Medicare Benefit Policy Manual - Centers for Medicare and ...
Medicare Benefit Policy Manual
Chapter 7 - Home Health Services
Table of Contents (Rev. 10738, 05-07-21)
Transmittals for Chapter 7
10 - Home Health Prospective Payment System (HH PPS) 10.1 - National 30-Day Period Payment Rate 10.2 - Adjustments to the 30-Day Episode Rates 10.3 - Continuous 60-Day Episode Recertifications 10.4 - Split Percentage Payment Approach to the 30-Day Period Unit of Payment 10.5 ? Requirements for Submission of "No-Pay" RAPs 10.6 - Low Utilization Payment Adjustment (LUPA) 10.7 - Partial Payment Adjustment 10.8 - Outlier Payments 10.9 - Discharge Issues 10.10 - Consolidated Billing 10.11 - Change of Ownership Relationship to Periods Under the HH PPS 10.12 - Change of Ownership Relationship to Episodes Under PPS
20 - Conditions To Be Met for Coverage of Home Health Services 20.1 - Reasonable and Necessary Services 20.1.1 - Background 20.1.2 - Determination of Coverage 20.2 - Impact of Other Available Caregivers and Other Available Coverage on Medicare Coverage of Home Health Services 20.3 - Use of Utilization Screens and "Rules of Thumb"
30 - Conditions Patient Must Meet to Qualify for Coverage of Home Health Services 30.1 - Confined to the Home 30.1.1 - Patient Confined to the Home 30.1.2 - Patient's Place of Residence 30.2 - Services Are Provided Under a Plan of Care Established and Approved by a Physician or Allowed Practitioner
30.2.1 - Definition of Allowed Practitioner
30.2. 2 - Content of the Plan of Care 30.2.3 - Specificity of Orders 30.2.4 - Who Signs the Plan of Care 30.2.5 - Timeliness of Signature 30.2. 6 - Use of Oral (Verbal) Orders 30.2.7 - Frequency of Review of the Plan of Care 30.2.8 - Facsimile Signatures 30.2. 9 - Alternative Signatures 30.2.10 - Termination of the Plan of Care - Qualifying Services 30.2.11 - Sequence of Qualifying Services and Other Medicare Covered Home Health Services 30.3 - Under the Care of a Physician or Allowed Practitioner 30.4 - Needs Skilled Nursing Care on an Intermittent Basis (Other than Solely Venipuncture for the Purposes of Obtaining a Blood Sample), Physical Therapy, Speech-Language Pathology Services, or Has Continued Need for Occupational Therapy 30.5 - Physician or Allowed Practitioner Certification and Recertification of Patient Eligibility for Medicare Home Health Services 30.5.1 - Physician or Allowed Practitioner Certification
30.5.1.1 - Face-to-Face Encounter 30.5.1.2 - Supporting Documentation Requirements 30.5.2 - Physician or Allowed Practitioner Recertification 30.5.3 - Who May Sign the Certification or Recertification
30.5.4 - Physician or Allowed Practitioner Billing for Certification and Recertification
40 - Covered Services Under a Qualifying Home Health Plan of Care 40.1 - Skilled Nursing Care 40.1.1 - General Principles Governing Reasonable and Necessary Skilled Nursing Care 40.1.2 - Application of the Principles to Skilled Nursing Services 40.1.2.1 - Observation and Assessment of the Patient's Condition When Only the Specialized Skills of a Medical Professional Can Determine Patient's Status 40.1.2.2 - Management and Evaluation of a Patient Care Plan
40.1.2.3 - Teaching and Training Activities 40.1.2.4 - Administration of Medications 40.1.2.5 - Tube Feedings 40.1.2.6 - Nasopharyngeal and Tracheostomy Aspiration 40.1.2.7 - Catheters 40.1.2.8 - Wound Care 40.1.2.9 - Ostomy Care 40.1.2.10 - Heat Treatments 40.1.2.11 - Medical Gases 40.1.2.12 - Rehabilitation Nursing 40.1.2.13 - Venipuncture 40.1.2.14 - Student Nurse Visits 40.1.2.15 - Psychiatric Evaluation, Therapy, and Teaching 40.1.3 - Intermittent Skilled Nursing Care 40.2 - Skilled Therapy Services 40.2.1 - General Principles Governing Reasonable and Necessary Physical Therapy, Speech-Language Pathology Services, and Occupational Therapy 40.2.2 - Application of the Principles to Physical Therapy Services 40.2.3 - Application of the General Principles to Speech-Language Pathology Services 40.2.4 - Application of the General Principles to Occupational Therapy 40.2.4.1 - Assessment 40.2.4.2 - Planning, Implementing, and Supervision of Therapeutic
Programs 40.2.4.3 - Illustration of Covered Services 50 - Coverage of Other Home Health Services 50.1 - Skilled Nursing, Physical Therapy, Speech-Language Pathology Services, and Occupational Therapy 50.2 - Home Health Aide Services 50.3 - Medical Social Services 50.4 - Medical Supplies (Except for Drugs and Biologicals Other Than Covered Osteoporosis Drugs), the Use of Durable Medical Equipment and Furnishing Negative Pressure Wound Therapy Using a Disposable Device 50.4.1 - Medical Supplies
50.4.1.1 - The Law, Routine and Nonroutine Medical Supplies, and the Patient's Plan of Care
50.4.1.2 - Routine Supplies (Nonreportable) 50.4.1.3 - Nonroutine Supplies (Reportable) 50.4.2 - Durable Medical Equipment 50.4.3 ? Covered Osteoporosis Drugs 50.4.4 - Negative Pressure Wound Therapy Using a Disposable Device 50.5 - Services of Interns and Residents 50.6 - Outpatient Services 50.7 - Part-Time or Intermittent Home Health Aide and Skilled Nursing Services 50.7.1 - Impact on Care Provided in Excess of "Intermittent" or "PartTime" Care 50.7.2 - Application of this Policy Revision 60 - Special Conditions for Coverage of Home Health Services Under Hospital Insurance (Part A) and Supplementary Medical Insurance (Part B) 60.1 - Post-Institutional Home Health Services Furnished During A Home Health Benefit Period - Beneficiaries Enrolled in Part A and Part B 60.2 - Beneficiaries Who Are Enrolled in Part A and Part B, but Do Not Meet Threshold for Post-Institutional Home Health Services 60.3 - Beneficiaries Who Are Part A Only or Part B Only 60.4 - Coinsurance, Copayments, and Deductibles 70 - Duration of Home Health Services 70.1 - Number of Home Health Visits Under Supplementary Medical Insurance (Part B) 70.2 - Counting Visits Under the Hospital and Medical Plans 80 - Specific Exclusions From Coverage as Home Health Services 80.1 - Drugs and Biologicals 80.2 - Transportation 80.3 - Services That Would Not Be Covered as Inpatient Services 80.4 - Housekeeping Services 80.5 - Services Covered Under the End Stage Renal Disease (ESRD) Program 80.6 - Prosthetic Devices 80.7 - Medical Social Services Furnished to Family Members 80.8 - Respiratory Care Services 80.9 - Dietary and Nutrition Personnel
80.10- Telecommunications Technology
90 - Medical and Other Health Services Furnished by Home Health Agencies 100 - Physicianor or Allowed Practitioner Certification for Medical and Other Health
Services Furnished by Home Health Agency (HHA) 110 - Use of Telehealth in Delivery of Home Health Services
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