Virginia Home Health Care Services Policy Manual
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This policy manual establishes the framework for compliance with 12VAC30-50-160 and 12VAC5-381, which govern home health service documentation standards and the licensure of home care organizations in Virginia. The policy ensures that providers deliver high-quality, medically necessary home health services while maintaining accurate, secure, and comprehensive records to support regulatory compliance and audit readiness. It aligns with the Virginia Department of Medical Assistance Services (DMAS) guidelines and the Department of Health’s regulations for home care organizations.
Under 12VAC30-50-160, providers must ensure that all home health services are ordered or prescribed by authorized practitioners, including physicians, nurse practitioners, clinical nurse specialists, or physician assistants. Documentation must include a face-to-face encounter record conducted within the required timeframe, a plan of care signed by the attending physician, progress notes detailing service delivery outcomes, and supervisory visit records for home health aides. Providers must also comply with Electronic Visit Verification (EVV) requirements to ensure accurate tracking of service delivery.
In accordance with 12VAC5-381, home care organizations must maintain licensure by adhering to standards for management, administration, personnel practices, infection control, client rights, and quality improvement. Organizations are required to implement robust systems for client record management, including secure storage and retention of records for at least five years post-service. Providers must also ensure compliance with on-site inspection protocols and criminal background checks for staff.
This policy emphasizes the importance of proper documentation to support Medicaid reimbursement claims, facilitate audits, and ensure compliance with state licensure requirements. By adhering to 12VAC30-50-160 and 12VAC5-381, providers can deliver safe and effective home health services while maintaining full regulatory compliance within Virginia’s healthcare framework.