Home Health Supplementary Guidelines

HHA services are covered only when non‑skilled assistance directly supports a skilled home‑health treatment plan, significant functional limitations and lack/refusal of a caregiver are documented, improvement is expected, and visit limits apply per 2‑week period (initial: minimal 6/12h, moderate 10/20h, maximal 14/28h, maximal without caregiver 28/56h; continued: minimal 5/10h, moderate 10/20h, maximal 14/28h, maximal without caregiver 28/56h) — HHA alone without supporting skilled services is excluded. Licensed social worker visits are limited to two visits per two weeks and are covered only when social/emotional barriers and a physician‑reviewed plan of care requiring social work are documented and the patient meets home‑health eligibility (homebound, under physician care, and need for intermittent skilled care or continued OT), with required assessments and documentation supporting the need.

"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 ..."