Who Qualifies through Medicare

We make it simple

We have all the answers you need to find out if your home care services will be covered by Medicare. Here’s a summary of the requirements.

Medicare requirements to qualify:

• The patient must be homebound, i.e., “it’s a taxing effort to leave the home.”
• There has been an acute exacerbation of an illness or a major change in condition so you now require the services of a skilled professional, i.e., hospitalization, changes in medications requiring instructions, change in ambulation status, new injections ordered by an MD
• Your primary physician must order the home care services and approve the home care plan of care set up by you and the skilled professional
• Your home care services are “short term and intermittent.” There needs to be a goal to the care being provided.

What Services are provided under Medicare:

• Skilled nursing: A nurse will visit for:
  • Assessment of your medical condition
  • Teaching of a specific task needed to manage your medical condition at home or regarding your medications and medical diagnoses and how to handle them 
  • Hands-on care: wound or catheter care, administration of injectable medications; “Wound care cannot be long term or for chronic non-healing wounds.”
• Physical therapy: Instruction on strengthening exercises, post-operative care, gait training, breathing and cardiac rehabilitation
• Speech therapy: Language and swallowing therapy
• Occupational therapy: Training in activities of daily living
• Medical social work: Planning for long-term care needs, evaluation of Medicaid eligibility, short-term counseling
• Home health aide: Assistance with personal care needs and the therapy home exercise program can only be provided if there is a need for skilled care, such as nursing, physical therapy or speech therapy. For home health aide services independent of skilled care, please contact our affiliate agency, VNSW at Home.

How does my physician make a home care referral?

Your physician may call VNS Westchester’s Admissions Department at (914) 682-1480, or download our Physician Referral Form or Face-to-Face Encounter Form.