HOME HEALTH SERVICES

DELIVERING HOME HEALTH SERVICES

Serving our BlueCare^℠ and TennCareSelect members

As a home care agency, it's important to use the appropriate forms to ensure services are authorized and members and their families are well-informed. Review the forms below and additional FAQ documents to help you best serve your patients.

• Private Duty Nursing/Home Health Plan of Care

  Submit the Private Duty Nursing/Home Health Plan of Care form with the prior authorization request after the initial assessment is completed, no later than 30 days from admission or receiving revised orders, and annually.

• Private Duty Nursing Home Plan of Care Agreement

  Use the Private Duty Nursing Home Plan of Care Agreement to review the expectations and responsibilities of receiving private duty nursing.

• Initial Member/Caregiver Training Checklist

  Include the completed and signed Initial Member/Caregiver Training Checklist within 60 days after an initial admission.

• Recertification Member/Caregiver Training Checklist

  Submit the Recertification Member/Caregiver Training Checklist with each recertification to continue or increase private duty nursing and/or home health services after completing the initial admission and initial member/caregiver training checklist. Don't submit this form unless the Initial Training Checklist has been completed.

• Home Health Critical Incident Form

  There may be times when concerning situations - a Home Health Critical Incident - occur while your staff is providing care in a patient's home. Home Health Critical Incidents include major/severe injuries, etc., and you should report them using our Home Health Critical Incident Form.

• Members Turning 21

  BlueCare Provider FAQ for Members Turning 21

  After a person turns 21, they can only get limited home health care. Throughout the transition process, which starts at age 18 through the member's 21st birthday, we work with our members to help them find services that are covered by their adult benefits and can meet their needs through (but not limited to) a series of assessments, face-to-face visits, an overview of member materials, and a discussion with the member's providers. This may also include enrollment into one of our Managed Long-Term Services and Supports programs. During this transition period, members currently enrolled in TennCareSelect will also need to complete a managed care organization (MCO) selection form to indicate the MCO of their choice. Review the FAQ document above to learn more.

• Missed Visits

  Agencies must report missed visits within three calendar days by submitting a completed Home Health Missed Visit Form. Home health agencies must have a backup plan to handle missed visits, and this plan should take effect as soon as an agency learns a visit is or will be missed. See these FAQs for more about missed visits: Provider FAQ - Amendment Nine Missed Visit Reporting Requirements.