Home Health Agency (HHA)

Key facts

Federal standards

Conditions of Participation, 42 CFR Part 484

Medicare payment

Home Health PPS, Patient-Driven Groupings Model (PDGM) since 2020

Payment unit

30-day period of care

Patient assessment

Outcome and Assessment Information Set (OASIS)

Beneficiary cost sharing

No Medicare coinsurance for covered home health services

What is a home health agency?

HHAs send nurses, physical therapists, occupational therapists, speech-language pathologists, medical social workers and home health aides to patients' homes. Typical patients are recovering from a hospital or skilled nursing stay, or managing conditions such as heart failure or chronic wounds that need skilled monitoring.

Medicare-certified home health is different from home care. Agencies that provide only personal care or companionship, such as help with bathing, meals and housekeeping, may be licensed by states but are not covered by Medicare unless that care is part of a skilled home health plan.

Who qualifies for Medicare home health

Medicare covers home health when all of these conditions are met:

• The patient is homebound: leaving home requires a considerable and taxing effort, and absences are infrequent or short, such as trips for medical care or religious services.
• The patient needs intermittent skilled nursing, physical therapy or speech-language pathology, or has a continuing need for occupational therapy.
• A physician or, since the CARES Act of 2020, a nurse practitioner, clinical nurse specialist or physician assistant certifies eligibility and establishes the plan of care.
• A face-to-face encounter related to the reason for home health occurs within 90 days before or 30 days after the start of care.

Why home health agency data matters

Home health links hospital discharge planning to care at home:

• Hospitals and accountable care organizations use home health to shorten stays and reduce readmissions, so they build preferred agency networks.
• Care Compare publishes quality star ratings and patient survey star ratings for agencies, supporting referral and network decisions.
• Home infusion, durable medical equipment, wound care and remote monitoring companies partner with HHAs to reach patients at home.
• The Home Health Value-Based Purchasing Model, expanded nationwide in 2023, ties agency Medicare payment to quality performance.