How Do I Get Approved to Use Home Health?

Home health is a valuable healthcare option that provides skilled nursing and therapy in your home. However, many people who are eligible to receive home health don’t know that they’re eligible.

Could you or a loved one be receiving care in the comfort of your own home? Home health is covered by original Medicare if you meet certain criteria:

1. You have a need for skilled care.

This means care that requires the use of a skilled nurse or therapist. The services must be reasonable and necessary for your illness or injury.

Because medical care is being provided in the home, you must need the services of a:

• Registered Nurse
• Physical Therapist
• Occupational Therapist, or
• Speech-Language Pathologist.
  
  

Your need cannot be only for housekeeping, bathing assistance, or other services that someone without medical training could provide.

Examples of skilled care include:

• Medication Management, Teaching, and Assessment – Nurses and therapists assess you for improvement or changes in your condition. This includes teaching you to take new or changed medicines correctly.
• Surgical Aftercare – Nurses and therapists can help you recover from surgery. This includes caring for incisions, anesthesia side-effects, stomach issues/nausea, etc. Therapists can help you regain movement and strength after surgery.

• Complex Nursing Interventions – This includes care for people with ostomies, tube feeding, ventilators, or intravenous (IV) medications.

• Musculoskeletal Rehabilitation – Therapists help you recover strength and ability to move your muscles and joints.
• Neurologic Conditions/Stroke Rehabilitation – Nurses assess your medical condition and teach about your medications. Therapists help you regain strength, reduce fall risks in the home, and perform daily activities.
• Wound Care – Home health nurses care for wounds to ensure they are healing. This includes care for surgical incisions, pressure ulcers, circulation issues, or injuries.
• Behavioral Health Care – Behavioral health issues like depression can impact your ability to heal. It’s important to address these issues so you can live safely and independently at home.
  

2. You are homebound.

“Homebound” means it’s difficult for you to leave home for care. You can be considered homebound if:

• You need devices like crutches, a wheelchair, or a scooter to leave home.
• You need special transportation or someone’s assistance to leave home.
• You are normally unable to leave home, except for short infrequent activities. (You can still be considered homebound if you just leave home for church, healthcare treatments, visits with family, etc.)
• You have a condition where leaving home could be dangerous. For example, if you have a lung disorder, it may be dangerous for you to go to public places during flu season. If you are weak because of an illness or surgery, it may be dangerous for you to drive to a medical appointment.

Getting Started with Home Health

If you think you meet these two criteria, you will just need a face-to-face visit with your doctor that addresses the reason for home health. This visit can happen 90 days before or 30 days after you begin receiving home health services. Your doctor will determine your specific home health needs and send an order to the agency. You have the right to choose any home health agency for your care.

If you have original Medicare, home health is pre-approved. If you have another type of insurance, it may require pre-authorization. The home health agency will verify your insurance coverage to be sure that there is no out-of-pocket cost to you. Then they will schedule a time to come to your home for an assessment and start of care visit.

At this initial visit, the Home Health nurse will do a full assessment of your situation. This includes your specific condition, home safety, medication review, and more. After the visit, the nurse will send a report to your doctor, who then signs orders for the care to be provided.

Over time, the agency will perform regular assessments on how you are doing. They will call your doctor to discuss any changes in your condition and make changes to your care plan as needed. No changes to your care will occur without your consent.

All of this is designed to help you live safely and independently at home. When you have reached your goals or no longer need home health care, you are discharged from service. For most patients, this is usually in 30-120 days, depending on the care you need.

Have questions about bringing this high level of care to you at home? Get in touch to discuss your eligibility with one of our caring Home Health Experts.