Home Health Benefit Education:

Introduction:

We would like to talk to you about the Medicare Home Health Benefit. There are three topics we are going to discuss 1.) the Services Covered by Medicare 2.) the criteria that needs to be in place for Medicare to pay for those services and 3.) the process of going home and/or receiving those services.

  1. Services Currently 100% Covered by Medicare ( NO co-pays or deductibles) are;
  2. Nursing
  3. Physical, Occupational & Speech Therapy
  4. Social Services
  5. Home Health Aide
  6. Dietitian
  7. Not everyone will get all of these services, you must first qualify for the benefit and then for each discipline after that.
  8. The criteria that needs to be in place to qualify for the benefit and for Medicare to pay for the services include;
  9. A “Skilled Need”
  10. Definition of Skilled Need: With treatments from one or more of the following RN, PT, OT or ST, the patient will show documented improvement with ADL’s or independence.
  11. A Dr.’s Order(s) to treat the need.
  12. These orders MUST come from their Primary Care Physician (PCP), or an MD assigned by the PCP.
  13. A documented Face-To-Face Encounter with either the DC’g physician and/or the PCP.
  14. Schedule the FTF visit with the PCP, for the patient, if necessary.
  15. The patient must be homebound as defined by Medicare.
  16. Must limit their activities outside the home to the allowable activities and not be driving, initially.
  17. The allowable activities are;
  18. Seeking Medical Treatment (any MD, ER, or Hospital) - Unlimited access
  19. Going to Church
  20. Limited to infrequent & taxing effort test.
  21. Going to hair dresser and/or barber
  22. Limited to infrequent & taxing effort test.
  23. The process of going home and/or receiving services.
  24. Prior to discharge or the facility staff may meet with you and go over three important things that all need to be available to the Home Health Staff upon Admission. They include, but not limited to;
  25. Discharge Instructions.
  26. Current Medication Lists with frequencies & dosages.
  27. Medications remaining in the punch-cards (for rehab facilities) or prescriptions (for Hospitals) for the current medications.
  28. Generally speaking, unless under special circumstances, Home Health cannot see you the same day of discharge. Therefore, we would like to schedule your Admission visit over the next 48 – 72 hours, based on the patient’s preference.
  29. On the selected day for admission the staff assigned to perform the admission will call either the day before or the morning of the visit and coordinate an agreeable time. The Admission visit will be the longest…about two hours and include;
  30. Signing forms
  31. Education on disease state and safety
  32. Head to Toe assessment
  33. The admitting staff will then confer with the MD and secure orders for further treatment.
  34. Within 48 – 72 hours of admission any other ordered disciplines (PT, OT, ST, MSW) will perform their evaluations and secure orders for further treatments.
  35. Together, the entire care team will put together a Plan Of Care (POC) specifically tailored to the patient’s goal and needs and this POC will be signed by the MD.
  36. The POC will identify a set number of visits by discipline spread out over a set number of weeks. The visits after the initial Admission visit will be about ½ hour to 1 hour in duration.
  37. The average POC lasts from 2 – 6 weeks and will include anywhere from 2 – 6 visits per week, depending on the patients needs and goals.
  38. Upon reaching their goal and/or reaching a plateau with respect to their abilities, we will be required to discharge the patient, but may make recommendations for other services to ensure the patient’s safety and independence whenever possible. Services a patient may be referred to are, but not limited to;
  39. Independent Sr. Living
  40. Private Duty
  41. Assisted Living
  42. Skilled Nursing Facility Placement
  43. Hospice
  44. As always, you have a choice of who provides your care. Please communicate your choice to the Social Service Coordinator/Case Manager.
  45. In the event the resident elects to be served by St. Andrews & Bethesda Home Health and communicates same to the St. Andrews & Bethesda representative, the representative will;
  46. Schedule the discharge meeting with the resident 24 –72 hours prior to discharge, if necessary (assuming this was far in advance of discharge).

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