What are Home Health Services under Medicaid?

As individuals seek ways to access healthcare services in the comfort of their own homes, Medicaid stands as a crucial resource for many. Understanding what home health services are covered under Medicaid can provide clarity and support for those in need. Let’s delve into a comprehensive guide to home health services under Medicaid:

What are Home Health Services?

Home health services encompass a range of medical and non-medical care provided to individuals in their homes. These services are designed to help individuals recover from illness or injury, manage chronic conditions, and maintain their independence. Home health services can include skilled nursing care, physical therapy, occupational therapy, speech therapy, personal care assistance, and more.

Coverage Under Medicaid

Medicaid, a joint federal and state program, provides health coverage to millions of low-income individuals and families in the United States. While Medicaid is administered by the states, it must adhere to federal guidelines regarding covered services. Home health services are typically covered under Medicaid, but coverage specifics may vary by state.

Eligibility Criteria

Eligibility for home health services under Medicaid is based on several factors, including income, assets, and medical necessity. Generally, individuals must meet their state’s income and eligibility requirements to qualify for Medicaid-covered home health services. Additionally, individuals must require skilled care or assistance with activities of daily living to qualify for these services.

Covered Services

Home health services covered under Medicaid may include, but are not limited to:

  • Skilled nursing care
  • Physical therapy
  • Occupational therapy
  • Speech therapy
  • Medical social services
  • Personal care assistance (such as help with bathing, dressing, and grooming)
  • Home health aide services
  • Medical equipment and supplies

Care Plan and Coordination

Before receiving home health services under Medicaid, individuals typically undergo an assessment to determine their care needs. A care plan is then developed in collaboration with the individual, their healthcare providers, and the Medicaid-approved home health agency. The care plan outlines the specific services and supports that will be provided to meet the individual’s healthcare needs.

How to Access Services

To access home health services under Medicaid, individuals can contact their state’s Medicaid agency or local Medicaid office for information on eligibility and enrollment. Once approved, individuals can work with their healthcare providers to coordinate the necessary services and supports.

Conclusion

Home health services under Medicaid play a vital role in supporting individuals’ health and well-being in their own homes. By understanding the coverage available and the eligibility criteria, individuals can access the care they need to recover from illness, manage chronic conditions, and maintain their independence. If you or a loved one may benefit from home health services under Medicaid, explore your options and reach out to your state’s Medicaid agency for assistance.

When is Home Health care covered by Medicare?

In an era where healthcare options can sometimes feel overwhelming, understanding what services are covered by Medicare is essential. For many individuals, especially seniors or those with chronic conditions, home health care can be a vital lifeline. But when does Medicare step in to assist with these services?

What is Home Health Care?

Home health care encompasses a wide range of medical services that can be provided in the comfort of one’s own home. This can include skilled nursing care, physical therapy, occupational therapy, speech therapy, and even assistance with activities of daily living.

When Does Medicare Cover Home Health Care?

Medicare covers home health care when all of the following conditions are met:

  1. Eligibility for Medicare: The individual must be enrolled in Medicare Part A and/or Part B.
  2. Physician’s Orders: A doctor must certify that the patient needs one or more of the following:
  • Skilled nursing care on an intermittent basis (less than seven days a week or less than eight hours a day over a period of 21 days or less, with some exceptions)
  • Physical therapy
  • Speech-language pathology services
  • Continued occupational therapy
  1. Homebound Requirement: The patient must be confined to their home, meaning leaving the home requires considerable and taxing effort. However, brief trips outside the home for medical treatment or religious services are allowed.
  2. Care Plan: The home health agency must create a care plan specifically for the patient, and the doctor must review it regularly.
  3. Medicare-Certified Home Health Agency: Services must be provided by a Medicare-certified home health agency.

What Does Medicare Cover?

Medicare covers a range of services under home health care, including:

  • Skilled nursing care
  • Physical therapy
  • Occupational therapy
  • Speech-language pathology services
  • Medical social services
  • Home health aide services (limited to personal care services)

What Costs Does Medicare Cover?

If the above conditions are met, Medicare generally covers 100% of the approved costs for home health care services. This means no copayments or deductibles for these services.

Conclusion

Understanding when Medicare covers home health care is crucial for individuals and families seeking assistance for medical needs in the comfort of their own homes. By meeting specific criteria, patients can access a wide range of essential services without worrying about excessive out-of-pocket costs. If you or a loved one may benefit from home health care, consult with a healthcare provider to explore your options and ensure eligibility for Medicare coverage.

Finding Your Path to Recovery – Identifying the Right Therapy

Recovering from illness, injury, or surgery is a journey that often requires the support of various therapeutic interventions. However, not all therapies are created equal, and finding the right approach for your unique needs is crucial for achieving optimal outcomes. Whether you’re rehabilitating from a sports injury, managing chronic pain, or recovering from a surgical procedure, identifying the right therapy can make all the difference in your recovery journey.

First and foremost, it’s essential to consult with healthcare professionals who can assess your condition and recommend the most appropriate therapies based on your individual circumstances. This may involve collaborating with physicians, physical therapists, occupational therapists, and other specialists who can provide insight into the most effective treatment options for your specific condition.

Next, consider the goals you hope to achieve through therapy. Are you aiming to regain mobility, reduce pain, improve function, or enhance overall well-being? By clarifying your objectives, you can align your therapy choices with your desired outcomes and track your progress more effectively along the way.

Additionally, consider the importance of consistency and commitment in achieving meaningful progress. Recovery often requires dedication to a prescribed treatment plan, including regular therapy sessions, exercises, and lifestyle modifications. By prioritizing your therapy regimen and staying engaged in the process, you can maximize the benefits of treatment and accelerate your journey toward recovery.

Lastly, don’t overlook the importance of self-care and holistic wellness practices in supporting your recovery efforts. Adequate rest, nutrition, hydration, and stress management are essential components of a comprehensive recovery plan that nurtures your body, mind, and spirit.

In conclusion, identifying the right therapy to support your recovery is a critical step in achieving your health and wellness goals. By seeking guidance from healthcare professionals, clarifying your objectives, exploring diverse therapeutic options, committing to your treatment plan, and prioritizing holistic wellness practices, you can navigate your recovery journey with confidence and resilience. Remember that recovery is a gradual process that requires patience, perseverance, and a willingness to embrace the therapeutic interventions that resonate with your unique needs and preferences.

Navigating Home Health Service Coverage

In the realm of healthcare, understanding what services are covered by insurance can be a labyrinthine task. For many seniors in the United States, Medicare serves as a vital lifeline for accessing healthcare services, including those provided in the comfort of one’s own home. Home health services under Medicare encompass a range of crucial medical assistance tailored to meet the needs of individuals requiring skilled care without the need for hospitalization or confinement in a healthcare facility.

Here’s a concise breakdown of what home health services are covered by Medicare:

  1. Skilled Nursing Care: Medicare covers skilled nursing care provided by registered nurses (RNs) or licensed practical nurses (LPNs) under specific circumstances. This includes wound care, disease process training, monitoring of vital signs, and other medically necessary services.
  2. Home Health Aide Services: Assistance with activities of daily living (ADLs) such as bathing, dressing, and toileting is covered by Medicare if deemed medically necessary and prescribed by a physician. However, it’s important to note that Medicare does not cover full-time home health aide services. These services are temporary in nature during the acute (or recent) change to support identifying your long-term needs.
  3. Physical Therapy: Medicare covers physical therapy services aimed at restoring or maintaining mobility and function. This includes exercises, manual therapy, and education on safe movement techniques.
  4. Occupational Therapy: Occupational therapy focuses on helping individuals regain the ability to perform activities of daily living, such as cooking, dressing, and household chores. Medicare covers occupational therapy when it’s deemed necessary for the patient’s recovery.
  5. Speech-Language Pathology Services: Medicare provides coverage for speech-language pathology services when needed to address speech, language, cognitive, or swallowing impairments.
  6. Medical Social Services: Medicare covers medical social services provided by licensed social workers when necessary to address emotional, social, or financial factors affecting the patient’s treatment.
  7. Medical Supplies and Equipment: Some medical supplies and equipment, such as wound dressings, may be covered by Medicare if deemed medically necessary for use at home.

It’s essential to keep in mind that Medicare covers home health services only when certain conditions are met:

  • The individual must be homebound, meaning leaving home requires a considerable and taxing effort.
  • The services must be ordered by a physician and provided by a Medicare-certified home health agency.
  • The services must be deemed reasonable and necessary for the treatment of the individual’s condition.

Moreover, Medicare typically covers only short-term, intermittent home health services. Long-term care or custodial care, which involves assistance with activities like bathing, dressing, and eating for extended periods, is generally not covered by Medicare.

Understanding Medicare coverage for home health services can significantly ease the burden for seniors and individuals with disabilities who wish to age in place or recover from illness or injury in the comfort of their homes. However, navigating the complexities of Medicare coverage often requires guidance from healthcare professionals and diligent advocacy on behalf of the patient.

By staying informed about the coverage options and requirements, individuals and their families can make informed decisions about their healthcare needs and access the support necessary to maintain independence and quality of life at home.

How does Home Health support Primary Care?

Home health agencies serve as vital partners in delivering comprehensive care to patients in the comfort of their own homes. For primary care providers, understanding the perspective and operations of home health agencies is crucial for effectively coordinating care and optimizing patient outcomes. In this guide, we’ll explore key insights from the home health agency perspective that providers should consider when recommending and managing home health services for their patients.

  1. Collaborative Care Coordination: Home health agencies operate within a collaborative care framework, working closely with referring healthcare providers to ensure continuity of care. Providers should recognize the importance of open communication and collaboration with home health agencies, providing timely referrals, sharing relevant patient information, and participating in care planning discussions. By fostering a collaborative relationship, providers can support seamless care transitions and promote the delivery of patient-centered care.
  2. Patient Eligibility and Assessment: Home health agencies conduct comprehensive assessments to determine patient eligibility and develop individualized care plans tailored to each patient’s needs. Providers should familiarize themselves with the criteria for home health eligibility and communicate effectively with home health agencies to facilitate timely referrals and assessments. By accurately assessing patient needs and goals, home health agencies can deliver personalized care that aligns with the provider’s treatment plan and enhances patient outcomes.
  3. Regulatory Compliance and Quality Standards: Home health agencies are subject to regulatory requirements and quality standards established by federal, state, and accrediting bodies. Providers should be aware of these regulations and standards to ensure that home health services meet quality benchmarks and regulatory compliance. By partnering with accredited home health agencies that adhere to rigorous standards of care, providers can have confidence in the quality and safety of the services provided to their patients.
  4. Care Plan Oversight and Monitoring: Providers play a critical role in overseeing the care provided by home health agencies and monitoring patient progress. Providers should review and approve the initial care plan developed by the home health agency, providing input based on their clinical expertise and patient’s medical history. Throughout the course of care, providers should maintain regular communication with home health agencies, review patient progress reports, and adjust the care plan as needed to optimize outcomes and address any changes in the patient’s condition.
  5. Patient and Caregiver Education: Home health agencies offer valuable opportunities for patient and caregiver education, providing guidance on medication management, disease management, symptom recognition, and self-care strategies. Providers should encourage patients and caregivers to actively participate in home health education programs and take advantage of resources offered by home health agencies. By empowering patients and caregivers with the knowledge and skills they need to manage their health effectively, providers can support long-term adherence to treatment plans and improve patient outcomes.
  6. Communication and Feedback: Effective communication between providers and home health agencies is essential for ensuring coordinated care and addressing any concerns or challenges that arise during the course of treatment. Providers should maintain open lines of communication with home health agencies, providing timely feedback, sharing relevant updates on the patient’s condition, and addressing any questions or concerns that arise. By fostering a collaborative and communicative relationship, providers and home health agencies can work together to optimize patient care and outcomes.

In summary, home health agencies are essential for providers seeking to optimize patient care in the home setting. By embracing collaborative care coordination, familiarizing themselves with regulatory requirements and quality standards, overseeing care plans and monitoring patient progress, supporting patient and caregiver education, and maintaining open communication with home health agencies, providers can effectively leverage home health services to enhance the quality of care and improve patient outcomes.

What are the quality ratings for home health?

Medicare.gov provides resources to review your home health options. Honestly, it provides resources to review doctors/clinicians, hospitals, skilled nursing rehabilitation services, inpatient rehabilitation, long term care facilities, dialysis, hospice, and medical equipment suppliers using the Care Compare feature. If you haven’t reviewed it, medicare.gov/care-compare/ is a necessary stop on your web surfing today!

The quality of patient care is rated along 5 items.

Managing daily activities: Are patients getting better at walking or moving around? At getting in and out of bed? At bathing? Were functional abilities assessed at admission and discharge and included in the care plan?

Treating symptoms: Is patients’ breathing improving? Frequency of pressure ulcers/injuries that are new or worsened?

Preventing harm: Are services started in a timely manner? Are patients getting better at taking their medications correctly? Are patients getting their flu shots for the current flu season? Are physician directions being implemented timely? Are patients experiencing one or more falls with injury?

Preventing unplanned hospital care: How often are patients admitted to the hospital? Needing urgent, unplanned care in the emergency room and not being admitted into the hospital? Remaining in community after discharge from home health services? Re-admitted to the hospital for a potentially preventable condition after discharge? Admitted to the hospital for a potentially preventable condition while receiving home health?

Payment & value of care: How much Medicare spends on episodes of care at this agency?

Elite is surveyed in the state of Washington every 3 years. Our goal is to strive for continuous improvement. It is why we review areas of challenge, establish teams to work collaboratively from different perspectives, and believe in the power of trial and error until we get it right. While no agency is perfect, we think we take feedback seriously to improve the services we provide every day.

How do I choose a Home Health Agency?

Home health is a program created and overseen by Medicare. Therefore, programs in general will look and feel very similar to be compliant with the laws that oversee how Home Health is provided. Depending on the state, agencies go through “surveys” at a regular interval (e.g., yearly, every 3 years, etc.) that review the operation, the clinical services, the documentation, the adherence to techniques, and patient satisfaction.

According to Medicare.gov, questions to ask yourself and review before selecting a home health agency include:

  1. Is the agency Medicare certified?
  2. Is the agency Medicaid certified?
  3. Does the agency offer the specific services I need?
  4. Will the agency be able to meet my special needs, like language or cultural preferences?
  5. Does the agency offer personal care services, such as bathing, dressing, and using the bathroom?
  6. Does the agency offer support services or help me arrange for additional services, such as meal delivery?
  7. Is the agency well-staffed to give the type and amount of care I need?
  8. Is the agency respected in my community, recommended by the hospital discharge planner, my doctor, or a social worker?
  9. Does the agency have staff available for emergencies at night or on the weekends?
  10. Is the agency transparent about what my insurance will cover, what must be paid out-of-pocket, and include me in discussions of resources?
  11. Have prior patients attested to the good care received by the agency?

Some additional questions that we have found helpful for patients and families include:

  1. How soon will my services start? Specifically, for each discipline?
    • Some agencies will start services with one discipline, e.g., nursing, and wait a few weeks before starting the next service, e.g., physical therapy. If your goal is physical therapy, then this timeline might be a reason to consider a different agency.
  2. How frequent will my services for each discipline be?
    • Some agencies plan for only 1 visit per week for the disciplines involved, e.g., 1 visit from the nurse, 1 visit from the physical therapist, 1 visit from the aide. If you have specific goals and needs, this cadence may not be right for you. If there is limited flexibility, this might be a reason to consider a different agency.
  3. Am I involved in my care plan? Does my opinion affect my services?
    • Some agencies have to submit care plans for review and approval. This may or may not take into consideration your needs, health plans, and environmental circumstances. If you are not comfortable with a third-party review, this might be a reason to consider a different agency.
  4. How much choice do I have in selecting an agency?
    • In states where patient choice is the law, you as the patient can freely choose an agency that serves your area. Your provider – doctor, nurse practitioner, physician assistant – may have a preference for whom they prefer to work with, but you ultimately have the choice of your provider for home health. In states where a certificate of need is issued, there may be a restriction on the number of providers. If you are displeased with your offerings, you can reach out to your state’s department of health for guidance on other options.

Elite Home Health & Hospice serves in both Washington and Idaho. We are the Certificate of Need holder for Asotin and Garfield counties. We also serve in Nez Perce, Latah, and Clearwater counties in Idaho where patients have choice. We are Medicare and Medicaid certified, as well as maintaining working agreements with multiple insurance companies.

We offer skilled nursing, physical therapy, occupational therapy, speech-language pathology, aide, and social work services through our home health program. We utilize qualified interpreters or a language service to communicate with members of the community whose primary language is different from English.

Our aides, or certified nursing assistants, are part of your rehabilitation program, and can be scheduled to support learning strategies for dressing, grooming, and bathing in coordination with our occupational therapy services.

Elite is proud to employ residents of the Lewis-Clark Valley, Moscow, and Orofino communities. We believe in hiring within the communities we serve, and we have been doing so since 1984. Our staff supports services 24 hours a day, 7 days a week.

If your insurance benefit does not cover services 100%, you will receive a call from our insurance team who will discuss with you the costs of your services before we send the nurse out to your home. You are a critical member of our healthcare team, and your financial health is important to us. Our customer reviews are publicly available, and we use positive and negative reviews to assess our quality of services and make changes.

Elite works with your schedule to get all of your ordered disciplines started within your first week of service. If you have a preference to delay a particular discipline, let us know, so we can accommodate that change. Our care plans are proposed and discussed with you at your evaluation session. That means, your voice helps determine how often you are seen and by whom. We do not send your care plan for review to a third-party to determine your frequency of visits from our team.

In Asotin and Garfield Counties, we are your provider. We are happy to serve and support your health goals.

In Idaho, you have a choice. We hope you will consider Elite for all of your home health and hospice needs. We are here to provide you with life-changing service.

October is Home Health & Hospice Month

Elite has the pleasure of serving both home health and hospice. Because we are a dual agency, we are able to support our patients along the continuum of their rehabilitation phases and in their end-of-life process. We believe that these relationships that we build with our patients and their families allows us to give care in a unique manner. Specifically, we are able to contextualize rehabilitation with the background of working through past rehabilitation stays and recoveries, facilitating family support or needing to hire additional aid, and building care plans based on your goals of care.

Elite does it differently. One of our key pieces of building your care plan is to discuss what your goals of care are. What procedures? What treatments? What family members? What friends? What resources? Our liaisons meet with current, prior, and potential patients to go through what your goals of care mean, and what needs to be done to make them a reality. We are intentional in these meetings to support you in making the choice for you in that moment. And, we are available to meet again if those goals change, and a different decision needs to be made.

Home health and hospice are about relationships.

This month we have the honor of celebrating the work our team does every day. Please join us in learning about home health and hospice services this month!

Healthy Aging Month

September is the month we look at how to support healthy aging. Healthy aging is a combination of physical and mental health as well as building community and resources for spiritual and emotional well-being. The aging process changes the mind and the body, and depending on lifestyle, community and social well-being may also evolve (dhs.gov).

Aging well involves learning new strategies and supporting the body’s changing abilities. Accident prevention is a critical element of this in order to best support healthy living and reduce emergency visits. Engaging the physical wellbeing often means learning new exercises and routines to safely engage in home life and access the community (cdc.gov).

Resources:

https://www.dhs.gov/employee-resources/news/2022/09/06/healthy-aging-month#:~:text=Healthy%20Aging%20Month%20is%20observed,our%20minds%20and%20bodies%20change.

https://www.cdc.gov/stillgoingstrong/index.html

Pain is a disease

September is Pain Awareness Month.

Understanding chronic pain is critical to how we support our patients on our service.

Join us in our learning:

Pain Awareness Month – International Association for the Study of Pain (IASP) (iasp-pain.org)

September is Pain Awareness Month: Complexity and Progress in Pain Research | National Institute of Neurological Disorders and Stroke (nih.gov)

Pain Awareness Month 2023 – U.S. Pain Foundation (uspainfoundation.org)