Post-Institutional Home Health Services Furnished During A

60.1 - Post-Institutional Home Health Services Furnished During A Home Health Benefit Period - Beneficiaries Enrolled in Part A and Part B (Rev. 1, 10-01-03) A3-3122.1, HHA-212.1, A3-3122.1, HHA-212.2, PMs A-97-12, A-97-16, A-98-49 Section 1812(a)(3) of the Act provides post-institutional home health services for individuals enrolled in Part A and Part B and home health services for individuals who are eligible for Part A only. For beneficiaries who are enrolled in Part A and Part B, Part A finances post-institutional home health services furnished during a home health spell of illness for up to 100 visits during a spell of illness. Part A finances up to 100 visits furnished during a home health spell of illness if the following criteria are met: • Beneficiaries are enrolled in Part A and Part B and qualify to receive the Medicare home health benefit; • Beneficiaries must have at least a three consecutive day stay in a hospital or rural primary care hospital; and • Home health services must be initiated and the first covered home health visit must be rendered within 14 days of discharge from a 3 consecutive day stay in a hospital or rural primary care hospital or within 14 days of discharge from a skilled nursing facility in which the individual was provided post-hospital extended care services. If the first home health visit is not initiated within 14 days of discharge, then home health services are financed under Part B. After an individual exhausts 100 visits of Part A post-institutional home health services, Part B finances the balance of the home health spell of illness. A home health spell of illness is a period of consecutive days beginning with the first day not included in a previous home health spell of illness on which the individual is furnished post- institutional home health services which occurs in a month the individual is entitled to Part A. The home health spell of illness ends with the close of the first period of 60 consecutive days in which the individual is neither an inpatient of a hospital or rural primary care hospital nor an inpatient of a skilled nursing facility (in which the individual was furnished post-hospital extended care services) nor provided home health services. EXAMPLE 1: An individual is enrolled in Part A and Part B, qualifies for the Medicare home health benefit, has a three consecutive day stay in a hospital, and is discharged on May 1. On May 5, the individual receives the first skilled nursing visit under the plan of care. Therefore, post-institutional home health services have been initiated within 14 days of discharge. The individual is later hospitalized on June 2. Prior to the June 2 hospitalization, the individual received 12 home health visits. The individual stays in the hospital for four consecutive days, is discharged and receives home health services. That individual continues the May 5 home health spell of illness and would have 88 visits left under that home health spell of illness under Part A. That individual could not start another home health spell of illness (100 visits under Part A) until a 60-day consecutive period in which the individual was not an inpatient of a hospital, rural primary care hospital, an inpatient of a skilled nursing facility (in which the individual was furnished post-hospital extended care services), or provided home health services had passed. EXAMPLE 2: An individual is enrolled in Part A and Part B, qualifies for the Medicare home health benefit, has a three consecutive day stay in a hospital, and home health is initiated within 14 days of discharge. The individual exhausts the 100 visits under Part A post- institutional home health services, continues to need home health services, and receives home health services under Part B. The individual is then hospitalized for 4 consecutive days. The individual is again discharged and receives home health services. The individual cannot begin a new home health spell of illness because 60 days did not pass in which the individual was not an inpatient of a hospital or rural primary care hospital or an inpatient of a skilled nursing facility in which the individual was furnished post- hospital extended care services. The individual would be discharged and Part B would continue to finance the home health services.