If you're new to home health or hospice, learning how patient care is structured can feel overwhelming, especially when it comes to charting and documentation. Medicare rules are strict. Improper or incomplete documentation doesn’t just cause billing issues—it can lead to denied claims, audit triggers, or worse, compliance violations.
One of the most foundational concepts to understand? The episode of care in home health & the benefit period in hospice.
At The Home Health Consultant, we help agencies like yours navigate the Medicare system with clarity. From startup to survey, we specialize in helping agencies understand how Medicare wants things documented and why it matters.
In this guide, we’ll break down:
- How long an episode/benefit period lasts in both home health and hospice
- The phases of an episode & benefit period: Evaluation, Treatment, and Re-Evaluation
- The roles of disciplines within the episode or benefit period
- What can cause variations (like transfers or refusals)
- How episodes/benefit periods end, and what happens next
By the end, you’ll have a clear picture of how home health and hospice episodes are structured and how each discipline fits into the care timeline.
(*If this article sounds too basic for you, feel free to save and share when you’re onboarding someone new to the industry.)
How Are Episodes & Benefit Periods in Home Health & Hospice Structured?
An episode or benefit period, simply put, is the defined period during which a patient receives home health or hospice care. While the type and intensity of care may vary based on individual needs, every patient’s journey must follow the same structure. That’s why it’s so important to understand how episodes/benefit periods are organized and what’s expected during each phase.
How Long Is an Episode or Benefit Period in Home Health & Hospice?
Home Health (HH) Episode Length:
- Each home health episode lasts 60 days, starting from the Start of Care (SOC) date.
- Reevaluation is required at the end of every 60-day period, or sooner if the patient's condition changes significantly.
Hospice (HSP) Benefit Period Length:
- Hospice certification follows two initial 90-day periods, then continues in 60-day increments.
- Each new certification period requires physician review and confirmation that the patient still meets eligibility requirements.
What Are the Core Components of an Episode or Benefit Period in Home Health & Hospice?
Now that we’ve broken down how long each episode/benefit period is, we can dive into the 3 main components that must occur during each. The three main phases of an episode/benefit period are:
1. Evaluation Phase
- SOC (Start of Care) and admission occur here. The start of care includes a comprehensive assessment (called OASIS in home health) and the initial care plan
- The initial care plan consists of identifying goals of care & establishing all core disciplines for the specific episode
2. Treatment Phase
- Care is provided according to the individualized plan of care.
- All disciplines follow specific visit frequencies, and services must align with physician-approved orders (more on this below).
- Supervision and updates to the plan of care may occur as needed or required by law. To learn more about supervision policies and requirements per discipline, check out our article below:
3. Reevaluation Phase
- In home health: a new OASIS is completed for recertification (RC) or discharge (DC). Recertification must be completed within the last 5 days of the episode. Discharge can happen anytime, for a variety of reasons.
- In hospice: physicians reassess prognosis and appropriateness of continued care at the end of each benefit period.
How Do the Disciplines Work Within Each Episode or Benefit Period?
In both home health and hospice, one primary discipline, most commonly nursing (RNs), takes the lead in coordinating the episode or benefit period.
- RNs typically complete the initial (SOC) and follow-up (RC/DC) evaluations.
- Other disciplines like MSW, PT, OT, or ST conduct their own discipline-specific evaluation, treatment, & re-evaluation phases.
For example, let’s say a home health patient’s primary discipline is nursing, but their M.D. has also ordered physical therapy. An RN would conduct the episode’s overarching evaluation, treatment, and recertification or discharge phases. A PT would be responsible for completing physical therapy-specific evaluation, treatment, and recertification phases within that same episode or benefit period.
- CHHAs (Certified Home Health Aides) do not conduct their own evaluations. Instead, they follow a care plan developed and supervised by the primary clinical discipline.
To learn more about disciplines, you can find our breakdowns for both home health & hospice below:
- Explore home health disciplines & responsibilities
- Learn about hospice disciplines & responsibilities
How Frequencies Come Into Play During the Treatment Phase of a Home Health or Hospice Episode
Care plans are tied to a frequency, which is the schedule of visits planned for the entire treatment within an episode. Every discipline involved in a patient’s treatment has their own frequency. Frequencies must be followed consistently and updated if the patient’s needs change, for each discipline.
Additionally, agencies must provide supervisory visits—especially for aide services—based on internal policy and Medicare requirements to ensure care is appropriate and effective.
How Do Disciplines Differ in Home Health Episodes vs. Hospice Benefit Periods?
Episodes and benefit periods are structured differently because the goals of home health and hospice care differ greatly. Here’s a quick comparison and breakdown:
The main takeaway:
In home health, over time the intensity of care should decrease as the patient’s condition improves. Home health care is rehabilitative.
In hospice, the intensity of care increases as the patient gets closer to the end of life. Hospice care is palliative.
What Variations Can Occur During the Treatment Phase of a Home Health or Hospice Episode?
Though the episode/benefit period structure is fixed, the patient’s journey within it can vary. Changes can occur based on a patient’s condition, preferences, and the disciplines involved in care.
These variations can include, but are not limited to:
- Plan of Care Changes: Any change to the frequency, scope, or type of service requires new physician orders.
- Patient Holds/Pauses: If a patient is hospitalized or pauses services (for a vacation for example), documentation must reflect the transfer or hold.
Upon return, a resumption of care is required within 48 hours, along with a new evaluation.
- Refusals: Patients, especially in hospice, may decline disciplines. For example, most hospice patients decline volunteers. This should be documented and reflected in the care plan.
- Condition Changes: A worsening or improvement in condition may require a revised care plan and could trigger a re-evaluation ahead of schedule. This can also trigger the addition or removal of disciplines as needed.
- Death or Discharge: Hospice episodes commonly end in death, requiring specific discharge documentation. In home health, patients are discharged when goals are met or they no longer meet eligibility. Additionally, a patient can choose to stop participating at any time, for any reason, in both programs.
What’s the Bottom Line About Episodes in Home Health & Hospice?
Understanding episodes is about more than just timelines. It’s about ensuring every patient gets the right care, at the right time, with the right documentation.
Here’s what you need to remember:
- Episodes follow fixed timeframes: 60 days in home health, and 90/60-day cycles in hospice.
- Each episode must start with a comprehensive evaluation and include a physician-signed plan of care.
- Reevaluation isn’t optional. It’s required at episode end, and sometimes earlier.
- Multiple disciplines can be involved in an episode, but the primary discipline leads the episode.
- The discipline that starts the episode is usually the one that closes it, however this is not required.
- Changes must be backed by MD orders, and everything must be clearly documented.
Mastering the episode structure is the first step in ensuring your agency stays compliant, and your patients receive consistent, high-quality care.
Need help setting up your charting system or training staff on documentation? Explore how The Home Health Consultant can support your compliance needs below.
*This article was written in consultation with Mariam Treystman.
*Disclaimer: The content provided in this article is not intended to be, nor should it be construed as, legal, financial, or professional advice. No consultant-client relationship is established by engaging with this content. You should seek the advice of a qualified attorney, financial advisor, or other professional regarding any legal or business matters. The consultant assumes no liability for any actions taken based on the information provided.
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