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Home Health Services

Skilled nursing services and therapy are covered when they are given on a part-time or intermittent basis. In order for skilled nursing care to be covered by Medicare home health benefit, your care must be necessary and ordered by your doctor for your specific condition. 

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You must NOT need full time nursing care and you must be HOMEBOUND. To be homebound means the following:

• Leaving your home isn't recommended because of your condition

• Your condition keeps you from leaving home without help (such as using a wheelchair or walker, needing special transportation, or needing assistance from another person). 

• Leaving home takes a considerable and taxing effort

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A person may leave home for medical treatment or short, infrequent absences for non-medical reasons, such as attending religious services. You can still get home health care if you attend adult day care, but you would get the home care services in your home. 

 

Skilled Nursing 

Skilled nursing services are given by either a registered nurse (RN) or a licensed vocational nurse (LVN). If you get services from a LVN, your care will be supervised by a RN. Home health nurses provide direct care and teach you and your caregivers about your care. They also manage, observe, and evaluate your care. Examples of skilled nursing care include: injections, wound care, disease and medication management.

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Plan of Care 

Your doctor and Ascensia will work together to provide you with skilled services that you may need in your home. Ascensia will obtain written doctor orders for home health services and treatments based on the patient's condition. The plan of care is developed by the doctor, the home health team, and the patient or caregivers. The home health team keeps the doctor up-to-date on the patient's condition and updates the plan of care as needed. It is the doctor, and not the home health team that authorizes what services are needed and for how long. 

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Physical, Occupational, and Speech Therapy

Physical (treatment of injury and disease by mechanical means, such as heat, light, exercise and massage), Occupational (services given to help you return to usual activities such as bathing, preparing meals and housekeeping after illness) and Speech-Language (services assist with problems involving speech, language and swallowing) therapies are considered skilled care by Medicare. In addition to providing direct care, these professionals manage, observe, and evaluate your care. Medicare uses the following criteria to assess whether these therapy services are reasonable and necessary in the home setting:

• The therapy services must be specific, safe, and effective treatment for your condition

• The therapy services must be complex or your condition must require services that can safely and effectively be performed only by qualified therapists

• The amount, frequency, and duration of the services must be reasonable. 

• One of the following conditions must exist:

  • It is expected that your condition will improve in a reasonable and generally-predictable period of time.

  • Your condition requires a skilled therapist to safely and effectively perform maintenance program.  ​

  • Your condition requires a skilled therapist to safely and effectively perform maintenance therapy.

Home Health Aide

Home health aide services may be covered when given on a part-time or intermittent basis if needed as support services for skilled nursing care.

 

Home health aide services must be part of your care for your illness or injury.

 

Medicare doesn't cover home health aide services unless you're also getting skilled care such as nursing care or other physical therapy, occupational therapy, or speech-therapy pathology services from Ascensia Home Health.
 

Medical Social Worker

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These services are covered when given under the direction of a doctor to help you with social and emotional concerns related to your illness. 

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This might include counseling or help finding resources in your community.