If the doctor ordered physical therapy home care time period has ended, how or when can it be ordered again by the doctor?

I've run into this as well. I do feel like my LO would have a better outcome in general if she had better quality therapy for a longer period starting several years ago. Granted LO's attitude and participation weren't the greatest from the get-go (probably laziness, denial, and treating the rehab facility like a resort) and seemed like she no sooner got with the program and it ended - not to be renewed unless there was a "change" in her condition - either up or down. For example, she got a few therapy sessions after a medical procedure. She got a few sessions after a fall. She got a few sessions for an achy joint after x-rays didn't reveal the cause. It's things like that with a specific goal that everyone agrees can be accomplished. If the person is at baseline and stable, I've found it difficult to get therapy ordered and approved because there's not a clear "goal." LO's goals are to live independently and be able to drive again. But, no one will order or pay for therapy for that type of thing because there's no hope of her ever accomplishing that. I've also been told there's "no insurance plan out there" which pays for "indefinite" or ongoing therapy. It's expensive to cover and there has to be a clear reason as to what is being paid for and why. That said, all insurance plans are not created equal. Just a few things I've run into over many years in the rehab setting, home care setting, outpatient facility setting, and NH.

Has she been formally released from homecare? If her home care episode has ended the doctors usually encourage more PT done in an out patient setting.
Homecare PT can be continued if there is medical necessity. If the therapist discharged her it’s because she has reached her homecare goals and it’s time to go to an outpatient PT center that is equipped with exercise equipment that will improve her rehab. Home PT teaches muscle strengthening exercises, etc. Homecare Physical therapists are limited in they have minimal tools they can use in the home setting.

What is her diagnosis? That matters quite a bit. Medicare has strict standards for treatment plans according to diagnosis.

Good luck!

"Medicare can pay the full cost of home health care for up to 60 days at a time. That period is renewable, meaning Medicare will continue to provide coverage if your doctor recertifies at least once every 60 days that the home services remain medically necessary"