Medicare Part A (Hospital Insurance)
and/or
Medicare Part B (Medical Insurance)
cover eligible home health services like these:
Usually, a home health care agency coordinates the services your doctor orders for you. The home health agency caring for you must be Medicare-certified.
Medicare doesn’t pay for:
- 24-hour-a-day care at your home
- Meals delivered to your home
- Homemaker services (like shopping, cleaning, and laundry)
that aren’t related to your care plan
- Custodial or personal care
that helps you wi
th daily living activities (like bathing, dressing, or using the bathroom), when this is the only care you need
Who’s eligible?
All people with Part A and/or Part B who meet all of these conditions are covered:
- You must be under the care of a doctor, and you must be getting services under a plan of care created and reviewed regularly by a doctor.
- You must need, and a doctor must certify that you need, one or more of these:
- Intermittent skilled nursing care (other than drawing blood).
- Physical therapy, speech-language pathology, or continued occupational therapy services. These services are covered only when the services are specific, safe and an effective treatment for your condition. The amount, frequency and time period of the services needs to be reasonable, and they need to be complex or only qualified therapists can do them safely and effectively. To be eligible, either: 1) your condition must be expected to improve in a reasonable and generally predictable period of time, or 2) you need a skilled therapist to safely and effectively make a maintenance program for your condition, or 3) you need a skilled therapist to safely and effectively do maintenance therapy for your condition.
- You must be homebound, and a doctor must certify that you’re homebound.
You’re not eligible for the home health benefit if you need more than part-time or “intermittent” skilled nursing care. You may leave home for medical treatment or short, infrequent absences for non-medical reasons, like attending religious services. You can still get home health care if you attend adult day care.
Advanced Competency in Home Health Certification
APTA Home Health’s Advanced Competency in Home Health (ACHH) certification is a marker of excellence in and commitment to the practice of physical therapy in the home health setting.
Who Should Attend?
ACHH is for licensed physical therapists and physical therapist assistants. Individuals who successfully complete the Advanced Competency in Home Health program are provided with a certificate in, and may describe themselves as having obtained a “Certificate of Advanced Competency in Home Health”.
How will you benefit from this certification?
- For clinicians entirely new to home care: This program prepares you for the unique characteristics of practicing in the home care setting. This includes an in-depth orientation to performing either patient assessments (PTs) or cardiopulmonary assessments of patients (PTAs) in their homes, recommended tests and measures to assess patient performance, and instruction in the regulatory requirements specific to home care. The program also will give you needed supplementary education in pharmacology to prepare you for medication review with home care patients, and will provide advanced tools for managing some of the most common treatment scenarios encountered in home care.
- For therapists already practicing in home care: This program allows you to expand your expertise in home health and keep your skill set competitive. The program also brings you up-to-date on regulatory requirements and best practices in the home care setting. Most important, certification distinguishes you as an advanced clinician in home health.
- For agencies and practices providing home care physical therapy services: This program enables you to ensure that the physical therapists you employ are adequately trained to work autonomously in the home health field. Whether you send new hires or existing staff through the advanced competency program, it’s an important investment in your peace of mind. You can also promote your company as employing certified staff, to set yourself apart from the competition.
About ACHH
The program synthesizes current evidence-based practice and tailors it to the unique physical therapy setting of home health. ACHH enables home health agencies and outpatient practices that provide home care physical therapy, and individual clinicians to enhance the efficacy and efficiency of treatment of their home health patients and clients.
Course completion requirements include a combination of five (5) online, pre-recorded courses and participation in a live program (currently virtual) offered several times throughout the year. For upcoming dates of the live program, visit our calendar of events. Requirements for physical therapists and physical therapist assistants varies slightly. Certificates are valid for five (5) years from the date completed. Graduates have 30 calendar days after their certificate’s expiration date to renew without having to re-take the program.
Other ACHH Resources:
- Check out the complete course list for the Advanced Competency program
- Calendar of Events for upcoming face-to-face/virtual Advanced Competency courses
- Review program pricing
- Certificate Renewal Requirements
- Host a course and let us come to you
- Meet our faculty
- ACHH Graduate Resources
- Program graduates
- FAQs
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Many older adults prefer to get their healthcare at home, if possible. With excellent home health coverage under Medicare, Medicaid and many private insurance plans, people are anxious to take advantage of Medicare’s Home Health Benefit. Usually the question is, “Am I eligible for home health?” Ultimately your doctor makes this determination, but the process may be easier if you understand Medicare’s home health coverage and home health criteria.
Adults 65 and older, and some individuals who otherwise qualify for benefits, meet the Medicare home health requirements detailed below.
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1. Your doctor orders home health for you
To determine if you meet home health eligibility criteria, your doctor will meet with you to evaluate your needs. Some of the signs you may be eligible for home health care include a new diagnosis or worsening of an existing condition, a new medication or change in medication, or frequent visits to your doctor or hospital.
When you meet with your doctor, they will consider:
[action 1]
- Do you need intermittent (not continuous) skilled nursing, physical therapy or speech therapy, or ongoing occupational therapy? Intermittent can be as often as daily in certain circumstances, or as little as every 60 days. The main point is you won’t need regular, long-term care.
- Which home health services are medically reasonable and necessary?
2. You’re considered “homebound,” or confined to your home
To be eligible for home health, you also need to meet the Medicare homebound criteria. Essentially, this means it’s very difficult for you to leave home and you need help to do so. Your doctor will evaluate how you’re doing to decide if you meet Medicare’s homebound criteria. They’ll likely certify that you’re homebound if:
- You need the help of a supportive device (cane, walker, wheelchair, etc.) or another person to get out of the house OR your doctor believes your illness could get worse if you leave home.
- It takes a great deal of effort for you to leave home, so:
- You don’t leave home often; and
- If you do leave home, it’s for a short time and to do something you really need to do. For example, you generally can:
- Visit your doctor or get medical treatment
- Get a haircut or visit the beauty parlor
- Attend religious services
- Go to a licensed or accredited adult daycare
- Attend an important event like a wedding, family reunion, graduation or funeral
3. You receive care from a Medicare-certified home health agency
Home health agencies must meet certain federal requirements to get certified by Medicare. To find a certified home health agency and compare quality scores among different providers, visit Medicare’s Care Compare website.
How Does Home Health Eligibility Work?
The Medicare home health benefit can be hard to understand. Here are a few real-world examples so you can see how it works in people’s lives:
- John fell in his bathroom and needed hip surgery. He spent five days in the hospital and is ready to be discharged, but he hasn’t fully healed. In his discharge paperwork, John’s doctor includes information about being homebound and needing short-term skilled care. His doctor lists the services and equipment John will need. John is eligible for home health care.
- Michael has ALS. His balance is getting worse, so he uses a cane to move around. It takes him hours to get dressed and ready for the day. By the time he’s done, he’s too tired to do much else. He leaves his house periodically to go to church, medical appointments, weekly support group meetings and special family celebrations, but he needs help to do so and is often worn out afterwards. For his safety, he needs constant assistance, but his spouse works and can only care for him a few hours per week. On a recent visit, his doctor ordered home health care, including physical therapy, occupational therapy, skilled nursing and a home health aide. Michael meets Medicare’s home health eligibility criteria.
- Janet is a 75-year-old with heart failure. Her daughter drives her to see her doctor and she’s usually so tired when she gets home that she sleeps for an hour and then rests for the remainder of the afternoon. “Every time I go someplace, I am just worn out when I get home,” she says. “I don’t know what I would do if my daughter could not go with me to help.” During her last visit with her doctor, she asked about home health care. Her doctor determined she meets the home health requirements and referred her to a local agency.
Eligibility Checklist
If you’re eligible for the Medicare home health benefit, your doctor will document your needs and sign a home health certification. They’ll also need to review and sign your plan of care at regular intervals. Some of the services that may be available to you include skilled nursing care, medical social services, help with daily activities from a home health aide, medical supplies, and speech, occupational and physical therapy.
If you’re interested in exploring your home health benefits, talk to your doctor. You can also call an Amedisys home health care center near you to learn more about home health care eligibility and our services.
