HI 00401.280 Home Health Agency (HHA) Defined
Social Security Act—Sec. 1861(o)
Regulations No. 5—405.1201-405.1230
An HHA is a public agency or private organization, or a subdivision of such an agency or organization, which meets the following requirements:
It is primarily engaged in providing skilled nursing services and other therapeutic services, such as physical, speech, or occupational therapy, medical social services, and home health aide services. A public or voluntary nonprofit health agency may qualify by:
Furnishing both skilled nursing and at least one other therapeutic service directly to patients, or
furnishing directly either skilled nursing services or at least one other therapeutic service and having arrangements with another public or voluntary nonprofit agency to furnish the services which it does not provide directly.
A proprietary agency can qualify only by providing directly both skilled nursing services and at least one other therapeutic service.
It has policies established by a professional group associated with the agency or organization (including at least one physician and at least one registered professional nurse) to govern the services, and provides for supervision of such services by a physician or a registered professional nurse.
It maintains clinical records on all patients
It is licensed in accordance with State or local law or is approved by the State or local licensing agency as meeting the licensing standards (where State or local law provides for the licensing of such agencies or organizations).
It meets other conditions found by the Secretary to be necessary for health and safety.
A private organization which is not exempt from Federal income taxation under Section 501 of the Internal Revenue Code of 1954 (sometimes referred to as a “proprietary” organization) must be licensed pursuant to State law. If the State has no licensing law for such organizations, a proprietary agency cannot participate in the health insurance program. Effective July 1, 1981, proprietary home health services in States without licensing laws are allowed to participate in the health insurance program.
For services under hospital insurance, the term “home health agency” does not include any agency or organization which is primarily for the care and treatment of mental disease. There is no such restriction under SMI (see HI 00610.390.