MEDICAL REQUIREMENTS

MEDICARE HOME HEALTH REQUIREMENTS

 

  • Patient must be homebound.

          (*see below Medicare Homebound Status Criteria)

 

  • Care must me medically necessary.

          (usually for conditions that are acute and serious vs. chronic

          and stable)

 

  • Care must be part-time or intermittent.

 

  • The patient requires at least one skilled professional service.

          (nurse: RN/LVN, Physical Therapist, Speech Therapist)

 

  • Care must be provided by a Medicare-Certified Home Care Agency.

 

  • Must have a signed Physician’s Order for requested services.

 

  • Services must be delivered in the patient’s primary place of residence.

MEDICARE HOMEBOUND STATUS CRITERIA
 
  • Leaving the home wound require “considerable and taxing effort”.  Examples:          Medical condition or symptoms like dyspnea, weakness, frailty, confusion, pain, or the need for significant assistance from another person to leave the home

  • The patient can leave the home only for infrequent, short absences.  Example:   Medical appointments, short walks, hairdresser appt. or to attend religious services.

  • A person may temporarily homebound while recovering from surgery, serious illness or trauma.

 

WHEN TO REFER TO HOME HEALTH?
 

* Wounds & skin ulcers

* Exacerbation of condition

* New diagnosis

* Medication changes & compliance issues

* Recent falls at home

* Special diet, weight loss, nutrition and bowel problems

* Home procedures such as catheterization and/or injections