Roanoke Home Care
Home Health Services
Please call 1-800-842-8275 for referrals or information on Roanoke Home Care. Ask to speak with the Referral Nurse.
Home Health describes services provided in the home setting to keep the patient functioning independently at home. This service is multidisciplinary and driven by the payor sources with multiple rules and regulations established both federally and locally. The following disciplines are usually offered: skilled nursing, medical-social services, physical therapy, occupational therapy, speech language therapy, infusion nursing, and home health aide services. The services are usually offered after a hospitalization or after an acute episode of illness.
The primary payor for the home health benefit in our region is Medicare. Medicare is a federally funded benefit that allows for short term, part time intermittent services in the home setting. The patient is required to be “homebound” and need a “skilled service”. A “skilled service” is defined as skilled nursing, physical therapy or speech language therapy. The other support services - home health aide, medical social services and occupational therapy - are services that may be offered to support the patient safely in the home. Each of the services must be offered on a part-time, intermittent basis and are goal driven.
“Homebound status” is defined by CMS as individuals that require a taxing effort to leave the home. This is a vague definition and Congress has given CMS a command to redefine and qualify the homebound status. The Medicare home health benefit does not cover prevention services for patients with chronic illnesses.
Another payor source in our region for home health services is Medicaid. Medicaid guidelines are not as strict for services as Medicare. Medicaid covers the following services: Skilled Nursing, Physical Therapy, Occupational Therapy, Speech-Language Pathology, Home Health Aide Services and Medical Supplies. Medicaid does NOT require a patient to be homebound but the agency must verify that the visits are medically necessary and the home must be deemed the most appropriate setting for the care. Therapy visits must obtain pre-authorization. Medicaid will provide services for the stable patient if there continues to be a documented medical necessary for intermittent nursing visits.
A third payor source for the Home Health benefit is private insurance. Each plan has its own rules and qualifying criteria for the beneficiary. Most private insurance companies predominantly follow the Medicare criteria requiring skilled services and homebound status. The amount of reimbursement usually depends on if the agency is a “preferred provider” for the insurance company.
All patients must have physician orders to receive home health services that designate each discipline, amount, and frequency of the visits along with the goals and treatments to be rendered. The critical substance of the home health benefit is its focus on short-term acute services.