Post Acute: Home Health Care Overview

More than 3 million elderly and disabled people with Medicare receive care from over 9,200 Medicare-certified home health agencies throughout the United States. Home health care is covered under the Part A Medicare benefit.¹

Guidelines for admission and OASIS assessment

The patient requires part-time, medically necessary skilled care (nursing, physical therapy, occupational therapy, and speech-language therapy) that is ordered by a physician. If patients are eligible for skilled services, they can also receive part-time assistance with personal care needs by a home health aide.
Patients are required to be "homebound" as a condition of eligibility for home health services.

Methods of payment

Under prospective payment, Medicare pays home health agencies (HHA) a predetermined base payment. The payment is adjusted for the health condition and care needs of the beneficiary and the geographic differences in wages for HHA across the country.

60-day episode

The Home Health Prospective Payment System (PPS) will provide HHA with payments for each 60-day episode of care for each Medicare patient. If a patient is still eligible for care after the end of the first episode, a second episode can begin; there are no limits to the number of episodes a patient who remains eligible for the home health benefit can receive.

The Outcome ASsement Information Set (OASIS-C) is a group of data elements that represent core items of a comprehensive assessment for an adult home care patient and form the basis for measuring patient outcomes for purposes of outcome-based quality improvement. Selected OASIS-C questions are used to determine the amount of payment the agency will receive for a 60-day episode of care for each patient.

Home Health PPS Model²

Low Utilization Payment Adjustment (LUPA)³

An episode with four or fewer visits is paid the national per visit amount by discipline, adjusted by the appropriate wage index based of the site of service to the beneficiary. Such episodes of four or fewer visits are paid the wage adjusted per visit amount for each of the visits rendered instead of the full episode amount.

Non-Routine Supply Component⁴

Medicare requires home health agencies to furnish the medical supplies (routine and non-routine) required by a patient under a home health plan of care. Effective January 1, 2008, Medicare added a non-routine supply (NRS) component to be paid in addition to the 60-day episodic payment for certain supplies. The non-routine supply payment amount is determined by the response to certain OASIS-C questions related to pressure ulcers, stasis ulcers, surgical incisions, and the presence of an ostomy.