Medicare Information

The Visiting Nurse Association of Ohio is certified by the State of Ohio to participate in the Medicare/Medicaid program. The information on this page defines and describes key criteria to establish home care eligibility for Medicare and Medicaid. Please use this information as a preliminary guide only. To determine actual eligibility, please contact the VNA at 1-800-HOMECARE.

Homebound
For a person to be considered homebound, most absences from the home must be for the purpose of receiving medical care.

A patient is considered homebound by Medicare if:

• Leaving the home requires a considerable and taxing effort
  AND
• Absences from the home for non-medical reasons are infrequent and are for a short period of time.

Plan of Care
Services must be provided under a plan of care established and approved by a physician. Plan of care must be updated and reviewed by the physician every 60 days.

Reasonable and Necessary
The services must be consistent with the nature and severity of the individual’s illness or injury, his or her particular medical needs, and accepted standards of healthcare practice.

Skilled Service
The patient must have a need for skilled nursing physical therapy or speech therapy on an intermittent part-time basis or a need for occupational therapy.

Intermittent/Part-time
To meet the Medicare requirement guideline of “intermittent,” the patient must have a recurring need for skilled nursing, physical therapy or speech therapy at least once every 60 days. Part-time means any number of days per week, up to and including either 28 or 35 hours per week (skilled services and home healthcare aide visits combined) for less than eight hours a day.

Home Care Aide (HCA) Requirements
For services to be covered, the following criteria must be met:

• Patient must be homebound and receiving a primary skilled service
• A physician must prescribe the HCA services
• The HCA must perform hands-on personal care for the patient
• An RN/Therapist must determine the specific personal care services to be provided
• The HCA must be supervised every 14 days
• HCA services must intermittent basis