The key to coverage is whether the individual requires skilled nursing or therapy and whether care would be safe and effective if skilled care was not provided. (And the individual meets other qualifying criteria: is homebound and has proper provider certifications.)
“A patient’s overall medical condition, without regard to whether the illness or injury is acute, chronic, terminal or expected over a long period of time, should be considered in deciding whether skilled services are needed. A patient’s diagnosis should never be the sole factor in deciding that a service the patient needs is either skilled or not skilled. Skilled care may, depending on the unique condition of the patient, continue to be necessary for patients whose condition is stable.” [Emphasis added.]
- Medicare Benefit Policy Manual, Chapter 7, Home Health Services, Section 40.1.1
For more information see the CMA Home Health Quick Guide