Supplementary Home Health Guidelines

HHA visits and licensed social worker visits are covered only when non‑skilled assistance directly supports a skilled plan of care (non‑skilled maintenance alone is excluded), the patient meets home‑health eligibility (homebound, under physician care with an established plan requiring intermittent skilled nursing/PT/SLP or continued OT), and social worker visits address documented social/emotional barriers to treatment (limit two visits per two‑week period). Key requirements: documentation of specific functional impairment, inability to perform needed care and lack/unwillingness of a caregiver, expectation of significant improvement, a plan of care requiring HHA/social work services with periodic physician review, and adherence to biweekly HHA frequency limits by impairment level (initial: minimal 6 visits/12 hrs, moderate 10/20 hrs, maximal 14/28 hrs, maximal without caregiver 28/56 hrs; continued: minimal 5/10 hrs, moderate 10/20 hrs, maximal 14/28 hrs, maximal without caregiver 28/56 hrs).