What are the requirements to receive home health care?

 

A patient must be under the care of a physician and must require the services of a skilled nurse or physical therapist. The physician writes the orders for the provision of home health services. Home health service is designed to meet the goals determined by the team on the treatment plan within a defined time period. Home health service is not "round-the-clock" care, but is a specialized treatment plan of skilled care visits by a team that teaches, gives treatments and helps a patient and family through an illness episode toward optimal independence.

Who pays for home health services?

 

Most medical insurance policies cover home health services. This includes Medicare and Medicaid, which cover 100% of the cost of services, provided the patient meets the requirements for home care. Some private policies require a co-pay fee for visits or a deductible to be met. Patients not covered by medical insurance can arrange for private pay or seek special arrangements with the agency. The agency handles the filing of all insurance claims.

HomeCare visits for Medicare beneficiaries are covered under the following conditions:

 

  • They have a need for skilled care.

  • They are confined to the home, considered homebound.

 

For those with a private insurance policy or a managed care plan, HomeCare visits are covered under the following conditions:

  • They meet the plan's conditions of participation.

  • They have an order from a physician. 

How do I choose a home health agency?

 

When choosing an agency, there are many important things to consider. First, understand what services your physician has ordered for you or your family member, such as physical therapy or home nursing. Locate an agency that provides those services. Call the agency and find out information that will help with your decision. A few questions you may want to ask are listed here:

 

  • Does the agency serve the geographical area where I live?

  • How long has the agency been in business?

  • What are the agency's accreditations, licenses and certifications?

  • Is the agency an approved Medicare provider?

  • What is the quality of care? (You can learn about the clinical outcomes of a Medicare approved agency by visiting www.medicare.gov.)

  • Are the agency caregivers available to meet your needs and follow your doctor's orders for treatments and services?

  • Does the agency accept your insurance or payer source?

  • How soon after receiving my information and doctor's orders can the agency visit me at home to start the plan of care?

FAQ

Asking questions at the beginning will help you have a good home care experience because you will learn more about what you can expect from the agency and what the agency can commit to you.