Conditions Patient Must Meet to Qualify for Coverage of Home

30 - Conditions Patient Must Meet to Qualify for Coverage of Home Health Services (Rev. 10438, Issued: 11-06-20, Effective: 03-01-20, Implementation: 01- 11-21) To qualify for the Medicare home health benefit, under §§1814(a)(2)(C) and 1835(a)(2)(A) of the Act, a Medicare beneficiary must meet the following requirements: • Be confined to the home; • Under the care of a physician or allowed practitioner; • Receiving services under a plan of care established and periodically reviewed by a physician or allowed practitioner; • Be in need of skilled nursing care on an intermittent basis or physical therapy or speech-language pathology; or • Have a continuing need for occupational therapy. For purposes of benefit eligibility, under §§1814(a)(2)(C) and 1835(a)(2)(A) of the Act, "intermittent" means skilled nursing care that is either provided or needed on fewer than 7 days each week or less than 8 hours of each day for periods of 21 days or less (with extensions in exceptional circumstances when the need for additional care is finite and predictable). A patient must meet each of the criteria specified in this section. Patients who meet each of these criteria are eligible to have payment made on their behalf for services discussed in §§40 and 50.