Medicare Home Health Agency Industry Information

Home care is one of the most sought-after Medicare benefits. Though Medicare's coverage of home health is limited, some people qualify for care through Medicare-certified home health agencies (HHAs).

Eligibility

• For Medicare to cover treatment from a HHA, the patient must be confined to the home, require skilled therapy (occupational, physical or speech) and have a plan of care designed by an agency nurse and the patient's doctor.

Services

• At an HHA, the patient is eligible to receive skilled nursing care, which includes injections, tube feedings and any care that requires a licensed nurse. Skilled therapy, social services and medical supplies are all covered at an HHA.

Relationships with Doctors

• HHAs work with doctors when devising a patient's plan of care. The plan of care is required for Medicare to cover services. The plan of care, drafted by an agency nurse and signed by the doctor, outlines the care required and the timeline for implementing the care.

Agencies' Rights

• An HHA has the right to deny service to any individual for any reason that does not violate discrimination laws. The agency may also limit the care given if it is unable to give the full care needed. (For example, the agency may lack the staff or equipment needed.)

Patients' Rights

• In the case that an HHA reduces care because the agency no longer feels the services are needed, the patient will need to speak with their doctor. If the HHA is terminating care because Medicare will not pay, the patient has the right to appeal to Medicare.