Medicare beneficiaries are eligible for coverage of home care if they are considered "homebound" and their physician orders skilled nursing or therapy services.
A patient is defined as homebound if a physician certifies that the patient is confined to his/her home. An individual does not have to be bedridden to be considered as confined to the home, but leaving home would require a considerable and taxing effort. The patient may still be considered homebound if there are absences from the home that are infrequent or for periods of relatively short duration, and are attributable to the need to receive health care treatment such as attendance at adult day centers to receive medical care, ongoing receipt of outpatient kidney dialysis, or the receipt of outpatient chemotherapy or radiation therapy. Occasional absences from the home for non-medical purposes, such as attendance at a religious service, family reunion, funeral, graduation, or other infrequent or unique circumstances will not cause the patient to lose his/her status as homebound.
WHAT IS CERTIFIED HOME HEALTH CARE?
Certified home health care services are provided for treatment and recovery after an illness or injury. Medicare will pay for home health services provided by a Medicare-certified home health agency if the following conditions apply:
These services include:
The home health agency will typically coordinate home medical equipment needs and any specialized services.
State-specific rules of eligibility govern coverage of services provided to the elderly and disabled for home health and community-based care. Consult your local Medicaid office or hospital social worker for guidance.
Private Insurance, Managed Care Plans and Workers Compensation
Many private insurance policies, HMOs, PPOs and Workers Compensation cover home health care when prescribed by a physician. Please consult your policy for specific terms. For insurance cases, AHCP will verify the patient's coverage, including any co-payment, and bill the insurance company or other third-party payer for the patient.
WHO PROVIDES HOME HEALTH CARE IN MY HOME?
Depending on your health care needs, various individuals may be assigned to provide care in your home. The types of individuals and the activities they typically provide include:
Registered Nurses (RN's) or Licensed Practical/Vocational Nurses (LPN's/LVN's) provide skilled nursing care, which includes but is not limited to:
Specially trained RN's and LPN's/LVN's provide high-tech care, including:
Physical Therapists (PT's)
Occupational Therapists (OT's)
Speech Therapists (ST's)
Medical Social Workers (MSW's)
Home Health Aides (HHA's), under the direction of a nurse, may provide:
Home Health Aides who pass certification examinations are Certified Home Health Aides (CHHA's) or Certified Nurse Aides (CNA's).