A home health referral asks an agency to evaluate and arrange services in the patient's home. The referring team's work includes describing the need, supplying the required information and confirming the agency's response. A referral sent is not yet a confirmed start of care.
Coverage depends on the benefit and the services involved. The criteria below describe Medicare home health; check the applicable payer and agency requirements for an individual referral.
Understand the Medicare eligibility concepts
CMS identifies homebound status, care under a physician or allowed practitioner, and an established, periodically reviewed plan of care among the requirements. The qualifying skilled need may involve intermittent skilled nursing, physical therapy or speech-language pathology. Occupational therapy can support continued eligibility after an earlier qualifying skilled need. A related face-to-face encounter is also required.
Homebound does not mean a person can never leave home. CMS describes both a need for assistance or a medical reason not to leave, and a normal inability to leave with considerable effort required. Certain absences, including medical care and short, infrequent outings, are compatible with the benefit. Document the person's actual circumstances; simply copying the phrase “taxing effort” is not enough.
These concepts guide a referral discussion; they do not replace the certifying practitioner's and agency's eligibility process.
Explain the service's limits
Medicare distinguishes covered skilled home health from round-the-clock home care, meal delivery and personal care when personal care is the only need. Covered home health must be ordered and provided through a Medicare-certified agency. Patients in Medicare Advantage should also check their plan's benefit arrangements.
Ask what the patient expects “home care” to provide. If the expectation is someone present all day, a plan for intermittent visits leaves an important question unresolved. Bring that question to the discharge or community support team.
Build a referral the agency can evaluate
A suggested referral review includes the requested services, relevant clinical information, patient goals, destination and contact details, communication needs, and the practitioner responsible for the plan. Identify equipment or supply arrangements separately when another organization is handling them.
Confirm which documents the receiving agency needs and who will supply missing information. Track requests for clarification so that an incomplete referral does not appear complete merely because it was transmitted.
Confirm the start arrangements
In a fictional discharge plan, an agency has received the referral but has not confirmed that it can serve the patient's location. The next action is to obtain that answer and establish the intended start arrangements, then update the patient and responsible team.
Before closing the referral task, confirm what was accepted, how the first contact will occur and which number the patient should use for questions. If arrangements change, return the gap to the team responsible for the transition.
For the specialty's broader work, see home health nursing. Related pages cover discharge planning, caregiver readiness and community referrals.
Sources
- Home Health Services: Provider Compliance Guidance (accessed 2026-09-17) — CMS.
- Home Health Services Coverage (accessed 2026-09-17) — Medicare.gov.