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We cover home health services if: The patient meets the criteria outlined in: Medicare Benefit Policy Manual, Chapter 7, section 30 42 CFR 409.42 Sections 1814(a)(2)(C) and 1835(a)(2)(A) of the Social Security Act The HHA providing the services has a valid Medicare Program agreement to participate The HHA submits a covered-services claim Services provided arenβt otherwise excluded from covered services Patient Eligibility Patients are eligible for Medicare home health services if they meet all these criteria: Are enrolled in Medicare Part A or B Need skilled nursing (SN) care (on an intermittent basis), physical therapy (PT), or speech-language pathology (SLP) services, or continue to need occupational therapy (OT) Are under a physicianβs or allowed practitionerβs care Get services under a home health plan of care (POC) that a physician or allowed practitioner established and periodically reviews Are confined to home (homebound) Had a face-to-face encounter with a physician, nurse practitioner, clinical nurse specialist, physician assistant, or certified nurse-midwife that was related to the primary reason the patient requires home health services Occupational therapists can complete the initial and comprehensive patient assessments only when the physician or allowed practitioner orders a therapy service with another rehabilitation therapy service (SLP or PT)
