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First, the patient must meet the Medicare definition of "HOMEBOUND": An individual does not have to be
bedridden to be considered confined to home. The condition of the patient should be such that there exists a
normal inability to leave home, and that it would be a considerable and taxing effort for the patient to leave
home. The absences from home should be of short duration and infrequent or to receive health care treatment
such as chemotherapy, radiation, outpatient dialysis, and/or day care for medical care. Day care services must
be certified or licensed by the state. Non-medical absences from home include beauty or barbershop, family
reunion, funeral, graduation, and/or any other unique event. If these absences occur, they must be infrequent
and of short duration and with a taxing effort.
Skilled Nursing: Medicare defines three primary nursing functions that it considers to be "skills" and therefore
reimbursable by Medicare:
Observation and Assessment of patient conditions including but not limited to:
• New Diagnosis
• Exacerbated Diagnosis
• Fluctuating Vital Signs
• Weight Changes Edema
• Symptoms of Drug Toxicity |
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• Respiratory Changes
• Circulatory Changes
• Initiation of Medical Gases
• Post-hospital Follow-up |
Teaching and Training needs including, but not limited to:
• Medications
• Medication Regimen
• Enteral/Parenteral Feedings
• Bowel/Bladder Training |
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• Specified Procedures :
• Injections
• Intermittent Catheterizations
• Wound Care
• Diabetic Care
• Ostomy Care
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"Skilled" Procedures including, but not limited to:
• IV Infusions
• Insulin and Other Injections
• Catheter Changes
• Wound Care |
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• Tube Feedings
• NP/Trach Suctioning
• Heat Treatments
• Ostomy Care, with associated complications |
Physical Therapy: may be indicated if the level of need is such that intervention by a trained therapist is
required, if:
• The patient has difficulty:
• Getting in/out or repositioning in bed
• Walking inside or outside
• Standing/Sitting
• Going up or down steps
• Getting on/off toilet or bedside commode |
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• The patient has:
• A history of falls
• Shortness of breath with activity
• Poor safety awareness
• A need for related teaching or training
• Contractures or pressure areas
• Equipment needs
• Limited ROM, decreased sensation or strength
• A decline in function due to stroke, pain, arthritis, amputation, etc
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Occupational Therapy: may be indicated if the skills of a trained therapist are needed by the patient who has:
• Difficulty in performing Activities of Daily Living (ADL's; dressing, grooming, bathing, feeding...) or safely
completing mobility tasks
• Poor coordination
• Difficulty in performing housekeeping or cooking chores
• Limited use of arms or hands
• Sensory loss
• Shoulder pain
• A need for adaptive equipment
• Decline in function
• Memory problems or problem-solving deficits
(NOTE: Occupational Therapy does not qualify to be the only "skilled" service, at the start of home health
services.)
Speech Therapy: may be indicated if the skills of a trained therapist are required by the patient who has:
• A voice disorder
• A speech articulation disorder
• Dysphagia
• A language disorder
• Aural rehabilitation needs
• Non-oral communication needs
Medical Social Services: may be indicated if the patient's social, emotional or economic situation impacts their
ability to recover or to reach maximum rehabilitation potential. Need must be at a level requiring the intervention
of a trained social worker for:
• Assessment of social and emotional factors
• Counseling for long-range planning and decision-making
• Education about or assistance in accessing Community Resources
• Short-term counseling
(NOTE: Medical Social Services does not qualify as a "skill", and cannot stand as the only home health
service.)
Home Health Aide Services: can be provided to patients who require assistance with ADL's if the patient is
also receiving care from a "qualifying" skilled professional. Home Health Aide services include:
• Assistance with bathing and grooming
• Assistance with transfers/ambulation
• Assistance with exercises
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