How do you qualify for home health with Medicare?


         From the Doctor

For Medicare beneficiary to be eligible to receive Medicare home health services, the physician must certify that:

     1. The patient needs or needed:

          a. Intermittent skilled nursing care;

          b. Physical Therapy

          c. Speech-language pathology services; or

          d. Has a continuing need for occupational therapy, if the patient no longer needs any of the therapies above.

      2. The patient is or was confined to the home (i.e. homebound)

      3. A patient plan of care for furnishing the services has been established by a physician who is a doctor of medicine, osteopathy, or podiatric medicine, and who has no financial relationship with the Home Health Agency (HHA). (A doctor of podiatric medicine may perform only plan of treatment functions that are consistent with the functions he or she is authorized to perform under state law.)

      4. The patient services will be or were furnished under the care of a physician who is a doctor of medicine, osteopathy, or podiatric medicine.

      5. A face-to-face encounter occurred no more then 90 days prior to or within 30 days after the start of home health care, and was related to the primary reason the patient requires home health care.

    "Confined to the home (Homebound)"


Documentation from the certifying physician/acute/post-acute care facility’s medical records serves as the basis upon which patient eligibility for the Medicare home health benefit is to be determined. Such documentation includes information that substantiates that the patient is confined to his/her home. In order to be considered “confined to the home” (i.e. homebound), the following two criteria must be met:

     1. Criteria-One: The patient must either, because of illness or injury:

          a. Need supportive mobility assist devices such as crutches, canes, wheelchairs, and walkers; or

          b. Need us of special transportation to leave their place of residence; or

          c. Require the assistance of another person in order to leave their place of residence; or

          d. Have a medical condition that prohibits leaving their place of residence.

The patient must meet one of the Criteria One conditions listed above and also meet the two additional requirements defined in Criteria Two below to be considered homebound for purposes of eligibility for the Medicare home health benefit.

     2. Criteria Two

          a. There must exist a normal inability to leave home; and

          b. Leaving home must require a considerable and taxing effort.

NOTE: In determining whether the patient meets Criteria Two (see above) in the homebound definition, the reviewer must take into account the illness or injury for which they met Criteria One (see above) and also consider the patients overall condition. Determination of homebound status requires clinical judgement. Clinical judgement is the application of information based on an actual observation of a patient and/or review of a patients clinical record to assimilate subjective and objective data that lead to a conclusion.

If the patient does in fact leave the home, the patient may nevertheless be considered homebound if the absences from the home are infrequent or for periods of relatively short duration, or are attributable to the need to receive health care treatment. Likewise, occasional absences from the home for nonmedical purposes does not necessitate a finding that the patient is not homebound if the absences are undertaken on an infrequent basis or are of relatively short duration and do not indicate that the patient as the capacity to obtain the health care provided outside rather than in the home.. e.g.;

     a. Occasional trip to the barber

     b. Walk around the block or a drive

     c. Attendance at a family reunion

     d. Funeral

     e. Graduation, or

     f. Other infrequent or unique event.​ce to begin entering your own content. 

    A Face-to-Face visit with your doctor​

A face-to-face encounter must happen 90 days before or 30 days after the start of care of the home health agency.  The face to face must be signed by an allowed  Provider, medical doctor, doctor of osteopathy, or a podiatrist.  Face-to-face's may now also be signed by a N.P. working for a doctor.  Document must also be dated by the person signing the document.  The Face-to-face also must indicate the reason for the encounter and was the assessment related to the need for home health services. (encounter must be related to the reason for home care).  the face-to-face document should also come with a progress note, and any other notes relating to the reason patient needs home health.

        COVID-19 Protocols

 While making a home visit, we need to identify patients at risk for having COVID-19 infection before or immediately upon arrival to the home. All patients need to be prescreened before contact.

All patients are asked:

  1.  Any international travel in the last 14 days to countries with sustained community               transmissions.
  2.   Signs and symptoms of a respiratory infection such as fever, cough, and sore throat.
  3.   In the last 14 days, has had contact with someone with or under investigation for COVID-19, or ill with a respiratory illness.
  4.  Residing in a community where community-based spread of COVID-19 is occurring.

For ill patients, implement source control measures (i.e. placing a face mask over the patients nose and mouth if that has not already been done.)

Inform the clinical manager, local and state public health authorities about the presence of a person under investigation (PUI) for COVID-19.

Hand hygiene should be preformed before putting on and after removing personal protection equipment (PPE) using alcohol based sanitizer that contains 60-95% alcohol.

PPE should ideally be put on outside of the home prior to entry into the home. If unable to put on PPE outside, it is still preferred that face protection (face mask and eye protection) be put on before entering the home. Other PPE should be put on at least 6 feet away from the patient.

Ask patient if an external trash can is present at the home, or if one can be left outside for disposal of PPE. PPE should ideally be removed outside of the home and discarded by placing in a external trash can before departing location. PPE should not be taken from the home in staff’s vehicle.

If unable to remove PPE outside of the home, it is still preferred that face protection be removed after exiting the home.