What are Home Health Services?
Home Health Services are Medicaid State Plan services that are provided on a part-time and intermittent basis to Medicaid consumers of any age. Home health services include home health nursing, home health aide, and skilled therapies (physical therapy, occupational therapy, and speech-language pathology). The only provider of home health services is a Medicare Certified Home Health Agency (MCRHHA).
The medical necessity for home health services must be certified by the consumer's qualifying treating physician. A face-to face encounter with the consumer and the physician, advanced practice nurse in collaboration with the physician, or a physician assistant under the supervision of the physician is required for certification of medical necessity. A face-to-face encounter must be conducted within the 90 days prior to the home health care start-of-care date, or within 30 days following the start-of-care date, inclusive of the start-of-care date.
Part-time and intermittent basis for home health services means:
- No more than a combined total of 8 hours per day of home health nursing, home health aide, and skilled therapies.
- No more than a combined total of 14 hours per week of home health nursing and home health aide services except as covered by the post-hospital benefit and for consumers under age 21 with medical need for increased services as ordered by the treating physician.
- Visits are not more than four hours. Typically, most visits are less than two hours.
Who is eligible to receive home health services?
In order to be eligible to receive home health services, the consumer must be eligible for Medicaid with some caveats:
- Consumers enrolled in the Program for the All-inclusive Care of the Elderly (PACE) must access home health services through PACE.
- Consumers who have elected hospice care must access home health services through the hospice benefit. However, children under age 21 who are receiving concurrent curative treatment with hospice care may receive home health services related to the curative treatment.
- Consumers enrolled in a Medicaid managed care plan must access home health services through their managed care plan.
What must a MCRHHA do in order for home health services to be covered?
- Be a Medicaid provider
- Obtain certification of medical necessity from the treating physician
- Provide services specified in the plan of care including amount, scope, duration, and type of home health services.
- Follow the all services plan for a consumer enrolled in a home-and-community based services (HCBS) waiver administered by ODJFS, or the service plan for a consumer enrolled in a HCBS waiver administered by the Ohio Department of Aging or the Ohio Department of Developmental Disabilities.
- Follow home health services rules in accordance with Chapter 5101:3-12 of the Ohio Administrative Code.
What are Private Duty Nursing Services and how are they different from Home Health Services?
Private Duty Nursing Services are Medicaid State Plan skilled nursing services that are provided on a continuous basis to Medicaid clients of any age in their home.
Home Health Services are Medicaid State Plan services that are provided on a part-time and intermittent basis to Medicaid clients of any age. Home Health services include home health nursing, home health aide, and skilled therapies (physical therapy, occupational therapy, and speech-language pathology).
Questions about Home Health Services? Call (614)466-6742 or email BCSP@medicaid.ohio.gov