Medicare pays for professional home healthcare services for eligible senior citizens, and younger disabled individuals, IF they meet certain criteria. Medicare covered services in the home include nursing and physical, occupational and speech therapy services. It will also cover social work and home health aide services IF nursing or therapy service is present. Medicare does not cover companions or homemakers.
- Medicare and most Medicare advantage plans require home healthcare patients to be homebound (see below for an explanation).
- However, Medicaid does not require patients to be homebound.
- Medicare requires that a patient have a “Face to Face” encounter with an approved provider during a specific time frame
- The patient must require the services of a “qualifying discipline” (nursing, speech therapy or physical therapy)
- Care must be intermittent and part-time
- A physician must sign orders (Medicare form 485) to certify that home healthcare is needed
Medicare pays physicians for home care certification.
Medicare Home Bound Rule – Patients must be “homebound” in order to receive Medicare coverage for home healthcare. This does not mean that the patient can never leave home. There are two aspects of homebound:
- The patient must require the help of assistive devices or another person and leaving home must be medically unadvisable.
- Homebound patients do not leave home on a regular basis and it is difficult for them to do so
- Homebound patients can legitimately leave home for:
- church services
- adult Day Center attendance
- medical appointments
- a trip to the hairdresser or barber
- family gatherings
- A short walk in the vicinity of home
- Patients are not homebound if they:
- regularly go out for recreational reasons, such as going to the senior center or to a casino
- drive (except for essential medical reasons such as getting to dialysis)
- regularly perform paid or volunteer work