Patient Qualifications

Traditional Medicare:
To qualify for Medicare skilled home care:

• The patient must be an eligible Medicare recipient.
• The patient must be under the care of a physician and the physician must order the services.
• The patient must be homebound. (Homebound does not man the patient may never leave the home. That patient’s physician must certify that the patient has a normal inability to leave home without a considerable and taxing effort. The patient may require assistance (human and/or device)to leave the home. The homebound status is not affected by frequent absences from the home for medical care that cannot be provided in the home. Homebound patients are allowed brief and infrequent absences from the home for non-medical reasons, i.e., church, graduations, and other infrequent and unique events.)
• The service must be reasonable and necessary for the treatment of an injury or illness.
• The patient must require a skilled service (i.e., Nursing, Physical or Speech Therapy). The patient must only require intermittent (part-time) nursing care, physical or speech therapy, or an ongoing need for Occupational Therapy. Medical social services and home health aide services are only covered if the patient is receiving nursing care or physical or speech therapy.
• The physician must complete documentation within 30 days stating the needs for home care services that occurred either 90 days prior or 30 days after the home care start date.
• When the above criteria are met, Medicare pays for 100% of your home care services.
• Managed Medicare Plans follow the above Medicare guidelines. Co-pays and deductibles are plan specific.

Traditional Medicaid:
To qualify for Medicaid Skilled home health services:

• The patient must be an eligible Medicaid recipient.
• The patient must be under the care of a physician, and the physician must order the services.
• The services must be reasonable and necessary for the treatment of an injury or illness.
• The patient does not need to be homebound. The services are only provided on a part-time and intermittent basis. No more than the following can be provided: 8 hours per day or 14 hours per week of combined nursing or home health aide visits, all visits under 4 hours in length.
• The physician must complete documentation within 30 days of a face-to-face encounter stating the needs for home care services that occurred either 90 days prior or 30 days after the home care start date.

*when the above criteria is met, Medicaid pays for 100% of your home care services.

Private Pay:
Private pay nursing, PT,OT, ST, MSU, and HHA services are available through our sister agency, Advantage Home Health Care, Inc.

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