What are Medicare’s Home Health Services?

Medicare beneficiaries can receive health care services in the home. Home health services can include:

Who is Eligible to Receive Home Health Services?

In order to receive Medicare Home Health Services:

• You must be a Medicare beneficiary and be home bound.
• You must need either skilled nursing care on an intermittent basis or physical therapy or speech therapy. Skilled nursing includes not only "hands-on" treatment, but observation of your changing condition. There is no requirement that your condition must improve. Intermittent can mean skilled nursing assistance as infrequently as once every 62 days. Some people can need a nurse less than once every 62 days and still receive home health aide services; as long as they have a regular and predictable need for a nurse. For instance, you may need a nurse to assist you in administering B12 injections once every 90 days.
• You must have a doctor prescribe the home-based care.
  
  Even if you are enrolled in a Medicare managed care plan, such as a health maintenance organization (HMO), you are eligible for the same home health services as all other Medicare recipients. However, we are only able to provide care to HMO companies that allow us to do so through contractual agreements. This means that if you are enrolled in a managed care plan, the care must be authorized by your primary care physician or the HMO plan you have.
  
  How Do I Get Home Health Services?
  
  If you think you may be eligible for home health benefits, ask your physician to call any home health care agency including Health1st Home Health Services. If you are hospitalized, you may ask the hospital discharge planner or Case Manager to set up these services for you. You can also ask a nurse for a home health provider to evaluate your need for home care services and to develop a plan of care.
  
  How Much Will I have to Pay for Home Health Services?
  
  Unlike other Medicare services, home health benefits require no co-payment or deductible amounts. There is an exception for durable medical equipment where you must pay a 20% co-payment.
  
  Is There Any Difference if I am Enrolled in a Managed Care Plan?
  If you are enrolled in a managed care plan, you must get prior approval from your primary care physician and/or the managed care plan in order to get home health benefits. If you request home health benefits and approval is denied, either all or in part, you should be notified in writing. However, if you do not get notified in writing, you can still appeal.
  
  How Long Am I Entitled to Home Health Services?
  
  You can receive home health services for as long as you continue to meet the coverage criteria. You can receive a combination of home health services for up to seven days per week and up to 28 hours per week as long as the need for these services is documented by the home health provider. In addition, you can receive up to 35 hours per week of daily services as long as the need for these services is for a limited period of time. A terminal condition, for example, might allow you to qualify for these increased hours.
  
  What Types of Home Health Services Are Available?
  
  Some examples of home health services covered by Medicare are:
  
  
• You have hypertension and suffer from dizziness and weakness. Your doctor is concerned that your blood pressure is too low and has stopped your hypertension medication. Home health coverage will allow a nurse to observe and monitor your blood pressure until it remains stable and in a safe range.
• You were recently diagnosed as a diabetic. You need a skilled nurse to teach you to self inject, to manage your insulin, to understand the signs and symptoms of insulin shock, and to respond to emergencies. The teaching services would be covered as a home health benefit.
• You recently broke a leg bone which has not healed and is unstable. You need regular exercise to maintain function until the bone heals. A physical therapist visits to make sure that your leg is properly aligned during your maintenance exercises. Medicare will cover the therapist’s services.
• You have Alzheimer’s disease and get confused about whether you took your medications and how much you are supposed to take. Medicare will cover a nurse to come to your home to assess your medical symptoms for medication compliance, and to ensure that your overall care plan is adequate.
• You have multiple sclerosis and require regular exercise so that your condition does not deteriorate. Medicare will cover a physical therapist to come to your home and ensure that your exercise program remains appropriate.
• Although you are homebound, your managed care plan requires you to obtain your physical therapy at their outpatient facility. You also require a nurse to come to your home to change your catheter once a month and the daily assistance of a home health aide with bathing and dressing. Because you leave home for a medical service, the managed care plan will cover the nursing and home health aide visits in your home.

Primary Nurse and Case Manger Model Ensures Continuity of Care, Which is Key

At Health1st Home Health Services, we understand the importance of care continuity in helping our patients recuperate and rehabilitate with ease. For that reason, we assign a primary nurse who coordinates your care and also serves as your case manger to ensure that you receive excellent care. After the initial in-home patient evaluation, your primary nurse will work in partnership with your physician and other member of the multi-disciplinary care team to develop a customized care plan to meet your individual needs on a consistent and ongoing basis. Your primary nurse performs an in-depth assessment to identify new needs and plans appropriately to address each identified healthcare need. Your case manger and primary nurse, depending on your approval and direction, connect with your family to ensure that every one understands the role they have to play in facilitating a speedy recovery for you!