Medical Services:

Admission Criteria for Medical Services requirements include, but are not limited to the following:

  • We believe that the patient’s medical, nursing, and social needs can be met adequately by Freedom In Home Services in the patient’s place of residence.
  • The patient’s primary physician orders home care services.
  • The patient lives in, or the location where the patient will receive care, is in the geographic area served by Freedom In Home Services.
  • The patient’s residence supports his or her well-being
  • Care, treatment or services is needed to prevent, to the extent possible, deterioration of the condition or to sustain current capacities of a patient
  • The patient needs therapy services or support services.

Non-Medical Services:

Admission Criteria for Non-Medical Services; requirements include, but are not limited to the following:

  • Patients are accepted for treatment in the home on the basis of reasonable criteria and under the expectation that the patient’s needs can be met adequately by Freedom In Home Services in the patient’s place of residence.
  • The patient lives in, or the location where the patient will receive care, is in the geographic area served by Freedom In Home Services.
  • The patient’s residence supports his or her well-being
  • Patient has a valid source of payment for services to be provided or ability to self pay.

Medicare Criteria for Payment for Medical Services:

A Medicare Beneficiary must meet all the “qualifying” criteria to be covered under the Medicare Home Health Benefit for Medicare to pay for home care services.

1. The Patient must be homebound:

  • a. The patient does not have to be bedridden to be considered as confined to the home according to the Home Health Agency Manual definition.
  • b. However, the condition of the patient should be such, that there exists a normal inability to leave the home and consequently leaving the home would require considerable and taxing effort (for example, being unable to walk without becoming short of breath after a few feet).
  • c. The patient may still be homebound if they only leave the home to attend a licensed adult day care center, go to a physician medical appointment or receive medical treatment such as outpatient kidney dialysis, chemotherapy or radiation therapy. The patient is allowed brief and infrequent absences from the home for non-medical reasons and for short periods. The patient may leave the house to for example to attend a religious service, go to a barber/beauty shop, funeral, a drive, walk around the block, attendance of a family reunion, graduation, wedding, or other infrequent or unique event. These examples are not all-inclusive and are meant to be illustrative of kind of infrequent and unique events that a patient may attend.
  • d. A patient will be considered homebound if he/she has a condition due to an illness or injury that restricts his/her ability to leave his/her place of residence except with the aid of supportive devices such as crutches, canes, wheelchairs and walkers, the use of special transportation, or the assistance of another person or if leaving home is medically contraindicated. Some examples would be a patient paralyzed from a stroke who is confined to a wheelchair or requires the aid of crutches in order to walk; a patient who is blind or senile and requires the assistance of another person to leave his/her residence; a patient who has the lost the use of his/her upper extremities and therefore is unable to open doors, use handrails on stairways, etc and requires the assistance of another individual to leave his/her residence; a patient who has just returned from the hospital stay involving surgery suffering resultant of weakness and pain and therefore his/her actions are restricted by physician for a specified period of time; a patient with arteriosclerotic heart disease of such severity that he/she must avoid all stress and physical activity; a patient with a psychiatric problem if the illness is manifested in part by a refusal to leave home or is in such a nature it would not be safe to leave the home unattended, even if they have no physical limitations and a patient in the late stages of ALS or neurodegenerative disabilities.
  • e. An aged person who does not leave the home due to feebleness and insecurity brought on by advanced age or a person who does not drive or the lack of transportation would not be considered confined to the home for the purposes of receiving home services unless he/she meets one of the above criteria.

2. Home care services must be provided in your place of residence:

  • a. A patient’s place of residence may be wherever he/she makes his/her home, such as his/her own house, an apartment, a relative’s home, an assisted living facility)
  • b. For Medicare payment, a hospital or skilled nursing facility (nursing home) can not be considered a patient’s residence

3. A patient must be under the care of a physician:

  • a. A plan of medical treatment must be approved and signed by patient’s physician certifying that home care services are medically necessary and that the patient is homebound.

4. The Patient’s care must require a skilled service:

  • a. Skilled services are those which are medically reasonable and necessary to the treatment of your illness or injury and may only be performed by a licensed nurse, licensed physical therapist, licensed occupational therapist, or speech language pathologist.

5. The patient’s care is needed on an intermittent basis:

  • a. The patient’s needs must be able to be met on a per-visit basis and there must be an on-going medical need for home care services.
  • b. Daily nursing care for an indefinite period of time is not considered intermittent and is not covered. Patients who receive daily care must have a realistic projected end date for daily visits and a physician order that support daily visits.