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What Are the Medicare Guidelines for a Home Health Care Plan of Care?
Date Updated: December 13, 2024
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Sarah has produced thousands of articles in diverse niches over her decade-long career as a full-time freelance writer. This includes substantial content in the fields of senior care and health care. She has experience writing about wide-ranging topics, such as types of care, care costs, funding options, state Medicaid programs and senior resources.
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Dr. Brindusa Vanta is a health care professional, researcher, and an experienced medical writer (2000+ articles published online and several medical ebooks). She received her MD degree from “Iuliu Hatieganu” University of Medicine, Romania, and her HD diploma from OCHM – Toronto, Canada.
The Medicare guidelines for a home health care plan of care include details of medically necessary services, how often an individual requires services and the expected goals following home health care. Home health agencies create customized service plans based on physicians’ orders and update care plans regularly.
Background Information about Home Health Care
Home health care supports seniors recovering at home after hospitalization, illness, injury or surgery. It also helps those with long-term conditions. Agencies employ or contract with diverse medical professionals, including various types of nurses, therapists and certified nursing aides. Providers may deliver services on a short- or long-term basis, but Medicare funding only continues as long as a physician deems services medically necessary. Individuals must also satisfy homebound criteria for care to continue.
Home health care packages may include various services, such as:
- Skilled nursing care, including changing wound dressings, collecting blood samples and administering medications
- Education for patients and family caregivers
- Physiotherapy
- Speech therapy
- Occupational therapy (so long as patients initially need skilled care or another type of rehabilitation therapy)
- Nutritional guidance
- Medical social services
- Home health aide support with personal care tasks (as long as individuals also receive skilled care)
Medicare Requirements for Home Health Care Support Plans
When a doctor orders home health care services, a Medicare-certified agency must devise a personalized care plan based on an individual’s health needs and the physician’s recommendations. Plans must contain detailed descriptions of the exact services the agency will provide for a patient. Home health care plans must also include information regarding:
- Which medical professionals will deliver services
- When services will be delivered, including the frequency and duration
- What medical supplies and equipment an individual needs
- What outcomes a physician expects following services
Doctors must reassess patients every 60 days and recertify that they still need and qualify for medical or rehabilitative support at home. Following each recertification, agencies must review and update home health care plans as necessary. This may result in reduced coverage; for example, if an individual no longer needs skilled nursing care and continues only with occupational therapy, they can no longer receive personal care.