June 16, 2016

Home Health Agencies in Jurisdiction M

By Bonny Kohr, Senior Manager, Advisory Services

Home Health Agencies in Jurisdiction M

Palmetto GBA the Jurisdiction M Medicare Administrative Contractor (MAC) for home health has updated the Type II Diabetes Local Coverage Determination (LCD – L35132) once again. This includes providers in Alabama, Arkansas, Florida, Georgia, Illinois, Indiana, Kentucky, Louisiana, Mississippi, New Mexico, North Carolina, Ohio, Oklahoma, South Carolina, Tennessee, and Texas.

Home health agencies who have Palmetto GBA as their MAC will no longer be at risk for a denial or down code when failing to obtain a copy of an HbA1c result when providing care to a patient with Type II Diabetes. Based on a response to the 16 State Coalition LCD reconsideration request, Palmetto GBA has removed the language in the LCD which required the home health agency to obtain a copy of the most recent HbA1c results and include monitoring for HbA1c levels quarterly for all patients who had Diabetes Type II listed as one of the diagnoses on the Plan of Care.

The goal of the LCD is to ensure that home health agencies include evidence-based medicine which address the increased risk of complications of diabetes mellitus in the care of their patients. In order to support this goal the following LCD language has replaced the previous language in the LCD “physicians and home health agencies should consider the inclusion of HbA1c testing in the Home Health Plan of Care.”

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