Supplementary Home Health Guidelines

Covers non‑skilled Home Health Aide (HHA) visits and up to two licensed social worker visits only when non‑skilled services explicitly support a skilled treatment plan and are documented with significant functional limitations, inability to self‑care/no available caregiver (or patient refusal), and an expectation of significant improvement; HHA visit limits per two‑week period are: minimal impairment 6 visits/12 hours initial (5 visits/10 hours continued), moderate 10 visits/20 hours, maximal 14 visits/28 hours, and 28 visits/56 hours when there is maximal impairment plus no caregiver. Excluded are skilled services or any services that do not support a skilled plan or lack required documentation (plan of care, specific impairment criteria, caregiver status, expectation of improvement) or exceed the specified two‑week limits; social worker visits also require home‑health qualification (homebound, physician‑directed plan of care, need for intermittent skilled care or continued OT) and documented social/emotional barriers, and are limited to two visits per two‑week period.