What does home health care include?
With improvements in medical sciences and technology, many treatments that could once only be done in a hospital can now be performanced in a patient’s home. Not only is home health usually less expensive, but it is often just as effective as caring for a patient in a hospital or skilled nursing facility. Short-term home health care focuses on treating an illness or injury, with the ultimate goal of helping patients regain their independence and become as self-sufficient as possible. On the other hand, long-term home health care is best suited for chronically ill or disabled patients and aims to help those individuals learn to live with their conditions.1
Home health care includes physical and occupational therapy, speech/language therapy, and medical social services. These services are provided by a variety of skilled health care professionals in the comfort of a patient’s home in order to coordinate the care and/or therapy recommended by a patient’s doctor. Home health staff teach the patient and/or any caretakers how to continue caring for the patient, which may include administering medication, wound care, therapy, and stress management. This education is particularly important for patients and their informal caregivers because most home health care is intermittent and part-time, meaning that there are limitations on the number of hours per day and days per week that patients can get skilled nursing or home health aide services.1,2
What does home health care not include?
Medicare home health care often gets confused with home-based primary care (HBPC), or the modern-day “house call.” Home health is often provided after a patient is hospitalized (e.g. following surgery) by nurses and physical, occupational, and speech therapists. To qualify, patients must have a Medicare-skilled need and a licensed provider. Despite the differences between short- and long-term home health, care does not typically last longer than two months.3
Meanwhile, HBPC is longitudinal and provides care for as long as a patient needs it, especially since many of these patients are the most medically complex (and therefore more costly to the health care system), in addition to being homebound and lacking continuous follow-up care. While HBPC patients may temporarily have some home health incorporated into their care for additional nursing and therapy services, they eventually stabilize and no longer require the skilled services associated with home health care. HBPC also provides significant palliative care services and commonly partners with palliative and hospice providers.3
Additionally, Medicare home health is not considered a long-term services and support (LTSS) program and does not provide unlimited 24/7 coverage. It also excludes custodial or personal care (if that is the only home care needed), household services (e.g. shopping, cleaning, and laundry when not related to a patient’s care plan), and meal deliveries. Home health care is limited to providing skilled care (instead of supporting activities of daily living, which is covered by Medicaid) and includes fewer than eight hours per day and less than 28 hours per week.3,4
How is home health care funded?
Patients have the option to select the home health agency that provides them with care, but their choices can be limited by agency availability or Medicare requirements. Some hospitals have their own home health agency (HHA) for patients to choose. However, if a patient is in a Medicare health plan, he or she may have to select an agency that is certified by Medicare, as Medicare will only pay for home health services provided by a home health agency that meets its standards.1
Additionally, patients must meet all of the following conditions in order to be eligible for Medicare-covered home health care:
- The patient’s provider determines that the patient requires medical care at home.
- The patient needs at least one of the following: intermittent (less than eight hours a day) skilled nursing care or physical, speech/language, and/or continued occupational therapy.
- The patient must be homebound or unable to leave his or her home without assistance.
- The home health agency must be a Medicare-certified program.1
If the above conditions are met, Medicare will cover the cost of the following on a part-time or intermittent basis:
- Skilled nursing care, which includes services and care that can only be performed by a registered nurse or a licensed practical nurse.
- Home health aide services, which can be completed by a professional that does not have a nursing license and include help with personal care, like bathing, using the toilet, or dressing. These services are not covered by Medicare unless the patient is also receiving skilled care.
- Physical, speech/language, and occupational therapy for as long as recommended by the patient’s doctor.
- Medical social services, such as counseling or help with finding resources in the community, to assist patients with social and emotional concerns related to their illness.
- Some medical supplies, like wound dressings. This does not include prescription drugs or biologicals.
- Medical equipment, like a wheelchair or walker.1
On the other hand, Medicare will not pay for:
- 24-hours-a-day care at home;
- Prescription drugs;
- Meal deliveries;
- Homemaker services, like shopping, cleaning, and laundry;
- Personal care provided by home health aides (like bathing, using the toilet, or help with getting dressed) when this is the only assistance that a patient needs.1
In 2020, the Centers for Medicare and Medicaid Services (CMS) implemented a new prospective payment system with a Patient-Driven Groupings Model (PDGM) that shifts reimbursement toward bundled payments based on patients’ clinical characteristics instead of fee-for-service payments based on the volume of therapy visits. As a result, home health providers receive two separate payments when care is initiated and when the episode of care is complete within 30 days. The motivation to change how CMS paid for home health services was rooted in an attempt to reduce costs while improving outcomes.2
Additionally, the Coronavirus Aid, Relief, and Economic Security (CARES) Act was also passed in March 2020 as a $3 trillion stimulus package. In particular, the plan allocated $100 billion to health care providers, $40 billion of which was distributed to hospitals LTSS providers, including home health agencies that bill Medicare.2
For patients with low incomes and limited resources, some state programs like Medicaid may offer support for basic home health care and medical equipment. That being said, Medicaid coverage does differ from state to state.1