Home health care can be covered by Medicare if it meets the following criteria:
- The patient must see a physician or authorized health care provider. The physician/provider must write a brief narrative describing the patient’s clinical condition and how the patient’s condition supports homebound status and the need for skilled home health services.
- A physician/authorized provider has signed or will sign a plan of care.
- The patient is homebound. This standard is met if leaving home requires a considerable and taxing effort which may be shown by the patient needing personal assistance, or the help of a wheelchair or crutches, or other supportive device. Occasional but infrequent “walks around the block” and outings are allowable. Attendance at an adult day center or religious services is not an automatic bar to meeting the homebound requirement.
- The patient needs skilled nursing care on an intermittent basis (at least once every 60 days), or physical therapy or speech-language pathology. (Occupational therapy can continue Medicare home health care but not begin coverage.)
- The care must be provided by, or under arrangements with, a Medicare-certified provider.
For more information see our Home Health Quick Screen for Medicare Coverage