Home health care involves providing professional medical services to a patient in their private residence. Because this setting is neither a hospital nor a clinic, confusion often arises regarding its official designation within the healthcare system. This uncertainty stems from whether this skilled care should be categorized administratively as an inpatient or an outpatient service. To understand how this care is regulated and covered, it is helpful to first review the definitions of facility-based care. This article clarifies the administrative classification of home health services.
Understanding Inpatient and Outpatient Care
The administrative difference between inpatient and outpatient care hinges on a patient’s formal admission status to a healthcare facility. Inpatient care requires a physician’s order for formal admission to a hospital, skilled nursing facility, or other acute care setting. This status typically involves an expectation of an overnight stay, where the patient receives continuous monitoring, treatment, and lodging. Inpatient services address serious ailments, surgeries, or traumas that necessitate institutionalized observation.
Outpatient care, also known as ambulatory care, covers any procedure or treatment that does not require formal admission to a facility. A patient receiving outpatient services may visit a clinic, doctor’s office, or hospital department for treatment. They are free to leave after the service is rendered, even if the service is complex, such as chemotherapy or minor surgery.
The Administrative Classification of Home Health
Home Health Services (HHS) are administratively classified as a form of outpatient care under federal regulations. This designation exists because the services are delivered outside of a traditional inpatient facility, and the patient is never formally admitted for the home care itself. Although often regulated as a distinct category of community-based care, home health falls under the outpatient umbrella for billing and regulatory purposes.
The primary federal program covering these services, Medicare, addresses home health under both Part A (Hospital Insurance) and Part B (Medical Insurance). While coverage often begins under Part A following a qualifying hospital or skilled nursing facility stay, the services provided in the home are not considered inpatient care. This framework treats the home health agency as an outpatient provider delivering skilled services in a non-institutional setting.
Criteria for Receiving Home Health Services
Eligibility for Medicare-covered home health care is determined by a strict set of patient requirements linked to its classification as a specialized outpatient benefit. A patient must be under the care of a physician who establishes and regularly reviews a plan of care. Furthermore, all services must be provided by a home health agency that is certified by Medicare.
The most significant requirement is that the patient must be considered “homebound,” meaning leaving the home requires a considerable and taxing effort. Although a homebound patient may leave for medical treatment or short, infrequent non-medical absences, they are generally unable to leave without assistance. The care provided must also be medically necessary and consist of intermittent skilled services, such as skilled nursing care, physical therapy, or speech-language pathology. Intermittent care means the patient does not require full-time, 24-hour-a-day skilled nursing care over an extended period.