Geriatrics

HOME HEALTH CARE COVERED BY MEDICARE

Medicare Qualifiers

  • Appropriate patient
  • Reasonable and necessary "for the treatment of an illness and injury"
               and
  • Requires Skilled Services
              
    and
  • Home Bound

Who is an "Appropriate patient"?

  • Consenting patients whose medical needs can be safely managed at home when the required time, financial, physical and emotional resources have been considered.

What "Skilled Services" are needed to qualify?
Any or all of the following 3:

  • Registered Nurse
  • Physical Therapist
  • Speech Therapist

Other services may be added only if one of the 3 above skilled services are needed:
Example:

  • Social Work
  • Home Health Aide
  • OT

What defines "Homebound"?
If the patients leaving home requires considerable and taxing effort
and Patient needs:

  • supportive devices such as crutches, canes, wheelchairs and walkers
    or
  • the use of special transportation
    or
  • the assistance of another person
    or
  • if the condition is such that leaving the home is medically contraindicated

Note: the HOMEBOUND can leave home if:

  • the absences from the home are infrequent*
    or
  • for periods of relatively short duration
    or
  • for the purpose of receiving medical treatment

    *Infrequent is often interpreted as once a week for non-medical outings)
  • Medical outings can be often as needed and does not affect homebound status e.g. dialysis can be 3 or more times per week

How much service will Medicare pay for?
Services that are:

  • part-time
  • intermittent
  • "skilled"
  • not "24/7" home care

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