Skilled nursing care

Skilled nursing services are covered when they’re given on a part-time or intermittent basis. In order for skilled nursing care to be covered by the Medicare home health benefit, your care must be necessary and ordered by your doctor for your specific condition. You must not need full time nursing care and you must be homebound . Skilled nursing services are given by either a registered nurse (RN) or a licensed practical nurse (LVN). If you get services from a LVN, your care will be supervised by a RN. Home health nurses provide direct care and teach you and your caregivers about your care. They also manage, observe, and evaluate your care. Examples of skilled nursing care include: giving IV drugs, shots, or tube feedings; changing dressings; and teaching about prescription drugs or diabetes care. Any service that could be done safely by a non-medical person (or by yourself) without the supervision of a nurse, isn’t skilled nursing care. Home health aide services may be covered when given on a part-time or intermittent basis if needed as support services for skilled nursing care. Home health aide services must be part of the care for your illness or injury. Medicare doesn’t cover home health aide services unless you’re also getting skilled care such as nursing care or other physical therapy, occupational therapy, or speech-language pathology services from the home health agency.

Physical therapy, occupational therapy, and speech-language pathology services

Medicare/HMO uses the following criteria to assess whether these therapy services are reasonable and necessary in the home setting: 

• The therapy services must be a specific, safe, and effective treatment for your condition.
• The therapy services must be complex or your condition must require services that can safely and effectively be performed only by qualified therapists. 
• One of the three following conditions must exist:
  •  It’s expected that your condition will improve in a reasonable
    and generally-predictable period of time.
  • Your condition requires a skilled therapist to safely and
    effectively establish a maintenance program.
  • Your condition requires a skilled therapist to safely and effectively
    perform maintenance therapy.
• The amount, frequency, and duration of the services must be reasonable. 

Medical social services

These services are covered when given under the direction of a doctor to help you with social and emotional concerns related to your illness. This might include counseling or help finding resources in your community.

Medical supplies

Supplies, like wound dressings, are covered when they are ordered as part of your care. 

ResourceS: www.medicare.gov