HHA Model Compliance Plan / Services to patients who reside in assisted living facilities

Article Overview

This article explains how home health agencies should evaluate whether services furnished to residents of assisted living facilities are appropriate for reimbursement and how to reduce the risk of submitting unallowable claims. It is aimed at HHAs, compliance staff, and billing professionals who need to understand overlap between home health services and services the facility is required to provide under state licensure or contract. The discussion also highlights related compliance concerns raised by audits and investigations, including referral and anti-kickback risk, and emphasizes coordination with state licensing authorities when facility care obligations may not be met.