Home Health Admission Criteria

Who Qualifies for home health services?

For many older patients, this service is covered under Medicare Part A. In addition, many managed care and commercial insurance programs will cover home health care.

Any physician can refer a patient for Medicare home health if two requirements are met:

  • The patient must be homebound (meaning they are unable to leave home or that leaving home is a taxing effort for them)
  • The patient has a need for skilled nursing and/or therapy

 

Home Health Care can provide:

  • Skilled Nursing
  • Rehabilitation Services — Physical, Occupational and Speech Therapy
  • Medical Social Work
  • Home Health Aide Care

 

Some examples of Skilled Needs Include:

  • Monitoring of vital signs or for side effects while medications are titrated
  • Education and monitoring of uncontrolled chronic illness (e.g. diabetes, CHF)
  • Physical therapy for weakness, gait impairment or falls
  • Infusion services (antibitotics, pain management or  nutrition)
  • PT/OT and/or speech therapy after CVA
  • Education regarding maintenance and use of catheters, ostomies, drainage tubes and trachs

 

What is the Medicare Face-to-Face requirement?

Since January 2011, all Medicare fee-for-service patients being referred for home health need a face-to-face visit with their physician or associated clinician (APRN, PA etc). The visit must be:

  • For the same diagnosis for which the patient needs home health
  • Completed in the 90 days prior or 30 after beginning home health services.
  • Documented with attestation that patient is homebound and has a skilled need.

 

The Face-to-Face form can be filled out by support staff from visit notes within the prescribed time period, and then reviewed and signed by the physician.

Please call 808-547-6500.