Medicare Qualifications for Home Health
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.
For purposes of the statute, an individual shall be considered “confined to the home” (homebound) if the following two criteria are met:
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
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.
There must exist a normal inability to leave home;
Leaving home must require a considerable and taxing effort.
Also to qualify:
Be confined to the home;
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.