HI 00601.510 Duration of Home Health Services Under Hospital Insurance

Prior to July 1, 1981, under hospital insurance the patient is entitled to up to 100 visits in the one-year period after the most recent discharge from a qualifying inpatient stay and before a new benefit period begins. If before a series of home health visits is completed, a patient receives inpatient services which start a new benefit period, the series of visits is terminated. Both of “inpatient stay” and “timely establishment of plan” requirements must be met in the new benefit period to provide coverage for a new series of home health visits.

If, during the same benefit period, the home health patient returns to a hospital or SNF for a stay which meets the prior-stay requirement, a new one-year period for the patient's Part A visits is established dating from the patient's latest discharge. The one-year period during which an individual may have up to 100 home health visits may thus in fact exceed a year overall. The total number of visits available before the next benefit period begins remains unchanged.

The end of the year for hospital insurance purposes is determined as follows:

Count 365 days (366 when February 29 is included) beginning with the latter of the following:

A. The date of discharge from a 3-day stay in any hospital, or

B. The date of discharge from an SNF stay for which posthospital extended care benefits were payable on the patient's behalf.

Effective July 1, 1981, the 100 visit limitation, the prior inpatient stay, and the spell of illness requirements under Part A are eliminated.