Basic Medicare Guidelines for Home Health Care:

Medicare will pay for health care services provided in a patient's residence ONLY if all four of these conditions are met:

1. Patient must need intermittent skilled nursing care, physical therapy, speech therapy or occupational therapy.
2. Patient must be homebound.
3. Patient is under the care of a physician who:
   ..- determines the need for home care is medically necessary & medically reasonable
   ..- sets up a home health Plan of Care
   ..- periodically reviews the Plan of Care
4. The home health agency serving the patient is approved for payment by the Medicare program.

Homebound = one who requires considerable effort and assistance to leave home, AND needs care on an intermittent basis. Patients may be considered homebound if absences from the home are infrequent or for periods of relatively short duration or attributable to the need to receive medical treatment.

Generally speaking, a beneficiary will be considered to be homebound if he/she:

1. has a condition due to an illness or injury which restricts the ability to leave home except with the aid of
   ... - supportive device (crutch, cane, wheelchair, walker)
   ... - special transportation, or
   ... - another person
2. has a condition which is such that leaving the home is medically contraindicated.