Home Care Services? How To Choose and Medicare Eligibility Requirements & Payments

Services – Home Care – How to Choose?

When a loved one needs home care services, the following guidelines can ensure you select the most reliable, reputable provider to deliver the care he or she needs.
Determining Needs

  • Be sure you are fully aware of the home care services your loved one requires by consulting his or her physician.
  • Obtain a list of area home care agencies from either a doctor, social worker or case manager. You can also get recommendations from friends, neighbors, and your church or temple.
  • Contact these agencies to determine their service offering and to learn more about their practices.

Ask the right questions

  • Ask how long the provider has been serving the community to determine the reliability and stability of the agency.
  • Find out if the provider furnishes patients with a Patient’s Bill of Rights, which outlines the rights and responsibilities of the provider, the patient and the caregivers.
  • Inquire about the agencies hiring practices. Do they perform criminal background checks?
  • Do they carry liability insurance on employees?
  • Ask about staff training. Is the training ongoing? Are staff members required to complete a set amount of in-service training hours each year?
  • Inquire about the patient evaluation process. Is a nurse or therapist required to evaluate the patient’s home care needs? What is involved in this evaluation process? Is the patient’s physician or family members consulted?
  • Find out how the plan of care is developed. Are the patient and his or her family members involved in the development of the plan of care? Are they involved in making changes to this plan? Is there a separate plan of care for each discipline whether it is nursing, physical therapy, occupational therapy, etc.?
  • Ask how the delivery of care is supervised. Who is assigned to oversee the quality of care being delivered? How often are supervisory visits conducted? Who is available to address questions or complaints? Are caregivers available 24 hours a day, seven days a week?
  • Ask if the agency participates in quality assurance programs such as the one organized by the Joint Commission on Accreditation of Healthcare Organizations, which evaluates quality of care and operations to determine compliance with national health and safety standards.
  • Ask for a list of references such as doctors, discharge planners, patients and their family members, community leaders, etc.

Services – Home Care – Medicare & Payment

Home care services are covered under Medicare Part A for those who meet the eligibility requirements as well as certain criteria defined by Medicare. When patients are not sure if they meet Medicare qualifications, Life Care at Home agencies will do a complimentary evaluation to determine whether or not they are eligible. For those who do not qualify for Medicare coverage, other payment options may include Medicaid, private insurance, private pay and HMOs.
Medicare Part A coverage requirements
To be eligible for home care benefits under Medicare Part A, a patient must:

  • Require at least one of these three services: skilled/intermittent nursing care, physical therapy or speech therapy
  • Have a doctor’s order for home care services
  • Be homebound and require occasional visits by a home care professional who performs a specific task such as giving an injection, changing a wound dressing, or providing instruction on a disease process or medication.

Occupational therapy, medical social worker services, and/or home health aide services are only covered by Medicare if the physician recommends the service along with skilled/intermittent care, physical therapy or speech therapy.
Medicaid coverage
Medicaid, state health insurance programs may pay the cost of home care services; however, coverage guidelines vary from state to state. To find out which services may be covered in your area, contact your state’s medical assistance office.
Private insurance
Private insurance typically covers the cost of skilled/intermediate care, physical therapy and speech therapy. Some insurance companies provide supplemental policies to cover additional home care services such as occupational therapy and sitter services.
Private pay
For those who are not eligible for Medicare or Medicaid benefits and are not covered by private insurance, expenses for home care services can be paid by the individual or his or her family.
Individuals enrolled in an HMO can expect the cost of skilled/intermittent nursing care, physical therapy and speech therapy to be covered. However the policies regarding coverage for other home care services varies depending on the HMO. For more specific information about payment of home care services, contact your HMO.

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