Home Health Qualifications

For qualified beneficiaries, Medicare pays 100% of allowable charges for home health services from A&D. Home health services can also be paid for using Medicaid, private insurance, veteran’s benefits, and private pay. Because A&D’s home health services are so convenient and comprehensive, Medicare has certain criteria that must be met before Medicare will pay. Insurance generally follows similar criteria. Medicaid does not require a home health patient to be homebound.

Qualifications and insurance information differs between medical home health and non-medical home care. For a discussion of payment for non-medical home care, click here.

If you need nursing or therapy services that do not fit an insurance company’s criteria, no problem. Through A&D’s private duty nursing services, your nurses and other health care professionals can work directly for you, delivering exactly the care you need, when and where you want it.

  • Homebound
    Most patients receiving home health services should meet Medicare's definition of homebound. This simply means that either your doctor has said unecessary trips away from the home are medically contraindicated, or it means that you need the assistance of another person or a device (e.g. cane, walker, wheelchair) to leave the home. A person who is homebound should find leaving the home to be a taxing effort, and the result should be that trips away from the home are infrequent and of short duration. However, homebound patients can certainly leave the home for church, special events, and needed care. This would include hair appointments and graduations. People need not be continually homebound before and after the home health episode. On the contrary, most home health patients are only temporarily homebound due to the effects of injury, illness, or recovery.
  • Physcian Supervision
    A&D delivers home health services under orders from one of your doctors. This is usuallly an MD, DO, or DPM. This means you should have seen your doctor recently before home health starts and/or soon after home health services begin. A&D requires that you keep your doctor appoints while you are under our care.

    A&D values the doctor / patient relationship. We never require nor encourage our patients to switch their doctors.
  • Intermittent Care

    A home health plan of care, especially with Medicare, requires that the care needed be intermittent. This usually means that half-hour to one-hour visits from a nurse or therapist from one to fourteen times per week will meet your medical needs. Most plans of care have nurses visiting one to three times per week (not counting the supportive care of home health aides). Aides, however, should also only be needed a few times per week under the home health plan of care. Patients who need more attention than this may need to supplement their home health plan of care with home care services for support with daily living and/or with private duty nursing services from A&D.