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MEDICARE
REQUIREMENTS
Medicare pays for home health care services
at NO COST to the patient. Patients must
meet the following conditions to be admitted
by a Medicare certified home health agency:
1. A Qualifying Service: Intermittent skilled care from
a nurse, physical therapist, or speech
therapist.
2. Medicare does NOT require a hospitalization to
qualify for care.
3. Patient must be under the care of a physician who
certifies, as well as periodically reviews,
a plan of care (POC) and determines that
services are medically necessary and
reasonable.
4. Patient must be homebound: "Confined to the home
except for absences for health care
appointments, to attend church or a licensed
adult day care setting, or for infrequent
absences of short duration for personal
reasons."
DO YOU QUALIFY?
To qualify for home health services a
Medicare or Medicare HMOclient must be
homebound (confined to the home except for
absences for health care appointments, to
attend church or a licensed adult day care
setting, or for infrequent absences of short
duration for personal reasons); require the
services of a skilled health professional;
and be under the care of a physician.
Skilled nursing services must be needed on
an intermittent bases. Skilled nursing care
on an intermittent basis qualifies for the
Medicare or Medicare HOM home health
benefits for the following reasons:
1. Observation and assessment of a patient’s condition
when only the specialized skills of a nurse
can determine a patient’s status.
2. Management and evaluation of a patient care plan
(due to the complexity of the unskilled
services needed for medical care).
3. Teaching and training of a patient or caregiver in
matters related to a health condition.
4. Administration of medications (IV, IM, SQ )
5. Tube feeding management.
6. Urinary catheter management.
7. Wound care requiring the skills of a nurse to
perform the treatment or assessment.
8. Ostomy care during a post-operative or complications
period.
9. Medical gasses management during the initial phases
of a regimen.
10. Rehabilitations nursing procedures and teaching.
11. Venipuncture, when that is not the sole reason for
the home health.
12. (Most other insurance plans follow the same
qualification criteria.) |
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First Call Home
Health • 565 Union St. NE, Ste
205, Salem OR 97301
Phone: 503-371-4567 • Fax:
503-371-4569 |
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