Home health care services are defined as services that are provided in the home setting by a licensed home health agency (HHA). Home health care services include the following:
Home is defined as the individual's place of residence (e.g., private residence/domicile, assisted living facility, long-term care facility, skilled nursing facility [SNF] at a custodial level of care).
An individual is considered to be homebound with one of the following:
- Skilled services (e.g., nursing, rehabilitative therapies) that provide treatment for a condition
- Unskilled services that are supportive in nature (e.g., bathing, feeding, assistance with dressing) and are provided in conjunction with a skilled service
- When the individual is unable to leave home due to severe restrictions on mobility
- The individual would require a considerable and taxing effort in an attempt to leave home
- The individual is unable to use transportation without another's assistance
An individual who is a child, an unlicensed driver, or an individual who cannot drive is not automatically considered homebound.
If the individual can leave the home, the individual may still be considered homebound if the absences from the home are infrequent, for periods of relatively short duration, attributable to obtaining health care treatment, or for occasional nonmedical purposes such as, but not limited to:
- A trip to the barber
- A walk around the block or a drive
- Other infrequent or unique events (e.g., attendance at a funeral)
Skilled home health care services include skilled nursing care, physical and occupational therapy, speech therapy, and medical social services as provided by a clinical social worker. The provision of these services requires the knowledge, expertise, and skills of a health care professional who has met the educational and licensing and/or certification requirements to practice the specific discipline in the state in which the service is provided.
A skilled nursing service requires the knowledge, expertise, and skills provided by a registered nurse (RN), or a licensed practical (vocational) nurse (LPN) under the supervision of an RN, to be safe and effective. Some services are classified as a skilled nursing service on the basis of complexity alone (e.g., intravenous and intramuscular injections, insertion of catheters). However, in some cases, the condition and/or situation of the individual may cause a service that would ordinarily be considered unskilled to be considered skilled (e.g., simple dressing changes [that in most circumstances would not require the knowledge, expertise, and skills of a nurse] in the absence of a competent person, to provide care, and when wounds exist in areas where the individual cannot reach but for which no other care options are available).
Part-time or intermittent skilled nursing care is that which is provided in the home setting and furnished to an individual fewer than 8 hours each day and for 35 hours or less each week. This service is provided to individuals who generally need at least one skilled nursing visit every 60 days and do not require daily skilled nursing care for more than 21 days. Services requested solely for venipuncture (i.e., for the purposes of obtaining a blood sample) are not considered skilled nursing services.
HOME HEALTH AIDE SERVICES
Home health aide services include hands-on personal care of the member or services needed to facilitate treatment of the member's illness or injury. These services may include, but are not limited to:
- Personal care
- Bathing, dressing, grooming, caring for hair, nail, and oral hygiene that are needed to facilitate treatment or to prevent deterioration of the member's health, changing the bed linens of an incontinent member, shaving, deodorant application, skin care with lotions and/or powder, foot care, and ear care; feeding, assistance with elimination (including enemas unless the skills of a licensed nurse are required due to the member's condition, routine catheter care and routine colostomy care), assistance with ambulation, changing position in bed, assistance with transfers.
- Simple dressing changes that do not require the skills of a licensed nurse
- Assistance with medications that are ordinarily self-administered and do not require the skills of a licensed nurse to be provided safely and effectively
- Assistance with activities that are directly supportive of skilled therapy services but do not require the skills of a therapist to be safely and effectively performed, such as routine maintenance exercises and repetitive practice of functional communication skills to support speech-language pathology services
- Provision of services incidental to personal care services, not care of prosthetic and orthotic devices
- When a home health aide visits a member to provide a health-related service as discussed above, the home health aide may also perform some incidental services that do not meet the definition of a home health aide service (e.g., light cleaning, preparation of a meal, taking out the trash, shopping). However, the purpose of a home health aide visit may not be primarily to provide these incidental services because they are not health-related services, but rather are necessary household tasks that must be performed to maintain a home.
PHYSICAL THERAPY AND OCCUPATIONAL THERAPY ASSISTANT SERVICES
PHYSICAL THERAPY ASSISTANT
A physical therapy assistant (PTA) implements certain components of patient care, obtains data related to the treatments provided, and collaborates with the physical therapist (PT) to modify care as necessary. PTAs are not permitted to perform evaluations, assessment procedures, or certain complex procedures; nor do they design plans of care or develop treatment plans.
Under the direction and supervision of PTs, PTAs treat patients with exercise, massage, gait and balance training, and other therapeutic interventions. They record the patient's progress and report the results of each treatment to the PT.
OCCUPATIONAL THERAPY ASSISTANT
An occupational therapy assistant (OTA) assists individuals to develop, recover, improve, as well as maintain the skills needed for daily living.
OTAs help provide treatments to assist individuals with disabilities to learn how to function independently in their homes and communities. They help patients regain the skills they may have lost due to injury and help them rebuild their health and self-esteem.
An OTA does not perform evaluations or create treatment plans.