When does HRSA reimburse for covered home health services?

HRSA reimburses for covered home health services provided to eligible clients when all of the criteria listed in this section are met. Reimbursement is subject to the restrictions or limitations in this billing instruction and other applicable published Washington Administrative Codes

Home health skilled services provided to eligible clients must:

Meet the definition of “acute care”;
Provide for the treatment of an illness, injury, or disability;
Be medically necessary (see Definitions);
Be reasonable, based on community standard of care, in amount, duration, and
frequency;
Be provided under a Plan of Care (POC). Any statement in the POC must be
supported by documentation in the client’s medical records;
Be used to prevent placement in a more restrictive setting;

In addition, the client’s medical records must justify the medical reason(s) that the
services should be provided in the client’s residence instead of a physician’s office,
clinic, or other outpatient setting. This includes justification for services for a client’s
medical condition that requires teaching that would be most effectively accomplished
in the client’s home on a short-term basis.
• Be provided in the client’s residence. HRSA does not reimburse for services if
provided at the workplace, school, child day care, adult day care, skilled nursing
facility, or any other place that is not the client’s place of residence.

Residential facilities contracted with the state to provide limited skilled nursing
services are not reimbursed separately for those same services under HRSA’s
Home Health program.
It is the home health agencies responsibility to request coverage for a client when
the services are not available to the client in the community or through LTC.
If the client meets the criteria in these billing instructions for therapy services,
HRSA will evaluate the need after receiving the request