Covered Services Under a Qualifying Home Health Plan of Care

40 - Covered Services Under a Qualifying Home Health Plan of Care (Rev. 10438, Issued: 11-06-20, Effective: 03-01-20, Implementation: 01- 11-21) Section 1861(m)of the Act governs the Medicare home health services that may be provided to eligible beneficiaries by or under arrangements made by a participating home health agency (HHA). Section 1861(m) describes home health services as • Part-time or intermittent skilled nursing care (other than solely venipuncture for the purposes of obtaining a blood sample); • Part-time or intermittent home health aide services; • Physical therapy; • Speech-language pathology; • Occupational therapy; • Medical social services; • Medical supplies (including catheters, catheter supplies, ostomy bags, supplies related to ostomy care, and a covered osteoporosis drug (as defined in §1861(kk of the Act), but excluding other drugs and biologicals); • Durable medical equipment while under the plan of care established by physician or allowed practitioner; • Medical services provided by an intern or resident-in-training under an approved teaching program of the hospital in the case of an HHA which is affiliated or under common control with a hospital; and • Services at hospitals, skilled nursing facilities, or rehabilitation centers when they involve equipment too cumbersome to bring to the home. The term "part-time or intermittent" for purposes of coverage under §1861(m) of the Act means skilled nursing and home health aide services furnished any number of days per week as long as they are furnished (combined) less than 8 hours each day and 28 or fewer hours each week (or, subject to review on a case-by-case basis as to the need for care, less than 8 hours each day and 35 or fewer hours per week). See §50.7. For any home health services to be covered by Medicare, the patient must meet the qualifying criteria as specified in §30, including having a need for skilled nursing care on an intermittent basis, physical therapy, speech-language pathology services, or a continuing need for occupational therapy as defined in this section.