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What Are the Medicare Requirements for Home Health Care Recertification?
Date Updated: December 13, 2024
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Medicare requires home health care recertification every 60 days, where the individual meets face-to-face with a medical professional to confirm continued eligibility. The home health care agency subsequently updates the service plan, which the physician must sign.
Home Health Care Medicare Certification
To receive Medicare funding, seniors must satisfy strict eligibility criteria. They or their spouse must have paid enough payroll taxes and must be at least 65 years old or have a disability, ALS or end-stage kidney failure. Qualifying for home health care coverage under Medicare involves extra measures. A physician must prescribe intermittent services and certify them as medically necessary. They must also certify the individual meets homebound criteria, meaning that they:
- Can’t leave their home because of their condition
- Can’t leave the house without great effort
- Shouldn’t leave their home because of professional recommendations
Medicare-certified providers must deliver the home health care services. Agencies collaborate with medical professionals, support workers, patients and families to create tailored service plans. Physicians must sign these care plans, and the initial home health care orders last for 60 days.
Home Health Care Medicare Recertification
Home health care review and recertification must happen every 60 days to maintain Medicare coverage.
Requirements include:
- A doctor, nurse practitioner or other high-level medical professional must meet a home health care recipient in person to assess their condition.
- A physician must review an individual’s condition and progress and confirm they still need intermittent home health care support.
- A doctor must confirm the individual remains homebound.
As part of the recertification process, home health care companies must review care plans and update them per physicians’ recommendations and orders. A doctor must sign amended service plans. Agencies and doctors must repeat this procedure every 60 days to meet Medicare requirements and ensure funding continues. Exclusions to the 60-day rule apply if an individual transfers to another agency or receives discharge having met their goals and with no expectation of returning to home health care.