Skilled home visits (RN, PT/OT, SLP, MSW, HHA) per CMS-485 plan of care.
Specialty pharmacy + home-infusion vendor for IV antibiotics, chemo, immunoglobulin, TPN, hydration.
Peritoneal dialysis or home hemodialysis — preferred modality for many ESRD patients per KDIGO. Avoids 3x/week clinic transport.
Symptom-management + goals-of-care support delivered at home without hospice election. Patient can still pursue curative treatment — distinguishes from HOSPICE_OVERLAY which requires forgoing curative coverage.
Post-acute therapy delivered in an outpatient clinic. Often continues after SNF or as alternative to home HH-PT.
Specialty pharmacy for high-cost drugs (PA-required tier 3-4) plus retail pharmacy refills. Meds-to-beds is the bridge.
Wheelchair van / sedan for recurring outpatient visits (dialysis, infusion clinic, PT/OT, behavioral IOP). Single-trip NEMT for discharge is in the Logistics library; this is the recurring overlay.
Step-down behavioral services — Intensive Outpatient Program, Partial Hospitalization, or individual therapy after a behavioral inpatient stay or as standalone.
Connected devices (CHF weights, CGM, BP cuff, pulse-ox) reporting back to a clinical team. Drives day-by-day re-evaluation post-discharge.
Specialty wound center — NPWT, hyperbaric oxygen, complex wound dressings, debridement. Distinct from HH skilled wound care for higher-complexity cases.
Paramedic home visits for high-risk discharges — CHF weight checks, COPD assessments, post-op wound checks. Reduces ED return for low-acuity decompensation. Growing in CA post-2020.
Hemodialysis or peritoneal dialysis at an outpatient unit (3x/week typical). Coordinates with NEMT_RECURRING for transport.
Oxygen, hospital bed, wheelchair, walker, CPAP, commode — anything the patient takes home as equipment.
Hospice services delivered wherever the patient is — home, ALF, memory care, SNF, or hospice IPU. The setting is the disposition; hospice is the service overlay.