Skilled Home Care

Our Medicare Clients

Medicare covers your home health care if:

1. You are homebound, meaning it is extremely difficult for you to leave your home and you need help doing so.
2. You need skilled nursing services and/or skilled therapy care on an intermittent basis.
   a. Intermittent means you need care at least once every 60 days and at most once a day for up to three weeks. This period can be longer if you need more care, but your care needs must be predictable and finite.
   b. Medicare defines skilled care as care that must be performed by a skilled professional, or under their supervision.
   c. Skilled therapy services refer to physical, speech, and occupational therapy.
3. You have a face-to-face meeting with a doctor within the 90 days before you start home health care, or the 30 days after the first day you receive care. This can be an office visit, hospital visit, or in certain circumstances a face-to-face visit facilitated by technology (such as video conferencing).
4. Your doctor signs a home health certification confirming that you are homebound and need intermittent skilled care. The certification must also state that your doctor has approved a plan of care for you and that the face-to-face meeting requirement was met.
   d. Your doctor should review and certify your home health plan every 60 days. A face-to-face meeting is not required for recertification.
5. And, you receive care from a Medicare-certified home health agency (HHA).

• Skilled nursing services: Services performed by or under the supervision of a licensed or certified nurse to treat your injury or illness.
• Services you may receive include injections (and teaching you to self-inject), tube feedings, catheter changes, observation and assessment of your condition, management and evaluation of your care plan, and wound care.
• Provided up to seven days per week for generally no more than eight hours per day and 28 hours per week. In some circumstances, Medicare can cover up to 35 hours per week.
• Speech Therapy: to help with communication following a Stroke
• Occupational Therapy: to help a patient become independent again by restoring the ability to dress, groom, or feed themselves.
• Physical Therapy: to help with Strength and balance issues after hip replacement and so on.
• Home health aide: Medicare pays in full for an aide if you require skilled care (skilled nursing or therapy services). A home health aide provides personal care services, including help with bathing, toileting, and dressing. Medicare will not pay for an aide if you only require personal care and do not need skilled care.
• Medical social services: Medicare pays in full for services ordered by your doctor to help you with social and emotional concerns you have related to your illness. This may include counseling or helping finding resources in your community.
• Medical supplies: Medicare pays in full for certain medical supplies, such as wound dressings and catheters, when provided by a Medicare-certified home health agency (HHA).
• Durable medical equipment (DME): Medicare pays 80% of its approved amount for certain pieces of medical equipment, such as a wheelchair or walker. You pay 20% coinsurance (plus up to 15% more if your home health agency does not take assignment).

Medicare should pay for these services regardless of whether your condition is temporary or chronic.