As a consumer of home care, you have several rights and a home care agency will usually provide you with a written copy of them. They include the following:
• The right to choose your home care provider. Your choice must be honored by your doctor, hospital discharge planner, or other referring agency. However, for members of managed care plans, the choices will depend upon which home care agencies your plan works with.
• The right to have your property treated with respect.
• The right to have your family or guardian act for you if you are unable.
• The right to complain to the agency or the State licensing body about your treatment or care if it is not provided, or if staff shows disrespect for you or your property.
• The right to be given a copy of your plan of care or service plan, so you can ask questions about the type of services and staff the home care agency plans to provide to you and how often you can expect those services.
• The right to be informed in writing about how much the services will cost you.
It is important for you to remember that the goal of home care is to keep residents independent in the location of their choosing.
Showing posts with label Home Care Agency. Show all posts
Showing posts with label Home Care Agency. Show all posts
Monday, November 9, 2009
Friday, November 6, 2009
Who Pays for Home Care?
Here is a look at some typical payors and what they usually cover for home care services.
Medicare Not all home care agencies are approved by Medicare to provide services to Medicare beneficiaries. A home care agency who is approved by Medicare is called certified. A certified agency has met strict federal requirements for patient care and management and therefore can provide home health services that are paid for by Medicare or Medicaid. These agencies typically focus on medical-related care such as nursing, therapies, and home health aides, but can also provide a range of supportive services. Most commercial health insurers require that services they cover be provided by Certified agencies.
The federal Medicare program provides comparative data on their website as to how certified home health agencies compare in providing care for some of their patients. Quality information that can be used to help you compare home health agencies can be found on Medicare's website www.medicare.gov
If you are a Medicare beneficiary and meet certain criteria, Medicare will cover:
• Skilled nursing care on a part-time or intermittent basis. Skilled nursing care includes services and care that can only be performed safely and correctly by a licensed nurse (either a registered nurse or a licensed practical nurse).
• Home health aide services on a part-time or intermittent basis. A home health aide does not have a nursing license. The aide provides services that support any services that the nurse provides. These services include help with personal care such as bathing, using the toilet, or dressing. These types of services do not need the skills of a licensed nurse. Medicare does not cover home health aide services unless you are also getting skilled care such as nursing care or other therapy. The home health aide services must be part of the home care for your illness or injury.
• Physical therapy, speech-language pathology services, and occupational therapy:
• Physical therapy, which includes exercise to regain movement and strength to a body area, and training on how to use special equipment or do daily activities, like how to get in and out of a wheelchair or bathtub.
• Speech-language pathology services, which includes exercise to regain and strengthen speech and swallowing skills.
• Occupational therapy, which helps you become able to do usual daily activities by yourself. You might learn new ways to eat, put on clothes, comb your hair, and new ways to do other usual daily activities.
• Medical social services to help you with social and emotional concerns related to your illness. This might include counseling or help in finding resources in your community.
• Certain medical supplies, like wound dressings, that are ordered as part of your care.
The criteria you must meet to be eligible for Medicare’s home health benefit have been defined by Medicare:
Physician involvement - Your doctor must decide that you need medical care at home, and make a plan for your care at home.
Patient is homebound - You must be homebound, or normally unable to leave home unassisted. To be homebound means that leaving home takes considerable and taxing effort. A person may leave home for medical treatment or short, infrequent absences for non-medical reasons, such as a trip to the barber or to attend religious service. A need for adult day care doesn’t keep you from getting home health care.
Patient requires skilled care or SN,PT,ST (or OT with another skill) - You must need at least one of the following: intermittent skilled nursing care, or physical therapy, or speech-language therapy, or occupational therapy.
The services are part-time/ intermittent - Eligibility is also based on the amount of services you need. Medicare covers your home health services for as long as you are eligible and your doctor says you need these services. However, the skilled nursing care and home health aide services are only covered on a part-time or “intermittent” basis. This means there are limits on the number of hours per day and days per week that you can get skilled nursing or home health aide services.
Therapy services don’t have to be part-time or intermittent.
Medicare doesn’t pay for
• 24-hour-a-day care at home;
• meals delivered to your home;
• homemaker services like shopping, cleaning, and laundry
• personal care given by home health aides like bathing, dressing, and using the bathroom when this is the only care you need.
Although Medicare doesn’t cover prescription drugs as part of home health care, a recent law added new prescription drug benefits to the Medicare program as a whole.
Medicare HMO
Medicare Advantage is the name for the Medicare Managed Care Plan or HMO. Your Medicare HMO plan is required by Medicare to provide the same home care benefits as the regular Medicare plan.
If you belong to a Medicare Advantage Plan, you may only be able to choose a home health agency that works with the health care plan. Call your plan if you have questions about the plan’s home health care rules, coverage, appeal rights, and your costs. If you get services from a home care agency that doesn’t work with your Medicare Advantage Plan, neither the plan nor Medicare will pay the bill.
Medicaid
Most states provide state-funded supportive services to elders and disabled individuals who meet income and functional eligibility guidelines. These non-medical supportive services are designed to enable frail elders to remain in their homes.
Most states also provide for state-funded nursing or physical therapy services at home for those individuals who qualify.
Insurance
Medicare is not the only payor who pays for home care. Commercial health insurance policies typically cover some home care services for when a person is recovering from surgery or illness. However, benefits for long-term services vary from plan to plan. Commercial insurers generally pay for medical care in the home with a cost-sharing provision. Cost sharing varies with individual policies. You should contact your health insurer for more information.
As the public's need and preference for home care has grown, private long-term care insurance policies have expanded their coverage for in-home care. Home care benefits vary greatly among plans but most plans today cover home care.
Other payors
There are other sources of payment for home care services. These can include Workers Compensation, the Veterans Administration, the Military Health Program, the Older Americans Act and more. Many home care providers have foundations that will pay for home care for low-income families.
Private Pay
If an individual does not qualify for home care benefits through insurance or Medicare or Medicaid, that individual may want to consider arranging payment privately with the agency.
Medicare Not all home care agencies are approved by Medicare to provide services to Medicare beneficiaries. A home care agency who is approved by Medicare is called certified. A certified agency has met strict federal requirements for patient care and management and therefore can provide home health services that are paid for by Medicare or Medicaid. These agencies typically focus on medical-related care such as nursing, therapies, and home health aides, but can also provide a range of supportive services. Most commercial health insurers require that services they cover be provided by Certified agencies.
The federal Medicare program provides comparative data on their website as to how certified home health agencies compare in providing care for some of their patients. Quality information that can be used to help you compare home health agencies can be found on Medicare's website www.medicare.gov
If you are a Medicare beneficiary and meet certain criteria, Medicare will cover:
• Skilled nursing care on a part-time or intermittent basis. Skilled nursing care includes services and care that can only be performed safely and correctly by a licensed nurse (either a registered nurse or a licensed practical nurse).
• Home health aide services on a part-time or intermittent basis. A home health aide does not have a nursing license. The aide provides services that support any services that the nurse provides. These services include help with personal care such as bathing, using the toilet, or dressing. These types of services do not need the skills of a licensed nurse. Medicare does not cover home health aide services unless you are also getting skilled care such as nursing care or other therapy. The home health aide services must be part of the home care for your illness or injury.
• Physical therapy, speech-language pathology services, and occupational therapy:
• Physical therapy, which includes exercise to regain movement and strength to a body area, and training on how to use special equipment or do daily activities, like how to get in and out of a wheelchair or bathtub.
• Speech-language pathology services, which includes exercise to regain and strengthen speech and swallowing skills.
• Occupational therapy, which helps you become able to do usual daily activities by yourself. You might learn new ways to eat, put on clothes, comb your hair, and new ways to do other usual daily activities.
• Medical social services to help you with social and emotional concerns related to your illness. This might include counseling or help in finding resources in your community.
• Certain medical supplies, like wound dressings, that are ordered as part of your care.
The criteria you must meet to be eligible for Medicare’s home health benefit have been defined by Medicare:
Physician involvement - Your doctor must decide that you need medical care at home, and make a plan for your care at home.
Patient is homebound - You must be homebound, or normally unable to leave home unassisted. To be homebound means that leaving home takes considerable and taxing effort. A person may leave home for medical treatment or short, infrequent absences for non-medical reasons, such as a trip to the barber or to attend religious service. A need for adult day care doesn’t keep you from getting home health care.
Patient requires skilled care or SN,PT,ST (or OT with another skill) - You must need at least one of the following: intermittent skilled nursing care, or physical therapy, or speech-language therapy, or occupational therapy.
The services are part-time/ intermittent - Eligibility is also based on the amount of services you need. Medicare covers your home health services for as long as you are eligible and your doctor says you need these services. However, the skilled nursing care and home health aide services are only covered on a part-time or “intermittent” basis. This means there are limits on the number of hours per day and days per week that you can get skilled nursing or home health aide services.
Therapy services don’t have to be part-time or intermittent.
Medicare doesn’t pay for
• 24-hour-a-day care at home;
• meals delivered to your home;
• homemaker services like shopping, cleaning, and laundry
• personal care given by home health aides like bathing, dressing, and using the bathroom when this is the only care you need.
Although Medicare doesn’t cover prescription drugs as part of home health care, a recent law added new prescription drug benefits to the Medicare program as a whole.
Medicare HMO
Medicare Advantage is the name for the Medicare Managed Care Plan or HMO. Your Medicare HMO plan is required by Medicare to provide the same home care benefits as the regular Medicare plan.
If you belong to a Medicare Advantage Plan, you may only be able to choose a home health agency that works with the health care plan. Call your plan if you have questions about the plan’s home health care rules, coverage, appeal rights, and your costs. If you get services from a home care agency that doesn’t work with your Medicare Advantage Plan, neither the plan nor Medicare will pay the bill.
Medicaid
Most states provide state-funded supportive services to elders and disabled individuals who meet income and functional eligibility guidelines. These non-medical supportive services are designed to enable frail elders to remain in their homes.
Most states also provide for state-funded nursing or physical therapy services at home for those individuals who qualify.
Insurance
Medicare is not the only payor who pays for home care. Commercial health insurance policies typically cover some home care services for when a person is recovering from surgery or illness. However, benefits for long-term services vary from plan to plan. Commercial insurers generally pay for medical care in the home with a cost-sharing provision. Cost sharing varies with individual policies. You should contact your health insurer for more information.
As the public's need and preference for home care has grown, private long-term care insurance policies have expanded their coverage for in-home care. Home care benefits vary greatly among plans but most plans today cover home care.
Other payors
There are other sources of payment for home care services. These can include Workers Compensation, the Veterans Administration, the Military Health Program, the Older Americans Act and more. Many home care providers have foundations that will pay for home care for low-income families.
Private Pay
If an individual does not qualify for home care benefits through insurance or Medicare or Medicaid, that individual may want to consider arranging payment privately with the agency.
Thursday, November 5, 2009
Benefits of Working with a Home Care Agency
It might be becoming to you, how working with a home care agency rather than a registry or individual worker can protect you as a consumer.
Hiring Most home care agencies have strict hiring criteria and hiring processes. In many states these criteria and processes are required by law. Any home care agency that receives payment for their services from a federal government program like Medicare or Medicaid are also required to have these strict criteria and processes in place. Registries are not subject to these laws and requirements. You want to use an agency who has successfully used their hiring criteria and processes for many years.
Background Checks
Although most states require that home health care agencies perform criminal background checks on their workers and carefully screen job applicants for these positions, the actual regulations vary depending on where you live. Therefore, before contacting a home health care agency, you may want to call your local area agency on aging or department of public health to learn what laws apply in your state.
Background checking laws usually do not apply to registries. When you do your own hiring, the background checking is up to you.
Caregiver Training
Most home care agencies have a structured program of training for their different levels of employees. State licensing laws, and the federal government in certain circumstances, require that home care agencies use only competent employees to provide home care services.
Again, registries are not subject to these laws. It’s up to you to determine the capabilities of any independent worker you choose to hire.
Insurance and Taxes
Home care agencies handle all aspects of employment, including all employer taxes and tax reporting.
With an individual worker and sometimes with a registry, you are responsible for
withholding taxes and social security, filing appropriate reports and paying employer
and employee taxes in a timely manner. Penalties are severe and could result in large
fines.
Scheduling
When you hire an independent worker, you are responsible for the hiring process from advertising to interviewing to separating the employment relationship. You are also responsible for scheduling. This means making all the phone calls and worrying about someone actually showing up to work.
If you are working with a home care agency, they take care of all of these issues.
Access to payors
If you require home care services that are covered under your insurance plan or by Medicare or Medicaid, you must use a home care agency that has been approved by your insurance plan and/or by the Medicare program.
Insurance companies (usually) and Medicare (always) will not pay for services delivered by a registry or by individual workers.
Hiring Most home care agencies have strict hiring criteria and hiring processes. In many states these criteria and processes are required by law. Any home care agency that receives payment for their services from a federal government program like Medicare or Medicaid are also required to have these strict criteria and processes in place. Registries are not subject to these laws and requirements. You want to use an agency who has successfully used their hiring criteria and processes for many years.
Background Checks
Although most states require that home health care agencies perform criminal background checks on their workers and carefully screen job applicants for these positions, the actual regulations vary depending on where you live. Therefore, before contacting a home health care agency, you may want to call your local area agency on aging or department of public health to learn what laws apply in your state.
Background checking laws usually do not apply to registries. When you do your own hiring, the background checking is up to you.
Caregiver Training
Most home care agencies have a structured program of training for their different levels of employees. State licensing laws, and the federal government in certain circumstances, require that home care agencies use only competent employees to provide home care services.
Again, registries are not subject to these laws. It’s up to you to determine the capabilities of any independent worker you choose to hire.
Insurance and Taxes
Home care agencies handle all aspects of employment, including all employer taxes and tax reporting.
With an individual worker and sometimes with a registry, you are responsible for
withholding taxes and social security, filing appropriate reports and paying employer
and employee taxes in a timely manner. Penalties are severe and could result in large
fines.
Scheduling
When you hire an independent worker, you are responsible for the hiring process from advertising to interviewing to separating the employment relationship. You are also responsible for scheduling. This means making all the phone calls and worrying about someone actually showing up to work.
If you are working with a home care agency, they take care of all of these issues.
Access to payors
If you require home care services that are covered under your insurance plan or by Medicare or Medicaid, you must use a home care agency that has been approved by your insurance plan and/or by the Medicare program.
Insurance companies (usually) and Medicare (always) will not pay for services delivered by a registry or by individual workers.
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