Supplementary Home Health Guidelines

HHA services are covered only when non‑skilled assistance directly supports a skilled treatment plan (not for sole long‑term maintenance), with documented significant functional limitations, inability to perform tasks independently and no appropriate caregiver (or caregiver refusal), and an expectation of improvement; visit limits per two‑week period are authorized by impairment level (initial: 6/10/14/28 visits — continued: 5/10/14/28 visits). Licensed social worker visits (up to 2 per two‑week period) are covered when social/emotional barriers impede treatment and the physician‑reviewed plan of care requires social work; both HHA and social work require documentation of homebound status, physician‑reviewed plan of care, and the specific functional and support-related documentation described.

"Documentation of an expectation that the individual's condition will improve significantly in a reasonable period of time"