Home Health Services

Quality medical care in the convenience of your own home...

The program

As a top notch Home Health Agency, we are committed to caring for your medical needs.  Our agency strives to provide medically necessary quality services with integrity and responsibility. Medicare, Medicaid, and most private insurance companies cover home health services for individuals who are confined to their homes and in need of skilled nursing care on an intermittent basis. Other services such as physical therapy, speech-language pathology, occupational therapy, and medical social work are also covered by most payers. To qualify for coverage, a patient must be under the care of a physician who certifies the need for care and that the individual is confined to his/her home.


 

What services are available?

All services are provided under the supervision of a registered nurse. Skilled services require the orders of a physician. Services offered through this Agency are:

�  Skilled Nursing

�  Speech Therapy

�  Home Health Aide / CNA Services

�  Social Worker

�  Physical Therapy

�  Infusion Therapy

�  Occupational Therapy

 


 

Cost of Services

Payment for home health services can be through Medicare, Medicaid, Health Maintenance Organizations (HMO), private insurance, Workers' Compensation, state contracts, or private pay. For some payer sources, the patient is not billed for any services. For example, Medicare Part A pays 100% of medically reasonable home health.  Some payers require a deductible and a co-payment, including Medicare Part B. Some payer sources may require pre-certification and then may make a medical necessity determination based on clinical notes written by the person(s) providing the services.  Some payer sources, including Medicare HMOs, may require pre-certification and limit the number and types of services we can provide.

Please be aware that certain supplies such as those used for ostomies, may be covered while you are cared for by the Home Health Agency. You must notify the agency of any medical supplies you are currently using. If you choose to pay for your supplies yourself, you will be responsible for 100% of the cost. Medicare and some private plans will not pay your supplier while you are on a home health Plan of Care.

Any charges not paid by your insurer will be discussed with you prior to rendering services when possible.  You, your guardian, parent, caregiver or family member will be informed in writing of all charges for services provided and available methods of payment.


 

Home Health Admission Criteria

Your admission to home health services depends on the reasonable expectation that your medical, nursing, and social needs may be adequately met in your residence. You are not admitted to the Agency until an assessment of your needs has been completed and you have given your consent for treatment. The Agency must have orders from your physician (a Plan of Care) before skilled care can be provided.  

 

Homebound Requirement:

Some payers, such as Medicare, require that you be homebound. "Homebound" means that you have a normal inability to leave home.   For the purposes of the regulation, an individual shall be considered �confined to the home� (homebound) if the following two criteria are met:

1.     Criteria-One:

The patient must either:

- Because of illness or injury, need the aid of supportive devices such as crutches, canes, wheelchairs, and walkers; the use of special transportation; or the assistance of another person in order to leave their place of residence

OR

- Have a condition such that leaving his or her home is medically contraindicated.

If the patient meets one of the Criteria-One conditions, then the patient must ALSO meet two additional requirements defined in Criteria-Two below.

2.    Criteria-Two:

- There must exist a normal inability to leave home;

AND

- Leaving home must require a considerable and taxing effort.

You may still be considered homebound if you leave your home for medical reasons.  You may also leave infrequently for short durations as long as leaving home requires a "considerable and taxing effort" and these absences do not indicate that you have the capacity to obtain the health care provided outside rather than in the home. If you drive for any reason, you are not considered homebound. Once you are able to freely leave home, you will no longer be eligible for home health services paid for by Medicare.

Face to Face Physician Encounter for Home Health Patients

To encourage greater involvement of the physician in a patient�s home health care services, most insurance companies require that the patient be seen face-to-face by the physician, or certain non-physician practitioners working with the physician, before home health services start or soon thereafter. 

In many situations, these visits with the doctor would have occurred just before the start of home health care. Where that has not happened, the patient must arrange to see his/her doctor or the doctor who will be involved in the care provided in the home. The key elements of this new requirement is that the patient must have the face-to-face visit within 90 days of home care starting or within 30 days after the start of care. In addition, the visit must be with the physician who is or will be caring for the patient during the home health care except for instances where the face-to-face encounter occurred in a hospital and was performed by the hospitalist.  In this case the hospital physician is responsible to convey his/her findings with the physician who will sign your home health plan of care.  Finally, the encounter must be for medical services related to the reason why home health is needed.

Our agency can help determine whether the patient has met the encounter requirement. The agency would need a full list of all the doctors the patient has seen in the 90 days before the start of home care. If none of those doctor visits qualify, the agency needs to know what doctor will be caring for the patient while on home care.


 

Discharge Planning

Discharge Planning will be initiated upon your admission to service.  Services will not be terminated until your physician has been consulted and arrangements are made for continuing care, if necessary. In most cases you will be given at least five days� notice before discharge. If you are admitted to and remain in the hospital or other acute setting over the end of your certification period you will be discharged. When you are discharged from the hospital, the Agency will readmit you or assist the hospital discharge planner in making other appropriate care arrangements for you.