Admission / Referral Requirements
 
Your doctor can help you to determine if you meet the requirements for home health eligibility.  However, you don't have to wait on the doctor to advise you on your home health needs.  If you feel as if you need home health care, be sure to contact your doctor to check to see if you are eligible. 
 
If you are eligible, your doctor will send us the certification. One of our certified professional nurses will sit with you and help you get a plan of care to get you back on track for a healthier lifestyle.
 
Below you can find a table explaining eligiblity criteria for different insurance providers. You can also go to our Insurance Accepted page to review the different insurances we accept.

Criteria for Service Eligibility

Potentially Covered Services

  • Patient must be homebound
  • Patient must require skilled, intermittent services that are medically reasonable and necessary
  • Attending physician must order the service 
  • Services must be provided in the patient’s place of residence
  • Skilled Nursing Care (SN) j 
  • Physical Therapy (PT)  j 
  • Speech Therapy (ST) j 
  • Occupational Therapy (OT)k 
  • Medical Social Servicesl 
  • Home Health Aide Servicesl 
  • Physician-ordered, approved medical supplies/equipmentm
  • Same as above for Medicare except if less than 21 years of age, patient does not have to be homebound.
  • Services also require pre- authorization
  • Patient must be a qualified veteran
  • VA physician must order service
  • Services must be coordinated and approved by a VA community health nurse
  • Policy must be in effect
  • Must have a home care benefit
  • Must meet patient’s policy criteria for home health care services
  • Specific to the patient’s policy coverage
                                       
Medicare Part A
and/or Part B
 
 
 
 
 
 
 
 
Medicaid
 
 
 
 
 
 
Veteran's Administration
(VA)
 
 
 
 
 
 
Private insurance
 
 
 
 
 
 
j  Regarding Medicare:  Skilled Nursing Care, Physical Therapy, and Speech Therapy may be provided in the absence of another service.  Regarding Medicaid:  ST services are not covered.
 
k  Regarding Medicare: Occupational Therapy cannot be the only service provided initially, but can continue after the SN, PT, or ST stops.
 
l  Regarding Medicare:  Medical Social Services and Home Health Aide Services are “dependent” services and cannot be provided in the absence of SN, PT, ST, or continuing OT. 
 
m Regarding Medicare:  Medical Social Services are provided by the Medicaid program therapists, not by the home health agency; and Home Health Aide services can be the only services provided.