For Medicare to pay for home health services, certain admission criteria must be met.

• PHYSICIAN SUPERVISION: Care must be delivered under the orders of an MD, DO, or DPM.  The patient must have had a face-to-face visit with the doctor at least 90 days before or 30 days after the home health start of care.
• HOMEBOUND: Medicare’s definition of homebound is not as restrictive as the term itself may imply.  This simply means that a patient currently finds leaving the home to be a considerable and taxing effort and that trips away from the home are subsequently infrequent and of short duration.  Patients may be temporarily homebound due to the current status of their injury or illness.
• NEED FOR SKILLED NURSING SERVICES: This means the initial plan of care must call for services that can only be legally provided by a skilled nurse, physical therapist, or speech therapist (or occupational therapists for recertification).  This criterion is meant to differentiate skilled care from non-medical plans of care.  While AmeriCare can and does provide aide services to assist with health-related ADLs during the care episode, for Medicare (and most health insurance) to pay, the ADL services must be ancillary to the services of a nurse or therapist.