Home Health Referral Requirements: Medicare, Orders and Documentation

Written by Maria Rodriguez Director of Nursing, RN Jul 28, 2026

Clear home health referral requirements help medical offices, hospitals, facilities, and care coordinators send an actionable record instead of an incomplete request. For Medicare home health, the central questions are whether the patient is homebound, needs intermittent skilled services, is under the care of an authorized practitioner, and has a supported plan of care. The home health agency must also determine that it can safely and appropriately serve the patient.

HarvardCare Home Health adds agency-specific intake criteria: the patient must live within its approved Los Angeles County service area, and HarvardCare currently accepts eligible patients when Original Medicare Part A and Part B are primary. That payer policy belongs to HarvardCare; it should not be described as a universal rule for every home health agency.

Overview of home health referral requirements

A referral packet should show who the patient is, where care will occur, what skilled service is requested, why it is medically necessary now, who will issue and manage the orders, and what recent documentation supports the request. It should also clarify payer information, homebound limitations, the discharge plan, and whether another home health agency is active.

Referral partners can review the professional referral requirements before transmitting protected information through an approved secure channel. Completing the form begins intake review; it does not replace provider orders or guarantee that HarvardCare Home Health will admit the patient.

Original Medicare and HarvardCare’s current intake policy

Medicare’s home health benefit may be covered under Part A or Part B when the applicable requirements are met. HarvardCare Home Health currently limits intake to eligible patients whose Original Medicare Part A and Part B are primary. Referral sources should send accurate Medicare information and disclose other coverage so intake can verify the situation.

This is an agency acceptance policy, not a statement that Medicare Advantage, Medi-Cal, commercial insurance, or other payers can never cover home health elsewhere. Other agencies may have different contracts and policies. If HarvardCare cannot consider a referral because of payer status, that does not determine the patient’s eligibility with another organization.

Homebound eligibility

Medicare describes a patient as homebound when illness or injury makes leaving home medically inadvisable or requires help from another person, a supportive device, or special transportation, and the patient normally cannot leave home without considerable and taxing effort. A patient can still attend medical treatment or have occasional short absences without automatically losing homebound status.

Documentation should describe the functional facts. Note whether the patient requires a walker, wheelchair, oxygen, one-person assistance, or special transportation; cannot manage stairs; has impaired balance or cognition; experiences significant pain, weakness, or shortness of breath; or faces another condition-specific barrier. A checkbox stating “homebound” without supporting detail can delay review.

Qualifying skilled nursing or therapy need

The record should identify a reasonable and necessary intermittent skilled service. Examples may include skilled nursing for assessment, teaching, or monitoring; wound care at home under specific orders; or therapy for documented mobility, daily-activity, communication, cognitive, or swallowing deficits.

A diagnosis alone is not enough. The referral should connect current findings to skilled intervention. “Diabetes” does not explain the need as clearly as a recent medication change with demonstrated teaching and monitoring needs. “Status post fall” is less useful than documented gait instability, transfer assistance, and the need for physical therapy at home.

Medicare does not cover 24-hour care at home, meal delivery, homemaker services unrelated to the care plan, or custodial personal care when that is the only need. HarvardCare Home Health likewise does not offer private-pay, live-in, companion, custodial, or non-medical caregiver services.

Home health order requirements

The order should identify the discipline and purpose of care with enough specificity for the agency to evaluate and implement it safely. CMS permits physicians and certain allowed practitioners—including nurse practitioners, clinical nurse specialists, and physician assistants—to order and certify Medicare home health within applicable requirements. Other professionals may initiate or coordinate the referral, but they cannot be assumed to have authority to sign every required order.

Orders should be internally consistent with the clinical record. If the request is for wound care, include the treatment and frequency instructions. If it is for therapy, identify the functional problem and requested evaluation or treatment. If it concerns IV therapy, include the medication, dose, route, frequency, duration, access information, monitoring needs, and responsible provider or pharmacy details as applicable.

Face-to-face documentation when applicable

Medicare home health certification includes a face-to-face encounter requirement. The encounter must be related to the primary reason for home health and performed within the applicable timeframe by an eligible practitioner. The certifying record or qualifying acute/post-acute documentation should support the patient’s homebound status and need for skilled services.

A referral form is not a substitute for the encounter note. Send the actual recent clinical note or discharge summary that explains the condition and findings. If the face-to-face encounter is scheduled or documentation is still being completed, state that accurately and identify the responsible office.

Recent clinical records

Current records allow intake and clinicians to understand what changed and what care is being requested. Depending on the referral, useful material may include a history and physical, progress note, specialist note, operative report, discharge summary, therapy evaluation, recent labs, relevant imaging reports, or emergency-department record.

Avoid sending hundreds of pages without identifying the relevant recent information. A concise current packet with the order, recent encounter, diagnoses, medications, and discipline-specific details is usually more actionable than an undifferentiated chart export.

Medication list and treatment information

Send the most current medication list available, including dose, route, frequency, allergies, and recent changes. Flag high-risk transitions, new injections, antibiotics, anticoagulants, insulin changes, or medications requiring laboratory or symptom monitoring. The list should be reconciled against discharge instructions when the patient is transitioning from a hospital or facility.

For medication-related skilled needs, explain what the patient or caregiver cannot safely manage and what the provider expects nursing to assess, teach, or monitor. HarvardCare’s medication management services operate under provider direction and an eligible plan of care; they are not a pharmacy or 24-hour medication-administration service.

Hospital or facility discharge records

A discharge referral should include the anticipated or actual discharge date, destination address, responsible contact, discharge summary, current orders, medication reconciliation, relevant procedure information, equipment arrangements, and follow-up appointments. Note whether the patient is going to a private residence, assisted living, board-and-care setting, or another location.

Do not assume the address on the insurance card is the care location. HarvardCare reviews the address where visits will occur against its approved Los Angeles County service area.

Wound-care and therapy orders

Wound referrals should identify location, type or etiology if known, measurements and findings, current treatment, dressing products, frequency, recent procedures, weight-bearing restrictions, offloading or compression instructions, and the provider responsible for changes. See the professional wound care home health referral guide for a focused checklist.

Therapy referrals should describe the functional deficit and relevant precautions rather than only listing a diagnosis. Include baseline and current mobility, transfers, activities of daily living, cognition or communication concerns, swallowing status, equipment, weight-bearing instructions, and recent evaluations when available. Relevant services may include occupational therapy at home and speech therapy at home.

Current home health agency status

Ask whether another home health agency is currently serving the patient. Medicare home health is generally managed by one elected agency at a time. If a transfer is intended, provide the current agency name and available discharge or transfer information. HarvardCare cannot treat a patient as unassigned merely because a new referral was sent.

Hospice, outpatient therapy, facility services, and other programs may also affect coordination. Describe them accurately so intake can determine what additional clarification is required.

Los Angeles County service-area review

HarvardCare Home Health serves its approved Los Angeles County service area, but county residence alone does not establish availability. Provide the full service address and ZIP code. Intake reviews geographic coverage together with requested discipline, clinical needs, staffing, and scheduling considerations.

Home health referral documentation checklist

• Patient demographics, service address, contact, and responsible party
• Original Medicare and other payer information
• Referral-source organization, role, secure contact information, and preferred follow-up method
• Ordering physician or allowed practitioner and office contact details
• Specific skilled discipline, reason for referral, and order status
• Recent face-to-face note or qualifying discharge documentation
• Homebound facts and functional limitations
• Current diagnoses, allergies, medications, and recent changes
• Discharge summary, procedure reports, and relevant clinical records
• Wound, infusion, catheter, ostomy, or therapy instructions when applicable
• Current home health agency status
• Requested timing and confirmed patient availability

When the packet is ready, use HarvardCare’s secure pathway to begin a home health referral. Transmit PHI only through an authorized secure method.

Common documentation mistakes

An order without a clinical narrative

A generic order such as “home health evaluate and treat” may not show why a discipline is required. Pair it with recent findings and a note that connects the patient’s condition to the skilled service.

A homebound checkbox without supporting facts

Describe the device, assistance, transportation, symptoms, safety risk, or effort associated with leaving home. The determination must be supported by the individual record.

Outdated medications or treatment instructions

Conflicting discharge and office lists create safety questions. Identify which list is current and who should resolve discrepancies.

Missing current-agency information

Failing to disclose an active home health agency can delay or prevent the intended transition. Confirm status with the patient, representative, facility, and available records.

Using unsecured communication

Do not send PHI through ordinary public forms, personal email, or unapproved messaging. Follow your organization’s privacy and security procedures and HarvardCare’s authorized intake instructions.

Frequently asked questions

What are the basic Medicare home health referral requirements?

The record generally must support homebound status, a need for part-time or intermittent skilled nursing or qualifying therapy, care under a physician or allowed practitioner, and services under a plan of care from a Medicare-certified agency. Individual documentation and Medicare rules control.

Does HarvardCare accept every patient with Medicare?

No. HarvardCare currently reviews eligible patients when Original Medicare Part A and Part B are primary. Admission also depends on homebound status, skilled need, provider documentation, service area, current agency status, clinical appropriateness, and availability.

Is Original Medicare primary a requirement for all agencies?

No. It is HarvardCare Home Health’s current intake policy. Other agencies may accept Medicare Advantage, Medicaid, commercial plans, or other payers based on their contracts and policies.

Who may sign a Medicare home health order?

CMS permits physicians and certain allowed practitioners, including nurse practitioners, clinical nurse specialists, and physician assistants, to order and certify home health subject to applicable requirements. Referral coordinators should verify the signer’s authority rather than assume it.

Can intake start while an order is pending?

HarvardCare may review available preliminary information, but care cannot proceed without the required orders and supporting records. Clearly identify what is pending and who is responsible for completing it.

How recent must the records be?

The record must be current enough to support the present condition, skilled need, and applicable face-to-face requirements. The appropriate timeframe depends on the document and clinical situation; send the most relevant recent encounter and discharge information.

Is a medication list always useful?

Yes. A current list helps evaluate safety, recent changes, teaching needs, monitoring, allergies, and coordination. It is especially important after hospitalization, surgery, infection treatment, or a new high-risk medication.

Does complete documentation guarantee admission?

No. Complete documentation supports a timely review, but it does not guarantee Medicare coverage or agency acceptance. HarvardCare must still assess eligibility, location, clinical needs, orders, capacity, and whether it can safely provide the requested care.

Where is the official Medicare guidance?

Referral partners can review Medicare.gov’s home health coverage information and the current CMS Medicare Benefit Policy Manual, Chapter 7. These drafts summarize—not replace—official requirements.

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