A Home Health Agency (HHA) is an organization certified to provide skilled, medical services to patients in their own homes. These agencies deliver professional care designed to help individuals recover from an illness, injury, or hospitalization, or to manage a chronic health condition. This care is temporary and rehabilitative, focusing on helping the patient regain independence and stability outside of a hospital or skilled nursing facility setting.
Defining the Scope of Home Health Services
Home health services focus exclusively on skilled, intermittent medical treatments that require the expertise of a licensed professional. Skilled nursing care is a foundational service, encompassing complex tasks such as wound care, management of intravenous (IV) medications, and administering injections. Nurses also provide patient and caregiver education on disease processes, new medications, and managing unstable health statuses.
Therapeutic services form the second major component of care provided by HHAs. Physical therapists work to restore mobility, strength, and balance following events like a joint replacement or a fall. Occupational therapists help patients adapt their environment and daily routines to safely perform activities of daily living (ADLs), such as bathing and dressing. Speech-language pathologists address swallowing difficulties (dysphagia) and communication disorders resulting from a stroke or neurological condition.
It is important to distinguish home health from non-medical home care, which involves custodial assistance like companionship, meal preparation, or housekeeping. Home health is always medical in nature, physician-ordered, and covered by insurance for eligible patients. While an HHA may provide a home health aide to assist with personal care, this service must be supplemental to the skilled nursing or therapy services already being received.
Patient Eligibility Requirements
To qualify for services from a certified Home Health Agency, particularly under Medicare guidelines, a patient must meet specific medical and situational criteria. The process begins with a physician or other allowed practitioner, such as a nurse practitioner, certifying the need for care and establishing a written plan. This plan outlines the specific skilled services required and the goals for recovery.
The care ordered must be intermittent. Medicare generally defines this as skilled care needed less than eight hours per day and for a maximum of 28 to 35 hours per week. The patient must demonstrate a continued need for skilled services to maintain eligibility throughout the treatment period.
A defining requirement is that the patient must be certified as “homebound,” which does not mean being bedridden. A patient is considered homebound if leaving the home requires a considerable and taxing effort, necessitating the assistance of another person or a supportive device. Alternatively, a patient is homebound if their medical condition makes leaving the home medically contraindicated.
Patients who meet the homebound definition are still permitted to leave the home for necessary medical treatments that cannot be provided at home. Brief, infrequent absences for non-medical reasons, such as attending religious services or getting a haircut, are also allowed without jeopardizing homebound status.
Certification and Payment Structures
Home Health Agencies operate within a highly regulated environment, requiring both state licensure and federal certification to serve the majority of patients. State licensure ensures the agency meets baseline operational standards for safety and quality. The most significant designation is Medicare certification, which requires the agency to comply with the federal Conditions of Participation (CoP) set by the Centers for Medicare & Medicaid Services (CMS).
Medicare Part A is the primary payer for eligible skilled home health services, covering the full cost for beneficiaries who meet the eligibility and homebound criteria. Medicare pays the HHA a predetermined rate for a 30-day period of care, using the Patient-Driven Groupings Model (PDGM). This payment is adjusted based on the patient’s clinical characteristics and the intensity of the services needed.
Regulatory compliance is maintained through oversight, including state surveys and mandatory reporting of quality data to CMS. Some agencies seek voluntary accreditation from organizations like The Joint Commission to demonstrate adherence to high-quality standards.
In addition to Medicare, HHAs receive payment through other mechanisms, including Medicaid for patients who meet medical and financial need requirements. Many patients with Medicare Advantage plans (administered by private insurance companies) also receive home health services, though the authorization process may differ. Private insurance plans and out-of-pocket payments cover the remaining portion of the home health market.