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Frequently Asked Questions

 

What is the history of home health?
The first organized home care program in the United States was created by the Boston Dispensary around 1800. Wealthy people preferred home care to hospitalization. In the late 1800's lay persons began organizing voluntary nursing services which later became Visiting Nurse Associations. Following the development of formal Nursing School programs, graduate nurses began to provide home care in the early 1900s. By 1940, when the focus of care shifted from Communicable Disease to Long Term illness, the players in the home care field began to expand and private insurance companies became involved. The enactment of the Medicare program in 1965 opened the floodgates and established the rules and regulations that would govern the management of these patients.

 

What is Home Health Care?
Home Health Care is an increasingly popular form of health care that is cost-effective and well accepted by patients. Home Health Care is provided in the less intrusive environment of a patient's own home. Patients are discharged from the hospital sooner now as they are able to receive care in their own home and it is believed that in the future more people will receive much of their medical care in their home.

 

Does Medicare cover home health care?
Medicare covers skilled nursing, physical therapy, speech-language therapy, occupational therapy, medical social services and home health aide services in the home if the patient meets certain criteria. The care must be provided on a part-time intermittent basis, be reasonable and necessary to treat the illness or injury. The patient must be under the care of a physician. The patient must be homebound. Currently there is no co-pay for Medicare Home Health and Medicare Home Health is exempt from a deductible.

 

Does private insurance cover home health care?
Most private insurers cover home health benefits under the major medical portion of the policy. Most insurance companies have a home health agency they contract with to provide care to their customers. If you feel you need home health services, you would need to contact your insurance carrier to see if they have a "preferred provider". If your insurance company does not have a "preferred provider" in your area you will have the choice of what agency you use but there may be limitations to the number of visits or hours of service you are allowed to receive on an annual basis. You would need to contact your insurance provider for this information.

 

Does Medicaid cover home health?
Medicaid is a state covered program and coverage will vary from state to state. Medicaid will pay for nursing and home health services as well as medical supplies but certain coverage requirements must be met and there may be a limitation on the number of visits you will receive.

 

What does homebound mean?
There is an inability to leave home without a considerable and taxing effort.
Your physician may certify you homebound due to a medical condition limiting your ability to drive for a short period of time.
The need for supportive devices in conjunction with physical limitations is taken into consideration when considering homebound status.
Status is not affected by frequent absences from home for medical care that cannot be provided in the home.
Patient is allowed brief and infrequent absences from home for non-medical reasons.
Not met when there are frequent absences from home for non-medical reasons.
Not met when the patient is able to drive a car.
A patient with a psychiatric disorder can be considered homebound if it is considered unsafe for the patient to leave home.
Note: A patient's inability to drive does not make him/her homebound.

 

How do I get home health?
You must contact your physician who will arrange for home health evaluation to see if you qualify for in-home care. There is no charge to either you or Medicare for an evaluation if you do not qualify.

 

How do I make the right choice for a home care provider?
Finding the best home care provider for your needs requires research, but it is time well spent.

Here are some questions to consider when deciding which home care provider is best for you:

  • How long has the provider been serving the community and what services does the provider offer?
  • Does your physician have a solid work relationship with the agency?
  • Does the provider have written statements describing it's services, eligibility, requirements, fees, patient rights, confidentiality, complaint procedures, range of services and emergency preparedness?
  • Is the provider certified by Medicare? Only Medicare certified home health agencies can provide services covered by Medicare.
    How does your provider choose it's employees? Does it ensure it's workers are functioning under written policies and clinical protocols? Does it carry malpractice insurance?
  • Will the agency continue services if Medicare or other reimbursement sources are exhausted?
  • How does the agency communicate to the family?
  • Will the agency discuss with the patient and family the specific plan of care?
  • Will the agency provide the family with patient education material?
  • What is the average length of time from referral to initial visit?