A physician’s prescribed plan of care must include the specific services needed and specify the professionals designated to
provide these services.
An individual is unable to leave their home unassisted, or leaving their home takes considerable effort. An individual may leave home for medical treatment or short, infrequent absences for non-medical reasons.
An individual requires short-term, intermittent care that is provided by at least one of the following:
- a licensed nurse
- physical therapist or speech therapist
- an occupational therapist on a continued basis
TO QUALIFY FOR MEDICARE HOME HEALTH SERVICES
- The patient is under the care of a physician (community physician willing to sign home care orders).
- The patient requires skilled nursing, physical therapy, or speech therapy services or has a continuing need for occupational therapy on an intermittent basis. (If daily, then there is an endpoint to daily care).
- Services are provided in the patient’s home.
- Services must be reasonable and necessary.
- The patient is homebound.
DEFINITION OF HOMEBOUND
Homebound means the condition of the patient causes a considerable and taxing effort for the patient to leave home:
- Absences from the home are infrequent or of short duration
- Examples of infrequent or short duration absences
- Attendance at religious service
- Attendance at a significant family event
- Trip to barber or hairdresser
- Walk outdoors
- To receive health care treatment
- To receive medical day care services
REFER TO HOME HEALTH SERVICES FOR:
- Skilled Nursing
- Observation & assessment
- Teaching & training
- Performance of skilled treatment of procedure
- Management & evaluation of a client care plan
- Physical, occupational and/or speech therapy
- Medical social work
- Home health aide service for personal care and/or therapeutic exercises