Home Health Eligibility Criteria


Many of your patient's would prefer to get their healthcare at home, if possible. With home health coverage under Medicare, Medicaid and many private insurance plans, you can make the determination if your patients are qualified.

Follow the guidelines below to help you determine whether you have patients who may be eligible to receive home health care.

Qualifying Conditions of Medicare

The following are the main conditions patients must meet in order to qualify for the Medicare home health care benefit.  

  • Medical Necessity

    Patient requires intermittent:

    • Skilled nursing
    • Physical therapy
    • Speech therapy
    • Or continuing occupational therapy
  • Homebound Status

    Patient is considered "homebound." This means the patient is generally confined or medically restricted to his or her residence. However, patients can leave the home for absences that:

    • Are infrequent in nature
    • Are short in duration
      • Require a considerable and taxing effort.
      • Church, barber and special, unique family events (funeral, graduation) are permitted.
      • Not nesessarily "bedbound".
  • Face-to-Face Meeting

    As a provider, you must provide documentation of a face-to-face encounter related to the patient's medical need for home health care within 90 days prior to and 30 days after the start of home health care.

    Face-to-Face documentation must include:

    • Patient's name
    • Clinical condition requiring home health
    • Homebound status
    • Need for skilled services
    • Date of the visit
    • Physician's signature and date

Refer a patient to home health or hospice seamlessly.

More than 110,000 physicians nationwide have chosen Amedisys as a post-acute partner.

Assess Your Patient's Needs

If one or more of the following questions applies to a patient in your care, he or she may benefit from home health care.

  1. Been diagnosed with heart failure, diabetes, COPD, chronic kidney disease, stroke, Alzheimer's/dementia, joint replacement or amputation?
  2. Within the last three months experienced serious illness, surgery, falls/dizziness/loss of balance, confusion or disorientation, hospitalization or visits to the emergency department?
  3. Been prescribed Coumadin/Warfarin, insulin, IV medication, dialysis or oxygen?
  4. Had difficulty or need significant help in keeping track of which medications to take, taken the wrong medication or taken the wrong dosage of medication?
  5. Had difficulty getting out of bed, bathing, getting dressed, preparing food or using the restroom?
  6. Needed multiple office visits to a physician to deal with symptoms of their condition?
  7. Had to make a visit to you or another physician due to side effects from medication?

Download our full guide on Medicare home health eligibility to help your patients assess their needs. 

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