Medicare Regulations for LPN Home Visits

In order to receive licensed practical nursing (LPN) home visits, the patient must be under the care of a doctor and receiving services under an established care plan reviewed regularly by a doctor. LPNs provide direct treatment and teach the patient and caregivers about the care being received. LPNs manage, observe and evaluate the patient's care. Examples of nursing care include administering injections and IV drugs, tube feedings, changing dressings and teaching about medical care.

Medically Necessary

• In order to qualify for LPN home care, the treatment must be medically necessary according to Medicare standards. Medicare's definition of "medically necessary" as it applies to home health care is that the service is proper and needed for the treatment of a medical condition, is provided for that condition, meets the standards of good medical practice in the area and is not for the convenience of the patient or the doctor.

Certification

• The home health care agency that employs the LPN must be Medicare certified. These agencies are certified by Medicare to meet federal health and safety requirements. The agency agrees to be paid by Medicare and to accept only the amount Medicare approves for their services. Home health care agencies that are not certified may not be covered by Medicare.

Medical Requirements

• Services rendered by an LPN are covered only when they are given on a part-time or intermittent basis. The patient cannot need full-time nursing care and must be homebound. The LPN's services are supervised by a registered nurse (RN). A physician must certify that the patient needs intermittent skilled nursing care.The patient must be under the care of a doctor and be certified as homebound. "Homebound" means leaving the home is not recommended because of the patient's condition, and the condition keeps the patient from leaving home without assistance. Assistance is considered a wheelchair, walker, special transportation or help from another person. Leaving home takes effort and is exhausting for the patient.