Section 7: Admission and Recertification Criteria for Admission Eligibility criteria for patient/client admission to the Agency are based on the following policy. Online Bookmark Title of Policy Assessment (PE) Criteria for Patient/Client Admission and Recertification Depending on the payer source, criteria may vary. Criteria for Medicare Coverage You will have the responsibility of admitting patients/clients to the Agency within 48 hours of referral, within 48 hours of the patient’s/client’s return home, or on the ordered start of care date. Medicare patients/clients must be admitted by an RN if nursing is ordered. If no nursing, then the Physical Therapist, if ordered or Speech Language Pathologist, if ordered may admit. The following information will assist you in understanding the admission process with a focus on Medicare fee-for-service requirements. A patient/client must meet criteria for services to be covered and reimbursed under Medicare. 1. The Patient/client must be Homebound. a. An individual shall be considered “confined to the home” (homebound) if the following two criteria are met: i. Criteria One: • Because of illness or injury, the patient/client needs the aid of supportive devices such as crutches, canes, wheelchairs, and walkers; the use of special transportation; or the assistance of another person in order to leave the place of residence. • OR • Have a condition such that leaving home is medically contraindicated. b. If the patient/client meets one of the Criteria One conditions, then the patient/client must also meet two additional requirements defined in Criteria Two. i. Criteria Two: • There must exist a normal inability to leave home. • AND • Leaving home must require a considerable and taxing effort.
