Community Home Health agencies provide Medicare-certified home health services to patients who qualify.
General Coverage Guidelines
Patients qualify for Medicare-covered home health services if the following conditions are met:
- Patient is home-bound or confined to home due to illness, injury, or post-operation (see below for specifications)
- Services are provided under a plan of care established and approved by a physician
- Services are medically necessary and reasonable (see below for specifications)
- Services are performed in an individual’s place of residence
- Patient requires skilled nursing on an intermittent basis or occupational therapy for ongoing services
For complete information on Medicare qualifications and guidelines, please visit the U.S. Government’s Site for People with Medicare.
A patient is considered home-bound if absences from the home are infrequent, require considerable and taxing effort, of short duration and are attributable to the need to receive medical care. Generally, a beneficiary will be considered home-bound if the condition is due to an illness or injury that restricts ability to leave place of residence except with use of following:
- Supportive aid devices (crutches, canes, wheelchairs and walkers)
- Use of special transportation
- The assistance of another person
Home health care is medically necessary if the patient has difficulty leaving the home setting and the patient’s condition requires skilled services such as skilled nursing care, physical therapy or speech therapy on an intermittent basis.