What is Medicare-certified home health?
By Scott McKenzie, founder of Home Care Agency Blueprint · Updated
Medicare home health is skilled care at home that a doctor or other allowed provider orders and a Medicare-certified home health agency provides. Medicare.gov describes who qualifies and what is covered; this page summarizes it at a high level. It is not an eligibility test for any patient.
What Medicare.gov lists as covered
- Medically necessary part-time or intermittent skilled nursing care, such as wound care, patient and caregiver education, intravenous or nutrition therapy, injections, and monitoring serious illness.
- Physical therapy, occupational therapy and speech-language pathology services, if the person meets certain conditions.
- Medical social services.
- Part-time or intermittent home health aide care, only if the person is also getting skilled nursing or therapy at the same time.
- Durable medical equipment and medical supplies for use at home.
Paraphrased from Medicare.gov. Read the source for the full wording.
What Medicare does not pay for
Medicare.gov says Medicare does not pay for round-the-clock care at home, home meal delivery, homemaker services such as shopping and cleaning that are unrelated to the care plan, or custodial or personal care that helps with daily living activities, like bathing, dressing or using the bathroom, when that is the only care the person needs. Much of what a non-medical home care agency offers falls in that last group, which is why the two businesses are different.
Homebound and part-time or intermittent, in brief
Medicare.gov says a person must need part-time or intermittent skilled services and be homebound, and it explains what homebound means. We do not restate the tests here or apply them to anyone. Read Medicare.gov for the current wording.
Orders and a certified agency
Before home health starts, Medicare.gov says a doctor or other health care provider must see the person in person, confirm the need, and order the care, and a Medicare-certified home health agency must provide it. The agency then works with the ordering provider on the care plan.
What this means for a founder
If your plan is personal care, companionship or homemaking, you are planning a non-medical home care agency, and Medicare home health is not your payer path. starthomecareagency.com, also published by Home Care Agency Blueprint, covers that start. If your plan is skilled, ordered care paid by Medicare, you are planning a home health agency that would seek Medicare certification, with the federal rules on the next pages.
A planning aid, not a promise. Nothing on this site can tell you which agency to open, whether you would be licensed, or whether you would be certified. It maps the differences and points you to Medicare.gov, CMS and your state so you can check them for your own plans.
Your state sets its own rules. Whether and how your state licenses non-medical home care, home health agencies or both is a state question, and the rules can change. This site does not list state rules. Check your state licensing or survey agency; homecarelicenseguide.com, also published by Home Care Agency Blueprint, helps you research non-medical licensing. Not legal, licensing, Medicare or financial advice.
What to do next
Frequently asked questions
Does Medicare pay for companion or homemaker services?
Medicare.gov says Medicare does not pay for homemaker services unrelated to the care plan, or for custodial or personal care when that is the only care needed.
Who provides Medicare home health?
Medicare.gov says a Medicare-certified home health agency must provide it, after a doctor or other allowed provider orders the care.
Want to talk through your options?
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