There are several requirements for receiving home healthcare:
- Homebound: Leaving the home presents a hardship for the patient. Patient leaves home primarily to receive medical care. Walking or moving requires assistance or an assistive device (wheelchair, walker, etc).
- Skilled Service Needed: Skilled medical care is necessary and can only be provided by an RN, LPN, physical therapist, occupational therapist, or speech therapist.
- Reasonable and Necessary: The patient needs treatment that requires skilled interventions.
- Intermittent and Part-Time: The patient has an ongoing need for professional skilled services on an intermittent or part-time basis.
- Face-to-Face Encounter: The Centers for Medicare and Medicaid Services (CMS) requires a face-to-face physician encounter to certify patients for homecare services.
- Authorization and Care of a Physician: The homecare orders must be written and signed by a licensed physician. A physician must also be willing to follow the patient's care at home during the course of treatment.
IV Therapy (Home Infusion) Eligibility
Individuals who require IV drug or nutritional therapy are likely to qualify for in-home IV therapy services. Insurance coverage of home infusion services varies by insurance provider. While many insurance companies cover in-home IV therapy as long as certain conditions are met, Medicare coverage of these services may be limited. Privately-insured patients should contact their insurance carriers to determine if home infusion services are covered by their plan. Our infusion admissions team can also assist with the qualification process. Learn more.