How your home health hours are set, and how they can grow.
The most common question in this program is also the least answered: who decides how many hours of care I get, and how do I get more when I need more? Here is exactly how it works under the White Card and OWCP, and how we document it so your hours match your needs.
Who decides your hours.
Your treating physician states what you need. The Department of Labor authorizes it. Your job is neither.
Hours of care are not picked by the agency and not negotiated on a phone call. They come from a Letter of Medical Necessity: your treating physician certifies the care you need — the type of caregiver, the hours per day, and the days per week — tied to your accepted conditions. The Department of Labor’s claims staff reviews that documentation and authorizes the services.
For the first request under the White Card, this runs through Form EE-17A (you or your representative start the request) and Form EE-17B (the DOL sends it to your physician, who certifies the need after examining you within the past 60 days).
Authorizations run in periods, and they expire.
An authorization is not permanent. It covers a defined period — commonly around six months — and must be renewed with updated medical documentation before it ends. This is where care breaks at other agencies: the renewal is late, the documentation is thin, and visits stop while everyone scrambles.
- Before the period ends, updated documentation of your needs goes back to the DOL.
- If nothing is submitted, the authorization lapses and care stops — not because your needs changed, but because the paperwork did not keep up.
- Tracking the renewal is the agency’s job. You should never learn about a lapse from a cancelled visit.
When your needs change, your hours can too.
Hours are set by medical evidence. New evidence can reset them.
If your condition has progressed — more help with bathing or mobility, a new wound, more frequent nursing needs — the authorized hours can be increased. The path is the same as the original request:
- The change is documented. What is different, since when, and what care it requires — specific, dated, clinical.
- Your physician certifies it. An updated Letter of Medical Necessity states the new hours per day and days per week, tied to your accepted conditions.
- It goes to the DOL’s claims staff, who review and adjust the authorization. Hours can go up when the evidence supports it — and can be reduced when documentation is weak.
The honest version
Whether your hours match your needs comes down to the quality of the documentation. Vague notes get vague authorizations. Specific, dated, clinical evidence of need is what moves hours — in either direction.
One more thing about those hours: some of them can be provided by your own family member, on payroll — trained, nurse-supervised, and chosen by you. How a family caregiver gets paid.
How Alara documents your need: with data, not memory.
This is where we are built differently. Most agencies assemble an LMN from recollection — a nurse’s memory of the month, written the week the renewal is due.
The LMN and hours are built from your care record.
Your clinical record captures what your care actually requires, visit by visit: assessments, wound measurements, medication changes, mobility and daily-living needs. From your in-home nursing assessment, the draft Letter of Medical Necessity is generated with the hours grid already mapped to your accepted conditions — functional findings, care types, hours per day and days per week — not written from memory. AlaraOS carries that draft through the full life cycle: to your physician for signature, through the Department of Labor’s authorization, and to every renewal before the period ends.
- Every renewal is prepared before the period ends — the deadline is tracked from day one, so authorizations do not lapse.
- A documented change triggers a documented request. When your recorded needs grow, the evidence for more hours is already assembled.
- Your physician signs a defensible document. Specific, dated, clinical — the kind of LMN that stands up to review.
What you should never have to do.
- Track your own authorization end date.
- Learn about a lapse from a cancelled visit.
- Convince anyone your needs grew — without documentation behind you.
- Accept “that’s all the hours you get” as a final answer when your condition has changed.
If any of that is happening now, it is fixable. Send us a referral, start a case review, or ask your physician to send the order to Alara.
Reviewed by Alara’s Director of Nursing, RN. General information, not a determination of coverage; the Department of Labor sets and adjusts authorizations. Sources: U.S. Department of Labor, Forms EE-17A / EE-17B · DEEOIC Procedure Manual, Home & Residential Health Care.
Think your hours don’t match your needs?
Start a case review. A nurse reads your care needs and your current authorization together and tells you what the documentation supports.