Medicare insurance benefits provide health coverage for people 65 and older as well as for individuals affected by physical disabilities. Coverage for home health care services makes up a portion of the benefits provided by Medicare. Issues affecting home health care coverage address eligibility requirements, payment procedures and limitations on available coverage.
Function
Medicare coverage for home health care benefits serves a rehabilitative purpose in circumstances where assistance in the home is deemed medically necessary, according to Medicare.gov. In-home care provides needed assistance in cases where a person has undergone surgery, been injured or suffers from a bout with an illness. Ultimately, individuals are expected to show improvement in their physical condition while in-home care services provide a short-term, or temporary means of assistance during their recovery. Any services covered under Medicare must be medically necessary per doctor's orders and administered by a Medicare-approved facility.
Eligibility Requirements
Issues affecting eligibility requirements for home health care benefits have to do with the conditions that must be in place in order for benefits to be granted. Medicare benefits only cover specific types of assistance or services for home health care, according to Medx Publishing, a Medicare reference site. Services covered include physical therapy, occupational therapy, part-time nursing care or speech language therapy. Individuals requiring one or more of these services must be physically disabled to the point where leaving the house requires a significant effort and seldom occurs. Medicare guidelines label this condition as "homebound" and list it as a primary requirement for qualifying for home health care coverage.
Medicare Payment System
The Medicare payment system uses a series of codes and quality measures to determine whether a particular service falls within Medicare coverage guidelines. According to the Center for Medicare Advocacy, the system was developed as a result of the Balanced Budget Act of 1997, which was designed to cut costs spent on Medicare services. Home health care agencies contracted through Medicare can only receive payments for services listed within the Medicare payment system guidelines. As a result, issues regarding the payment system address the limitations placed on home health care agencies in terms of the types of services considered reimbursable under Medicare guidelines.
Terminations & Coverage Reductions
Medicare's classification of home health care services as a "short-term" benefit coupled with the requirements put in place by the Medicare payment system creates a significant coverage gap for individuals in need of post-acute care or long-term care services. As a result, Medicare recipients receiving home health care services can lose their eligibility for certain services deemed non-reimbursable by Medicare. According to the Center for Medicare Advocacy, individuals in need of long-term home care become ineligible for continued services due to the requirements imposed by Medicare guidelines and the Medicare payment system. These conditions can force home health care agencies to terminate services for individuals who fail to meet Medicare's criteria for reimbursement.
Tags: health care, home health, home health care, care services, home health care
