1. Location, other than a hospital or other facility, where the patient receives care in a private residence. 2.When the physician’s office or an outpatient hospital is billing, the “Place of Service” two-digit numerical code for home (12) is inserted in Block 24B of the CMS-1500 insurance claim form.

Home and community health care established under Section 1929 of the Social Security Act. It allowed states to provide a large range of services to the functionally disabled as an optional state plan benefit. In every state, except Texas, the option can serve only people older than 65. In Texas, people of any age are eligible if they meet the state’s functional disability test and financial criteria. Also known as the frail elderly provision .

Established under Section 2176 of the Omnibus Reconciliation Act; permit states to offer, under a waiver, a wide array of home and community-based services that an individual may need to avoid institutionalization. These programs offer different choices to some people with Medicaid such as case management, homemaker, home health aide, personal care, adult day health care, rehabilitation, respite care, and other services. Those that qualify may obtain care in their home and community so that they can stay independent and close to family and friends. HCBS programs help the elderly and disabled, mentally retarded, developmentally disabled, and certain other disabled adults. These programs give quality and low-cost services.

Type of program with health and social services given to individuals and families where they reside for promoting, maintaining, or restoring health and minimizing effects of illness and disability.

Public or private licensed, certified, or authorized state agency or organization that gives home care services that have been prescribed by a patient’s physician such as skilled nursing care, physical therapy, occupational therapy, speech therapy, and personal care by home health aides. To be certified under the Medicare program, a provider or agency must meet certain health and safety standards and provide skilled nursing services and at least one additional therapeutic service (physical, speech, or occupational therapy; medical social services; or home health aide services) in the home. Some outpatient services may be covered if equipment is necessary and cannot be used in the patient’s home. Also called home health care agency .

Person who, under the supervision of a home health or social service agency, assists elderly, ill, or disabled person with household chores, bathing, personal care, and other daily living needs. Social service agency personnel are sometimes called personal care aides .

1. Limited part-time or intermittent skilled nursing care and home health aide services, as well as other health-related services given to the patient in his or her home. Examples of palliative and therapeutic care are assistance with medications, wound care, intravenous (IV) therapy, help with basic needs (e.g., bathing, dressing, mobility), physical and rehabilitation therapy, nursing, counseling, and social services. Usually this care is given to elderly, disabled, sick, or convalescent patients who do not need care in a facility. These services are provided by home health agencies (HHAs), hospitals, and other community organizations. Medicare pays for home care only if the type of care needed is skilled and required on an intermittent basis and is intended to help people recover or improve from an illness, not to provide unskilled services over a long period of time. There is no beneficiary cost sharing for home health care services. Also known as home care . 2. In Medicare fraud, certification or recertification by a provider of the need for home health care services, knowing that all of the requirements relating to being homebound and medical necessity have not been met.

Physician receives, reviews, adjusts treatment, documents the plan in coordination with the care of the home health agency, and then bills for this service. For subsequent plan adjustment, see home health plan recertification .

Physician receives, reviews, adjusts treatment, documents the plan in coordination with the care of the home health agency, and then bills for this subsequent plan adjustment. For initial certification, see home health plan certification .

Supplies and services provided to patients by health care professionals in a patient’s home. These individuals suffer from an injury, illness, or disabling condition or are terminally ill and require short- or long-term care. For Medicare to pay for the benefits, the services must be prescribed by a physician. Services consist of audiology, dental, medical supplies, part-time or intermittent skilled nursing care, nutrition counseling, occupational therapy, pediatric therapy, physical therapy, some rehabilitation equipment, social services, and speech-language pathology.
***
Health care services provided by a licensed home health agency in the patient’s home.