Home health
aides provide many important services for the elderly and disabled. Medicare does pay for home health aides--under certain conditions. Here are some guidelines to follow.
Home Health Aide Definition
A home health aide helps patients with activities of daily living (ADLs). These activities include bathing, dressing, toileting, oral care and other day to day necessities. Home health aides are not usually licensed (although they may be state-certified nursing assistants) and cannot give medical care. Aides follow a plan of care created by a doctor or nurse. By using the services of a home health aide, many elderly and disabled people are able to live independently and have an improved quality of life over those in nursing homes.
Medicare Gidelines
Medicare will cover the cost of a home health aide if:
* A doctor decides the patient needs medical care at home and has written a plan of care.
* The home health aide is employed by a Medicare-certified agency.
* The patient is homebound and unable to leave without help. This doesn't mean the patient can never leave home: He or she can go on short outings (i.e., doctor appointments, church) but must have help to do so.
* The patient is getting some other care, such as nursing services, physical or occupational therapy.
Considerations
* The patient and the patient's family may choose which agency to use. However, individual insurance plans may specify which agency to use.
* Medicare will cover home health care if given for less than 8 hours per day or less than 28 hours per week. This amount may be increased to up to 35 hours per week on a case-by-case basis. Nurse, therapist and other caregiver hours are included in these hours. That is, if a nurse visits 1 hour each weekday (5 hours total) and a therapist visits 2 hours each weekday (10 hours total), home health aides can only provide up to 13 hours of Medicare-covered service.
Limitations
*Medicare will not cover full-time or live-in home health aides, only part-time or intermittent aides.
* Medicare will not cover "Meals on Wheels", housekeeping, laundry or other services.
* Medicare will not cover home health aides if no other home medical services are used.
If Service Is Cancelled
If the home health agency cancels or reduces home health aide services, the patient will receive a Home Health Advance Beneficiary Notice (HHBN), which will explain why the agency believes Medicare won't pay for the service. The HHBN will provide instructions on filing an appeal. Home health aide service can continue during the appeal and Medicare will reimburse payments made during the interim if the appeal is granted.
Warning
During the appeal process, a patient will be required to pay for home health aide services as an out-of-pocket expense.
Tags: health aide, home health, Medicare will, health aides, Medicare will cover
