Home Visits by Medical Personnel


Home Visits by Medical Personnel are individually designed services to provide diagnosis, treatment and wellness monitoring in order to preserve the waiver participant's functional capacity to remain in his/her own home. Wellness monitoring is critical to the overall health of the waiver participant. Wellness monitoring includes disease prevention, the provision of health education and the identification of modifiable health risks. Through increased awareness and education, the waiver participant is more apt to make healthy lifestyle choices which will decrease the likelihood of unnecessary institutionalization. The frequency of wellness monitoring will be contingent on the waiver participant's needs.

Home visits by Medical Personnel must be needed to decrease the likelihood of exacerbations of chronic medical conditions and unnecessary and costly emergency room visits, hospitalizations and nursing facility placement. In addition to assessing the waiver participant, this service will also include the evaluation of the home environment from a medical perspective and the waiver participant's natural (informal) supports' ability to maintain and/or assume the role of caregiver. The provider's assessment of the natural (informal) supports/caregivers will not be one in which a physical exam is performed; instead the assessment will focus on the natural (informal) supports'/caregivers' relationship to the waiver participant in terms of the physical, social and emotional assistance that is currently provided or may be provided in the future. Based on the outcome of this assessment, the provider of this service can make referrals for or request that the SC make referrals for additional assistance as appropriate, thus promoting the ability of the waiver participant to remain at home. The provision of this service allows the waiver participant to remain in the least restrictive setting. This service will enhance the quality of medical care and the quality of life of the waiver participant.

Home Visits by Medical Personnel differs from what is offered under the State Plan as this waiver service is used for wellness monitoring, the assessment of the natural (informal) supports'/caregivers' ability to provide assistance to the waiver participant, and/or the evaluation of the waiver participant's home environment from a medical perspective.

This service is especially beneficial for those waiver participants who have significant difficulty traveling or are unable to travel for needed medical care provided by a physician, physician's assistant or nurse practitioner because of:

  1. severe mobility impairments;
  2. terminal illness;
  3. when travel is contraindicated due to the person's chronic condition;
  4. severe pain;
  5. when medical providers at a physician's office and/or transportation providers refuse to provide services due to an individual's disruptive behavior;
  6. the home visit is cost-effective; or
  7. where transportation to medical appointments is limited due to geographical considerations.

The Medical Personnel will perform a comprehensive assessment of the physical, psychosocial, environmental and economic factors in the waiver participant's own environment that could affect the waiver participant's health and welfare and the ability to remain in the community. This comprehensive assessment and medical follow-up in the waiver participant's home is intended to improve the waiver participant's functioning. As a result of this improved functioning, and by having the Medical Personnel complete a comprehensive assessment in the waiver participant's home, the Medical Personnel is more apt to detect conditions in the home environment that negatively affect the waiver participant's health and welfare and respond accordingly. This preventive activity is expected to decrease the likelihood of accidents in the home, lower the waiver participant's and caregiver's stress level, increase the quality of medical care provided to the waiver participant and increase the efficiency of medication management which will promote the waiver participant's ability to remain at home.

As part of the home visit, the medical personnel will evaluate safety issues and other conditions in the home from a medical perspective. Medical Personnel will conduct a basic assessment of the home environment in relation to the waiver participant's health and welfare. Any concerns about the home environment that may affect the waiver participant's health and welfare will be shared with the SC and other relevant members of the team.

The Medical Personnel are an integral part of the waiver participant's service provider team. It is the responsibility of the Medical Personnel to inform the SC of any recommendations for services that will meet the waiver participant's medical needs and other significant findings. The SC will utilize this information in revising the waiver participant's SP.

Provider Qualifications

Home Visits by Medical Personnel must be provided by a Physician in Private Practice or a corporation licensed pursuant to Public Health Law Article 28. Persons providing Home Visits by Medical Personnel shall be a:

  1. Physician - Licensed pursuant to NYS Medicine Education Law;
  2. Licensed Nurse Practitioner - Licensed pursuant to NYS Education Law; or
  3. Licensed Physician's Assistant - Licensed pursuant to Medicine Education Law.


Home Visits by Medical Personnel must be provided by a DOH approved provider and must be included in the SP to be reimbursed.

Home Visits by Medical Personnel are provided on an individual basis and billed in twenty (20) minute units with a maximum of three (3) units per visit.

Home Visits by Medical Personnel providers participating in Team Meetings will be reimbursed at regular rate for attendance at these meetings.