Skip to main content
Corporate

Providing Care Under Arrangement with Other Organizations

A home health agency may have other organizations furnish covered items or services under an arrangement in three situations:

  1. Where an agency or organization, in order to be approved to participate in the program, makes arrangements with another agency or organization to provide the nursing or other therapeutic services that it cannot provide directly.
  2. Where an agency or organization, which is already approved for participation, makes arrangements with others to provide services it does not provide.
  3. Where an agency or organization, which is already approved for participation, makes arrangements with a hospital, skilled nursing facility, or rehabilitation center for services on an outpatient basis because the services involve the use of equipment that cannot be made available to the patient in his/her place of residence.

There should be a formal contract between the two providers, unless the agency is using another provider within their company, such as a branch office.

When services and items are provided under arrangement, both the home health agency and the agency providing services must agree not to charge the beneficiary for covered services and items.

A home health agency may not serve only as a billing mechanism for another party, but must exercise professional responsibility over the arranged services.

Refer to the Medicare General Information, Eligibility and Entitlement Manual ( CMS Pub. 100-01, Ch. 5, § 50.2 and 50.5External PDF) for more specific guidance on requirements for providing care under arrangement with other providers and rehabilitation providers.

Updated: 07.30.12


26 Century Blvd Ste ST610, Nashville, TN 37214-3685 © CGS Administrators, LLC. All Rights Reserved