What exactly can be counted home health care?
Home health care is a wide range of health care services that can be given in your home for an illness or injury. Home health care is usually less expensive, more convenient, and just as effective as care you get in a hospital or skilled nursing facility (SNF).
In general, the goal of home health care is to provide treatment for an illness or injury to help you get better, regain independence and become as self-sufficient as possible. Home health care may also help you maintain your current condition or level of function or to slow down decline.
Medicare pays for you to get health services in your home if you meet certain eligibility criteria and if the services are considered reasonable and necessary for the treatment of your illness or injury. Who’s eligible? If you have Medicare, you can use your home health benefits if:
1. You’re under the care of a doctor, and you’re getting services under a plan of care established and reviewed regularly by a doctor.
2. You need, and a doctor certifies that you need, one or more of the following:
. Intermittent skilled nursing care (other than drawing blood) . Physical Therapy . Speech-Language Pathology Services
. Continued Occupational Therapy
. Home Health Aide Services (only if you are receiving Skilled Care) . Medical Social Services . Medical Supplies such as wound dressings when your doctor orders them as part of your care
3. The home health agency caring for you is approved by Medicare.
4. A doctor certifies that you are homebound. To be homebound means:
. You have trouble leaving your home without help (like using a cane, wheelchair, walker, or crutches; special transportation; or help from another person) because of an illness or injury, or leaving your home isn’t recommended because of your condition.
. You are normally unable to leave your home, but if you do it requires major effort.
You may leave home for medical treatment or short, infrequent absences for non-medical reasons, like an occasional trip to the barber, a walk around the block or a drive, or attendance at a family reunion, funeral, graduation, or other infrequent or unique event. You can still get home health care if you attend adult day care or religious services.
5. As part of your certification of eligibility, a doctor, or certain health care professionals who work with a doctor such as a nurse practitioner, must document that they have had a face-to-face visit with you within required time frames and the visit was related to the reason you need home health care.
If you only need skilled nursing care, but you need more than “intermittent” skilled nursing care, you don’t qualify for home health services. To determine if you are eligible for home health care based on a medically predictable recurring need for skilled nursing, Medicare defines “intermittent” as skilled nursing care that is needed or given either: . Fewer than 7 days a week. . Daily for less than 8 hours each day for up to 21 days. Medicare may extend the three-week limit in exceptional circumstances if your doctor can predict when your need for daily skilled nursing care will end.
If you are expected to need fulltime skilled nursing care over an extended period of time, you would not qualify for home health benefits.
Mike Zimmer is president of Bay State Insurance Agency Ltd. in Centreville. He is available to answer your questions or speak to groups regarding Medicare, Medicare Advantage, Medicare Supplements, Medicare Part D (Prescription Plans) and Home Health Care Indemnity Plans. He may be reached at 410-758-1680.