Medicare covers all home health services for covered seniors provided that the following criteria are met:
- Your physician must order the services prescribed. A verbal or written desire to have home health services wll not be paid by Medicare unless it is supported by a written order duly signed by your physician (HIM 11…204.5).
- The services must be reasonable and medically necessary to the treatment of an illness or injury. Reasonable and medically necessary means the services of a Skilled Nurse is needed to keep you safe and ensure that the orders prescribed by your doctor will be implemented effectively (HIM 11…203.1).
- You must be home bound. In order to be homebound, you must have a medical condition that restricts your ability to leave your place of residence without assistive devices like a cane, or assistance of another person or if leaving your home is medically contraindicated. Examples of home bound patients are: a patient paralyzed from a stroke, blind or senile, loss of upper extremity strength making it hard to open doors, a a patient who underwent a surgery and is restricted by his doctor to certain specified and limited activities, a patient with heart disease ordered to stay away from any form of stress or physical activity, a patient who finds it a considerable taxing effort to leave home, a patient experiencing shortness of breath when ambulation more than 20 feet, and a patient with a psychiatric problem (HIM 11…204.11)
- Skilled nursing and/or home health aide services must be provided on an intermittent basis within a specified period of time. You must have a potential to improve your general health status leading to an improved quality of life (HIM 11…205.1)