o Psychiatric conditions manifested by a refusal to leave home or it is unsafe for the patient/client or others if the patient/client leaves home, may render the patient/client homebound. • AND • Homebound status is not affected by frequent absences from the home when the reason to leave is to receive medical treatment, such as: o Attendance at a state licensed adult day care o Doctors’ office visits o Outpatient kidney dialysis o Outpatient chemotherapy or radiation therapy • The patient/client is allowed brief and infrequent absences from the home for non-medical reasons. c. Continued care of a Medicare patient/client who is not homebound is considered fraud. 2. Patients/clients must be under the care of a physician. a. A medical plan of care (POC) must be established by the attending physician in conjunction with the home health professional staff. b. The physician’s signature on the POC must be obtained prior to billing for reimbursement from Medicare. c. The POC must be reviewed by the physician at least every 60 days. 3. The physician must certify that: a. Home health services are or were needed because the patient/client is homebound. b. The patient/client needs or needed skilled nursing services on an intermittent basis (other than solely venipuncture for the purposes of obtaining a blood sample), or physical therapy or speech-language pathology services; or continues to need occupational therapy after the need for skilled nursing care, physical therapy, or speech- language pathology services has ceased. Where a patient’s/client’s sole skilled service need is for skilled oversight of non-skilled services (management and evaluation of the care plan), the physician must include a brief narrative describing the clinical justification of this need as part of the certification and recertification, or as a signed addendum to the certification and recertification. c. A plan of care has been established and is periodically reviewed by a physician. d. The services are or were furnished while the patient/client is or was under the care of a physician.
