(Medicare Benefit Policy Manual)

If a beneficiary is enrolled only in Part A and qualifies for the Medicare home health benefit, then all of the home health services are financed under Part A.  The 100- visit limit does not  apply to beneficiaries who are only enrolled in Part A.  If a beneficiary is enrolled only in Part B and qualifies for the Medicare home health benefit, then all of the home health services are financed under Part B.  There is no 100- visit limit under Part B.  The new definition of post -institutional home health services provided during a home health spell of illness only applies to those beneficiaries who are enrolled in both  Part A and Part B and qualify for the Medicare home health benefit.  60.4 - Coinsurance, Copayments, and Deductibles  (Rev.  233, Issued: 02-24-17, Effective: 01-01-17, Implementation: 03-27-17)  There is no coinsurance, copayment, or deductible for home health services and supplies other than the following:   coinsurance required for durable medical equipment (DME) and furnishing NPWT using a disposable device covered as a home health service; and    deductible and coinsurance for the osteoporosis drug, which is part of the home health benefit only paid under Part B.  The coinsurance liability of the beneficiary for DME and the osteoporosis drug furnished as a home health service is 20 percent of the fee schedule amount for the services.  Coinsurance for furnishing NPWT using a disposable device as a home health service is 20 percent of the payment amount.  70 - Duration of Home Health Services  (Rev. 1, 10-01-03) A3-3123, HHA-215, A3-3123.1, HHA-215.1  70.1 - Number of Home Health Visits Under Supplementary Medical Insurance (Part B)  (Rev. 1, 10-01-03) A3-3123.2, HHA-215.2  To the extent that all coverage requirements are met, payment may be made on behalf of eligible beneficiaries under Part B for an unlimited number of covered home health visits.  The determination of Part A or Part B Trust Fund financing and coverage is made in accordance with the financing shift required by the BBA described above in 60.  70.2 - Counting Visits Under the Hospital and Medical Plans  (Rev. 10438, Issued: 11-06-20, Effective: 03-01-20, Implementation: 01- 11-21)   A.  Visit Defined   A visit is an episode of personal contact with the patient by staff of the HHA, or others under arrangements with the HHA, for the purpose of providing a covered home health service.  Though visits are provided under the HH benefit as part of 30-day periods, and periods are unlimited, each visit must be uniquely billed as a separate line item on a Medicare HH claim, and data on visit charges is still used in formulating payment rates.  B.  Counting Visits  Generally, one visit may be covered each time an HHA employee, or someone providing home health services under arrangements with the HHA, enters the patient's home and provides a covered service to a patient who meets the criteria in 30.  If the HHA furnishes services in an outpatient facility under arrangements with the facility, one visit may be covered for each type of service provided.  If two individuals are needed to provide a service, two visits may be covered.  If two individuals are present, but only one is needed to provide the care, only one visit may be covered.   A visit is initiated with the delivery of covered home health services and ends at the conclusion of delivery of covered home health services.  In those circumstances in which all reasonable and necessary home health services cannot be provided in the cour se of a single visit, HHA staff or others providing services under arrangements with the HHA may remain at the patient's home between visits (e.g., to provide noncovered services).  However, if all covered services could be provided in the course of one visit, only one visit may be covered.  EXAMPLES:   1. If an occupational therapist and an occupational therapy assistant visit the patient together to provide therapy and the therapist is there to supervise the assistant, one visit is counted.  2. If a nurse visits the patient in the morning to dress a wound and later must return to replace a catheter, two visits are counted.  3. If the therapist visits the patient for treatment in the morning and the patient is later visited by the assistant for additional treatment,  two visits are counted.   4. If an individual is taken to a hospital to receive outpatient therapy that could not be furnished in their own home (e.g., hydrotherapy) and, while at the hospital receives speech -language pathology services and other services, two or more visits would be charged.  5. Many home health agencies provide home health aide services on an hourly basis (ranging from 1 to 8 hours a day).  However, in order to allocate visits properly against a patient's maximum allowable visits, home health aide services are to be counted in terms of visits.  Thus, regardless of the number of continuous hours a home health aide spends in a patient's home on any given day, one "visit" is counted for each such day.  If, in a rare situation, a home health aide visits a patient for an hour or two in the morning, and again for an hour or two in the afternoon, two visits are counted.  C.  Evaluation Visits  The HHAs are required by regulations to have written policies concerning the acceptance of patients by the agency.  These include consideration of the physical facilities available in the patient's place of residence, the homebound status, and the attitude s of family members for the purpose of evaluating the feasibility of meeting the patient's medical needs in the home health setting.  When personnel of the agency make such an initial evaluation visit, the cost of the visit is considered an administrative cost of the agency and is not chargeable as a visit since at this point the patient has not been accepted for care.  If, however, during the course of this initial evaluation visit, the patient is determined suitable for home health care by the agency, and is also furnished the first skilled service as ordered under the physician or allowed practitioner's plan of care, the visit would become the first billable visit in the 30 -day period.  The Medicare contractor will cover an observation and evaluation (or reevaluation) visit made by a nurse (see 40.1.2.1 for a further discussion of skilled nursing observation and evaluation visits) or other appropriate personnel, ordered by the physician or allowed practitioner for the purpose of evaluating the patient's condition and continuing need for skilled services,  as a skilled visit.   A supervisory visit made by a nurse or other appropriate personnel (as required by the conditions of participation) to evaluate the specific personal care needs of the patient or to review the manner in which the personal care needs of the patient are bein g met by the aide is an administrative function, not a skilled visit.   80 - Specific Exclusions From Coverage as Home Health Services  (Rev. 1, 10-01-03) A3-3125, HHA-230.A  In addition to the general exclusions from coverage under health insurance listed in the Medicare Benefit Policy Manual, Chapter 16, "General Exclusions from Coverage," the following are also excluded from coverage as home health services:   80.1 - Drugs and Biologicals (Rev. 1, 10-01-03) A3-3125.A, HHA-230.A  Drugs and biologicals are excluded from payment under the Medicare home health benefit.   A drug is any chemical compound that may be used on or administered to humans or animals as an aid in the diagnosis, treatment, prevention of disease or other condition, for the relief of pain or suffering, or to control or improve any physiological pathologic condition.  A biological is any medicinal preparation made from living organisms and their products including, but not limited to, serums, vaccines, antigens, and antitoxins.  The one drug exception is the osteoporosis drug, which is part of the home health benefit, and home health agencies may provide services such as vaccines outside the home health benefit.   80.2 - Transportation  (Rev. 1, 10- 01-03) A3-3125.B, HHA -230.B   The transportation of a patient, whether to receive covered care or for other purposes, is excluded from home health coverage.  Costs of transportation of equipment, materials, supplies, or staff may be allowable as administrative costs, but no separate pa yment is made.   80.3 - Services That Would Not Be Covered as Inpatient Services  (Rev. 1, 10- 01-03) A3-3125C, HHA -230.C   Services that would not be covered if furnished as inpatient hospital services are excluded from home health coverage.  80.4 - Housekeeping Services  (Rev. 1, 10- 01-03) A3-3125D, HHA -230D   Services for which the sole purpose is to enable the patient to continue residing in their home (e.g., cooking, shopping, Meals on Wheels, cleaning, laundry) are excluded from home health coverage.   80.5 - Services Covered Under the End Stage Renal Disease (ESRD) Program  (Rev.  208, Issued: 04- 22-15, Effective: 01 -01-15, Implementation: 05- 11-15)  Renal dialysis services that are covered and paid for under the ESRD PPS, which include any item or service furnished to an ESRD beneficiary that is directly related to that individual's dialysis, are excluded from coverage under the Medicare home health benefit.  However, to the extent that other requirement s for coverage are met, an item or service that is not directly related to a patient's dialysis would be covered (e.g., a skilled nursing visit to furnish wound care for an abandoned shunt site).  Within these restrictions, beneficiaries may simultaneously  receive items and services under the ESRD PPS through their ESRD facility at home at the same time as receiving items and services under the home health benefit that are not related to ESRD.  80.6 - Prosthetic Devices  (Rev. 1, 10- 01-03) A3-3125F, HHA -230F   Prosthetic items are excluded from home health coverage.  However, catheters, catheter supplies, ostomy bags, and supplies related to ostomy care are not considered prosthetic devices if furnished under a home health plan of care and are not subject to this exclusion from coverage but are bundled while a patient is under a HH plan of care.  80.7 - Medical Social Services Furnished to Family Members (Rev. 1, 10-01-03) A3-3125G, HHA-230G  Except as provided in 50.3, medical social services furnished solely to members of the patient's family and that are not incidental to covered medical social services being furnished to the patient are not covered.  80.8 - Respiratory Care Services  (Rev. 265, Issued: 01-10-20, Effective: 01-01-20, Implementation: 02-11-20)   If a respiratory therapist is used to furnish overall training or consultative advice to HHA staff and incidentally furnishes respiratory therapy services to patients in their homes, the costs of the respiratory therapist's services are allowable only as administrative costs to the HHA.  Visits by a respiratory therapist to a patient's home are not separately billable during a HH period of care when a HH plan of care is in effect.  However, respiratory therapy services furnished as part of a plan of care ot her than a home health plan of care by a licensed nurse or physical therapist and that constitute skilled care may be covered and separately billed as skilled visits when the beneficiary is not in a home health period of care.  Note that Medicare billing does not recognize respiratory therapy as a separate discipline, but rather sees the services in accordance with the revenue code used on the claims (i.e. 042x).  80.9 - Dietary and Nutrition Personnel  (Rev. 1, 10-01-03) A3-3125.I, HHA-230.I  If dieticians or nutritionists are used to furnish overall training or consultative advice to HHA staff and incidentally furnish dietetic or nutritional services to patients in their homes, the costs of these professional services are allowable only as administrative costs.  Visits by a dietician or nutritionist to a patient's home are not separately billable.   80.10 - Telecommunications Technology  (Rev. 10438, Issued: 11-06-20, Effective: 03-01-20, Implementation: 01- 11-21)