Increasing numbers of patients need continuing professional medical services when they return home. Professional home health care services include a broad range of care and support services for those who are recovering from a hospital stay, are disabled, chronically or terminally-ill, and need medical, nursing, social, or therapeutic treatment and/or assistance with essential activities of daily living.
Home care services are typically provided by home care organizations. There are a variety of home care organizations, including Medicare certified home health care agencies, Visiting Nurse Agencies (VNAs), hospices, area agencies on aging, homemaker agencies, and staff and private duty nursing agencies. Other companies may be utilized to deliver specialized services and products such as medical equipment and supplies, pharmaceuticals, and drug infusion therapy.
Skilled nursing services and home health services provide care up to seven days a week for no more than eight hours per day and 28 hours per week (Medicare can cover up to 35 hours in unusual cases). Medicare pays in full for skilled nursing care, which includes services and care that can only be performed safely and effectively by a licensed nurse. Injections (and teaching patients to self-inject), tube feedings, catheter changes, observation and assessment of a patient’s condition, management and evaluation of a patient’s care plan, and wound care are some examples of skilled nursing care that Medicare may cover. Medicare pays in full for a home health aide if skilled services are required. A home health aide provides personal care including help with bathing, using the toilet, and dressing. If your clients ONLY require personal care, they do NOT qualify for the Medicare home care benefit.
Skilled therapy services are physical, speech, and occupational therapy services that can only be performed safely by or under the supervision of a licensed therapist, and that are reasonable and necessary for treating an illness or injury. Physical therapy includes gait training as well as supervision of and training for exercises to regain movement and strength for a specific area of the body. Speech-language pathology services include various exercises to regain and strengthen speech and language skills. Occupational therapy helps to regain the ability to do usual daily activities independently, such as eating and putting on clothes. Medicare should pay for therapy services to maintain your client’s condition and prevent him/her from getting worse as long as these services require the skill or supervision of a licensed therapist, regardless of potential to improve.
If your clients only need occupational therapy, they will not qualify for the Medicare home health benefit. However, if they qualify for Medicare coverage of home health care on another basis, they can also get occupational therapy covered. When your client’s other needs for Medicare home health end, they should still be able to get occupational therapy under the Medicare home health benefit if they still need it.
Medicare pays in full for services ordered by a doctor to help with social and emotional concerns related to an illness. This might include counseling or help finding resources in your client’s community.
Medicare pays in full for certain medical supplies provided by a Medicare certified home health agency, such as wound dressings and catheters needed for your care.
Medicare pays 80 percent of its approved amount for certain pieces of medical equipment, such as a wheelchair or a walker. Your clients pay a 20 percent coinsurance (plus up to 15 percent more if your home health agency does not accept “assignment,” which is the Medicare approved amount for a service as payment in full).