Medicare Guidelines

In order to qualify for HOME HEALTH SERVICES under Medicare, the patient must:

  • Be eligible for Medicare benefits
  • Be under the care of a physician who establishes and periodically reviews the plan of care
  • Require skilled nursing on an intermittent basis or physical therapy or speech (or occupational therapy) for on-going services
  • Require services reasonable and necessary for treatment of the illness or injury
  • Be homebound

Definition of Homebound The patient’s condition must be such that leaving the home requires an extremely taxing effort. In most instances a “homebound” patient’s absence from home will occur for the purpose of receiving medical treatment.

Absences are infrequent, are of relatively short duration and do not indicate that the patient has the capacity to obtain health care provided outside rather than inside the home. If patient’s condition, due to an illness or injury, restricts the patient’s ability to leave home except with the aid of supportive device: cane, wheelchair, walker, maximum assistance of another person. If patient’s condition is such that leaving home is medically contradicted.

Any absence for religious services is deemed to be an absence of infrequent or short duration, and thus does not negate homebound status. Reimbursement for home health services is contingent upon the claimant being “confined to home.” (5240.1) Failure to meet these guidelines means that the individual is unable to receive home health services under Medicare benefits.