C.F.R. » Title 42 » CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER B—MEDICARE PROGRAM › PART 409—HOSPITAL INSURANCE BENEFITS › Subpart E—Home Health Services Under Hospital Insurance

42 C.F.R. § 409.41

Requirement for payment

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In order for home health services to qualify for payment under the Medicare program the following requirements must be met:

(a) The services must be furnished to an eligible beneficiary by, or under arrangements with, an HHA that—

(1) Meets the conditions of participation for HHAs at part 484 of this chapter; and

(2) Has in effect a Medicare provider agreement as described in part 489, subparts A, B, C, D, and E of this chapter.

(b) The certification and recertification requirements for home health services described in § 424.22.

(c) All requirements contained in §§ 409.42 through 409.47.

[59 FR 65494, Dec. 20, 1994, as amended at 85 FR 27619, May 8, 2020]
Notes of Decisions
Cited in 5 cases (2 in the last 5 years), 2016–2025 · leading case: United States Ex Rel. Prather v. Brookdale Senior Living Communities, Inc., 838 F.3d 750 (6th Cir. 2016).
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United States Ex Rel. Prather v. Brookdale Senior Living Communities, Inc., 838 F.3d 750 (6th Cir. 2016). · cites it 4× “” 42 C.F.R. § 409.41 . Thus, the same certification requirement—and the same timing 8 The dispute regarding the face-to-face encounter documentation follows the same analysis.”
United States Ex Rel. Prather v. Brookdale Senior Living Cmtys., Inc., 892 F.3d 822 (6th Cir. 2018). · cites it 3× “Thus, "[i]n order for home health services to qualify for payment under the Medicare program," 42 C.F.R. § 409.41 mandates that "[t]he physician certification and recertification requirements for home health services described in [ 42 C.”
United States ex rel. Prather v. Brookdale Senior Living Communities, Inc., 265 F. Supp. 3d 782 (M.D. Tenn. 2017). · cites it 4× “In addition, 42 C.F.R. § 409.41 , titled “Requirement for payment,” states: “In order for home health services to qualify for payment undei the.”
Marshall v. Univ. of TN Med. Ctr. Home Care Servs., LLC (E.D. Tenn. 2021). “42 C.F.R. § 409.41 (b). Medicare also conditions payment on the beneficiary actually being homebound and actually needing skilled services.”
U.S. ex rel. v. LHC Grp., Inc. (6th Cir. 2025). “See 42 C.F.R. §§ 409.41 (c), 409.42. Congress prohibits Medicare payments for services that fail to meet medical reasonableness and -2- No.”
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