The Center for Medicare and Medicaid services, or CMS, describes the Medicare home health benefit as a program that covers care for short-term conditions and the management of chronic illnesses for people in their homes. Medicare-certified home health agencies provide nursing, physical and occupational therapy, and speech therapy to help restore and preserve function and independence. Medicare is vested in quality home health care because it is just as effective as and less costly than inpatient services.
Medicare Home Health Benefit
Traditional Medicare, also known as original Medicare, is available to most U.S. citizens over 65. The Medicare home health benefit is included in this federal plan. The option to choose a privately administered Medicare health plan is also available. Contact your Medicare health plan if you do not have original Medicare for details about how to receive home health services.
Eligibility Requirements
Medicare has specific guidelines to determine eligibility for the home health benefit. A physician must determine if home health services are appropriate and oversee the care plan through a Medicare-certified home health agency. A doctor may order one or more of the following: nursing, physical therapy, occupational therapy or speech therapy. You must be unable to leave home without considerable, difficult effort--and then only for short trips.
Services
Nurses provide skilled services such as wound care, medication teaching and IV therapy. Medicare limits nursing services to no more than eight hours per day, seven days per week, over a period of 21 days.
Physical and occupational therapists work to help patients regain strength, function, fine motor skills and independence following a serious illness, injury or surgery. Speech therapists assess and treat for difficulty swallowing and/or communicating, symptoms often suffered by stroke victims.
Medical social workers are available to help patients find resources.
Home health aides provide personal care to those who need assistance with activities such as bathing, dressing and using the toilet.
Home health agencies also provide durable medical equipment such as walkers at 80 percent off the cost.
Rights
The Center for Medicare and Medicaid Services wants you to know that you have the right to choose a home health agency and be informed about services. The right to refuse or terminate services and choose another agency is clear. The home health agency must provide written 48-hour notice before discharge from services so that you may appeal the decision. Medical information is private and confidential and must not be shared with anyone who is unauthorized.
Choosing an Agency
Home health agencies must be Medicare-certified to be eligible for reimbursement. Make sure the agency provides the services the physician deems necessary. Recommendations from former patients, a doctor's office or hospital are also helpful. The home health agency you choose should respect cultural differences and individual preferences. The agency should clearly explain your rights, responsibilities and services covered, and involve you in the treatment plan.
