The Basics of Skilled Home Health Care

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Home health care is medically necessary skilled care provided by a nurse or therapist from a licensed home health agency for an episode of illness or injury usually following, or in lieu of, hospitalization.
The care is provided in intermittent visits in the patient's home or place of residence such as an assisted living facility, board and care home, etc. It is not provided as shift care or meant to replace a primary caregiver.
There are 3 main criteria that MUST be met in order for home health care to be provided.
  1. The patient must be HOMEBOUND. This may be temporary but in effect for the duration of the home care.
  2. The care must be medically necessary and provided for a SKILLED NEED.
  3. The care must be ordered by and overseen by a physician, podiatrist or doctor of osteopathy. (NOTE: PAs and NPs were approved for this by the CARES Act in 2020.)

The RULES regarding recent Face-to-Face visits with the ordering physician have changed multiple times since 2011 and more changes are probably on the way. Please be sure to check with your Intermediary for guidance if you have questions. NPs and PAs can also make the face-to-face visits. CMS offers this powerpoint presentation to answer burning questions.
 A TEAM of professionals including nurses, home health aids, social workers, physical, occupation and speech/language therapists, and dieticians provides the skilled home health care.
Home health care is provided by licensed home health agencies following the Conditions of Participation and guidelines set up by Congress and Medicare specified in the HIM11. It is reimbursed by Medicare, Medicaid and most private insurance companies.

OASIS (Outcome and Information Assessment Set) data is collected at various points during an episode of care such as the Start of care, Recertification (every 60 days), and Discharge. If the patient is transferred to a hospital and resumed by home care upon returning home, data is collected at these points as well.

This data reflects the medical diagnosis and necessity; the functional status; and the social status of the patient at each of these points. The data is encrypted and transmitted to Medicare for analysis on all patients over 18. It is required for reimbursement from Medicare.

Home health care is a short-term episode of care to help the patient transition from the illness or injury back to his/her prior level of care or to a new level of care if necessary. Discharge planning begins at the start of care. The patient and/or an able and willing caregiver are expected to participate in the plan of care and to assume as much of the care as possible as quickly as possible under the direction of the nurse or therapist and the physician.
The Home Health Care Team
Homebound Status
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