Medicare Qualifications for Palliative

To qualify for the Medicare home health benefit, a Medicare beneficiary must meet the following requirements:

 

For a patient to be eligible to receive covered home health services under both Part A and Part B, the law requires that a physician certify in all cases that the patient is confined to his/her home.

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For purposes of the statute, an individual shall be considered “confined to the home” (homebound) if the following two criteria are met:

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Criteria-One:

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The patient must either:

• Because of illness or injury, need the aid of supportive devices such as crutches, canes, wheelchairs, and walkers; the use of special transportation; or the assistance of another person in order to leave their place of residence

      OR

• Have a condition such that leaving his or her home is medically contraindicated. If the patient meets one of the Criteria-One conditions, then the patient must ALSO meet two additional requirements defined in Criteria-Two below.

 

Criteria-Two:

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• There must exist a normal inability to leave home;

       AND

• Leaving home must require a considerable and taxing effort.

 

Also to qualify:

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Be confined to the home;

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• Under the care of a physician;

• Receiving services under a plan of care established and periodically reviewed by a physician;

• Be in need of skilled nursing care on an intermittent basis or physical therapy or speech-language pathology; or

• Have a continuing need for occupational therapy.

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