate. This care plan, as well as the aforementioned family member documents, are then presented to the state for approval. Based on their review, generally, the state will approve the PA (prior authorization) for up to 6 months.