To qualify for home health services, Medicare beneficiaries must (1) be
homebound; (2) need intermittent skilled nursing care or physical, speech, or
occupational therapy; (3) be under the care of a physician; and (4) be under a
plan of care that has been established and periodically reviewed by a
physician.3
For a home health agency (HHA) to receive payment from
Medicare, a physician must certify the beneficiary’s need for home health
services and must recertify the need at least every 60 days.
Homebound Status
Medicare considers beneficiaries homebound if, because of illness or injury,
they have conditions that restrict their ability to leave their places of
residence. Homebound beneficiaries do not have to be bedridden, but
should be able to leave their residences only infrequently with “considerable
and taxing effort” for short durations or for health care treatment
Intermittent Skilled Nursing or Therapy Services
The Social Security Act defines “part-time or intermittent services” as
skilled nursing and home health aide services furnished any number of days
per week as long as the combined services are less than 8 hours each day and 28 or fewer hours per week.6 A registered nurse or licensed vocational nurse
must provide the skilled nursing care.7
Home health aide services include
personal care, such as bathing and dressing, feeding, and simple dressing
changes that do not require the skills of a licensed nurse.8 Therapy services
must be performed by a qualified therapist or therapy assistant under the
supervision of a qualified therapist.
