The following defines and describes key criteria to establish
homecare eligibility for Medicare and Medicaid. Use this information as a
preliminary guide only. To determine actual eligibility, please contact the VNA
at 216-931-1400 or 1-800-442-1VNA.
Homebound
For a person to be considered homebound, most absences from the home
must be for the purpose of receiving medical care.
A patient is considered homebound by Medicare if:
 Leaving the home requires a
considerable and taxing effort AND
Absences from the home for
non-medical reasons are infrequent and are for
a short period of time
Plan of Care
Services must be provided under a plan of care established and approved by a
physician. Plan of care must be updated and reviewed by the physician every 60
days.
Reasonable and Necessary
The services must be consistent with the nature and severity of the
individual’s illness or injury, his or her particular medical needs, and
accepted standards of healthcare practice.
Skilled Service
The patient must have a need for skilled nursing physical therapy or speech
therapy on an intermittent part-time basis or a need for occupational therapy.
Intermittent/Part-time
To meet the Medicare requirement guideline of ‘intermittent’, the patient must
have a recurring need for skilled nursing, physical therapy or speech therapy
at least once every 60 days. Part-time means any number of days per week, up to
and including either 28 or 35 hours per week (skilled services and home health
care aide visits combined) for less than eight hours a day.
Home Care Aide (HCA) Requirements
For services to be covered, the following criteria must be met:
Patient must be homebound and
receiving a primary skilled service
A physician must prescribe the
HCA services
The HCA must perform hands-on
personal care for the patient
A RN/Therapist must determine
the specific personal care services to be provided
The HCA must be supervised every
14 days
HCA services must be provided on
a part-time, intermittent basis
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