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Frequently Asked Questions

Medicare Skilled Home Health Benefit

Frequently Asked Questions

The Medicare Skilled Home Health Benefit is a program of care and support for individuals recovering from an illness, injury, new diagnosis or recent hospitalization. The focus is on recovery, rehabilitation and health education.

  • Recent hospitalization, surgery or post-op orthopedic rehab
  • New diagnosis such as CHF, COPD, stroke or diabetes
  • New, changed or multiple medications
  • Frequent falling or fear of falling/safety at home after health changes
  • Swallowing issues/new dysphagia diagnosis
  • Neurological conditions such as Parkinson’s, multiple sclerosis and cerebral palsy
  • Bowel or bladder incontinence
  • Macular degeneration, glaucoma or other visual impairments

Home health care is a Medicare Part A benefit that requires no copay or deductible for patients who meet eligibility criteria. Other payment sources may include Medicaid, private insurance, worker’s compensation, private pay or other funding.

Medicare covers eligible home health services including:

  • Part-time or intermittent skilled nursing care
  • Physical and occupational therapy and speech-language pathology services
  • Medical social services
  • Part-time or intermittent home health aide services providing personal
    hands-on care

Frequency is based on physician orders and the level of care appropriate for each person’s unique diagnosis and care needs. Skilled home health services are intermittent, meaning that clinicians will visit to perform specific tasks and return at scheduled intervals unless health conditions change. Our care model is designed to be responsive to health changes with visits adjusted as needed.

The patient must be under the care of a
doctor and getting services under a plan of
care. Patients must be certified homebound
by a doctor and are not eligible if more than
part-time or intermittent skilled nursing is
required. A doctor must certify the need for
one or more of the following:

  • Intermittent skilled nursing care other
    than drawing blood
  • Physical or speech therapy or
    speech-language pathology services

Leaving home must require supportive devices or assistance or be medically contraindicated. There must be a normal inability to leave home that requires a taxing effort. A patient may be considered homebound if absences from the home are infrequent or relatively short in duration such as for health care treatment or attending religious services, adult day care or events such as funerals, graduations or trips to a barber or salon.

Provider Resources

We can help support your patients wherever they are in their health care journey. Explore our skilled home health provider resources.

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