CMS Publication No. 11357

August 2008

www.medicare.gov/HHCompare

KNOW YOUR RIGHTS

If Medicare doesn’t pay for a service or supply, the home health agency will give you a Home Health Advance Beneficiary Notice to sign. This notice says 

Medicare probably (or certainly) won’t pay for the item or service. Read this notice carefully because if you sign and Medicare doesn’t cover the item or service, you may be responsible for paying the entire cost. Your home health agency will also give you a notice called the Notice of Medicare Provider Non-Coverage before your Medicare-covered services end. If you think your Medicare-covered home health services are ending too soon, you may have the right to a fast appeal (also called an “expedited review” or an “immediate appeal”). Your Notice of Medicare Provider Non-Coverage gives instructions on how to ask for a fast appeal. Ask your doctor for any information that may help your case. If you ask for this fast appeal, an independent reviewer will decide if your services should continue. You have the right to be included in decisions about your treatment, the right to a fair process to appeal decisions about coverage and payment of services, and the right to privacy and confidentiality. For more information, read the free booklet “Your Medicare Rights and Protections,” visit www.medicare.gov, or call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

WHERE CAN I GET MORE INFORMATIO

You can view or print Medicare publications and fi nd helpful phone numbers and websites by visiting www.medicare.gov ocalling 1-800-MEDICARE (1-800-633-4227). TTY users shocall 1-877-486-2048. • To get a report on a particular home health agency, call 

your State Survey Agency. 

• Compare how well home health agencies in your area c

for patients (their quality) by visiting www.medicare.gov

• To learn more about eligibility, coverage, and cost 

information, read the free booklet “Medicare and Home Health Care.”

• For help with home health care bills, call your Regional 

Home Health Intermediary (RHHI).

• For free health insurance counseling and personalized h

call your State Health Insurance Assistance Program (SHI

• Learn more about your right to appeal coverage and 

payment decisions.

CENTERS FOR MEDICARE & MEDICAID SERVICE
S O YO U R D O C TO R S AYS YO U NEED HOME HEALTH C ARE

LET’S GET STARTED.

1 - 8 0 0 - M E D I C A 

Home health care provides skilled nursing care, physical and occupational therapy, speechlanguage pathology services, and medical social services ordered by your doctor and delivered in the comfort of your home. Usually, a home health care agency coordinates these services. Health care professionals from a Medicare-certifi ed home health agency work with you and your doctor to evaluate your health care needs and write your plan of care, which tells you what home care services you need. The home health agency staffwill teach you and your caregiver(s) (family or friends who are helping you) to continue any care you may need, including wound care, therapy, and disease management. The goal is to help you reach and keep your best physical, mental, and social well-being.If you’re leaving a facility like a hospital or skilled nursing facility, the discharge planner may help set up home health care for you. Although you have a say in which agency you use, your choices may be limited by the services the agency provides, your insurance coverage, or whether the agency is available.

WHAT’S COVERED

For Medicare to cover home health services, they must be reasonable and necessary for the treatment of an illness or injuA Medicare-certified home health agency may provide the 

following services: • Skilled nursing care on a part-time or intermittent basis by 

registered nurse or a licensed practical nurse 

• Physical therapy, speech-language pathology services, and 

occupational therapy

• Home health aide services on a part-time or intermittent ba

(like help with personal care such as bathing, using the toilor dressing) and medical social services (such as counseling or help finding resources in your community) if you are alsgetting skilled care such as nursing care or other therapy frthe home health agency

• Certain medical supplies, like wound 

dressings, that are ordered as part of youcare 

• Durable medical equipment (like a walk