Supplementary Home Health Guidelines

EviCore covers non‑skilled Home Health Aide (HHA) visits only when they directly support a skilled treatment plan and licensed social worker visits only to address documented social/emotional barriers tied to a defined, physician‑reviewed home health plan; services requiring a licensed nurse/therapist or social work without a defined plan are excluded. Approval requires documentation of significant functional limitations (minimal/moderate/maximal = 1/2/3+ specified conditions), inability or lack of an available/willing caregiver, expectation of significant improvement, and adherence to two‑week visit limits (initial HHA 6/10/14/28 and continued HHA 5/10/14/28 visits for minimal/moderate/maximal/maximal-without-caregiver respectively) and social worker visits limited to two per two‑week period.

"When non-skilled (not requiring assistance of licensed nurse or therapist) assistance is needed for personal care or other health-related services to maintain the individual's health or facilitate ..."