Medicare Home Care Coverage
<br />Medicare is a principal provider of home health care and hospice care in the nation; although, there is now a growing trend for Medicaid to provide home care.
<br />
<br /><b>Home health care, instead of nursing care, is often used as an alternative for hospital patients recovering from hip or foot surgery, joint replacement or complications of diabetes. In addition, homebound patients not having spent time in a hospital, but suffering from congestive heart failure or other disabling conditions are sometimes covered with "episodes" at home.
<br />
<br />Home care must be under a "plan of care" ordered by a doctor. There must be a skilled need requiring frequent visits by either a therapist, LPN or RN. Although allowed prior to 1997, blood draws are not covered. As part of the plan of care, aides may also be provided to help with bathing, dressing, transferring, toileting, incontinence or feeding. In addition, social services are often provided. The patient must be homebound, meaning it would be very difficult to leave the home during the period of recovery. Although, a recent ruling now allows Medicare home care patients to leave their home for therapy or treatment and still receive coverage. Medicare part B may also cover certain durable medical equipment for home care such as bed rails, walker, etc.</b>
<br />
<br />Prior to 1997, Medicare payments were very helpful in allowing long-term care recipients to stay at home and avoid institutions. But, Medicare was never intended to pay for chronic, long-term home care. A 1989 lawsuit asserting rights of homebound recipients as well as a lack of Medicare oversight allowed the system to get out of hand. Home health payments by Medicare increased an astounding 25% a year between 1990 and 1997, about 4 times the health care inflation rate.
<br />
<br />In 1996, Congress passed the Balanced Budget Act and along with the Health Insurance Portability and Accountability Act of the same year, access to Medicare home health was restricted and the intent of only covering acute-care recovering patients was reasserted by these Acts.
<br />
<br />In November 1997, under BBA, Medicare adopted an interim payment system based on a projected 1999 implementation of a Prospective Payment System for home care. PPS greatly restricted eligibility and reimbursements for homebound patients. Medicare home health benefits went from a high of $18.3 billion in 1997 to $9.5 billion in 1999, a drop almost in half. At the same time demand for covering more home care patients increased. After 1997, the number of home health agencies fell by a large amount almost overnight. Home health was 8.8% of Medicare's budget in 1997. In 1999 it was 4.6% of the budget. Medicare paid 35.6% of home health costs in 1998.
<br />
<br />Under Prospective Payment, a health agency is only reimbursed per patient for each 60 day episode. This does not mean care can be less or more than 60 days since the agency can schedule visits until the prospective payment runs out. There are provisions to cut off reimbursement if the patient recovers early, or to extend payment if the condition worsens. Recent complaints from the home health industry indicate that Prospective Payment is not covering actual care given.
<br />
<br />Medicare is not now a source of help for chronic, non-improving and homebound long-term care recipients. Recently, because of pressure from home health agencies, Congress passed legislation to restore some funding to home care.
<br />
<br />The text below was copied from the Medicare home page of the Centers for Medicare and Medicaid Services it can be found online at: <a target=_blank class=ftalternatingbarlinklarge href="http://www.medicare.gov/Nursing/Alternatives.asp
">http://www.medicare.gov/Nursing/Alternatives.asp
</a><br />
<br />
<br />
<br />
<br />HOPE THIS HELPS EXPLAIN!
<br />
