Iowa's Supreme Court strikes down a portion of the state's Medicaid statute permitting home health visits only for intermittent care, ruling that federal law calls for coverage of home health care services that are required on a part-time basis as well. TLC Home Health Care, L.L.C., v. Iowa Dept. of Human Services (Sup. Ct. Iowa, No. 175/00-0255, Jan. 24, 2002).
Ardeth Blackwell suffers from diabetes and is eligible for both Medicare and Medicaid. Due to other chronic illnesses, Ms. Blackwell is unable to administer her own insulin injections. TLC Home Health Care provided Ms. Blackwell twice-daily insulin injections through home health care visits. TLC charged nearly $14,000 a month for these skilled nursing visits
Medicare denied payment for the visits because Ms. Blackwell is not considered homebound. Medicaid also refused payment because the visits were not a covered service under the Iowa Medicaid statutes, which provide nursing services through home health agencies only on an intermittent basis. Ms. Blackwell's care failed to meet the statutory requirements for intermittent skilled nursing services. TLC appealed, arguing that the federal Medicaid statute requires coverage of home health care services on both part-time and intermittent bases. TLC further argued that Medicare's exception to the intermittent requirement allowing coverage for insulin injections applies to Ms. Blackwell. Because Medicaid is silent on the issue, TLC reasoned, the Iowa Department of Human Services Department must follow Medicare law and read the insulin injection exception into the Iowa Medicaid statute. The district court affirmed the Department, and TLC appealed.
The Iowa Supreme Court reverses in part, holding that federal law requires states to provide home health care services whether they are required on either a part-time or an intermittent basis. In covering only intermittent services, the Iowa statute conflicts with the federal statute, the court ruled. The court rejects the Department's argument that the phrase "part-time or intermittent" in the federal statute permits states to choose one or the other. 42 C.F.R. § 440.70. The court, however, agrees with the Department that Iowa is not required to include Medicare's insulin injection exception in its Medicaid plan.
For the full-text of this decision, click here.
Subscribe to the Knowledge Bank.
