Financing Home Care
Select:
"Home care" generally refers to healthcare services provided in the home, including:
- professional services from nurses, social workers, physiotherapists, etc.
- durable medical equipment
- infusion therapies
- supplies
Medicare
Medicare covers home care services for patients that meet 4 criteria. They must:
- need intermittent skilled nursing care or physical therapy or speech language pathology
- be homebound
- be under a physician's care plan
- receive services from a Medicare participating home health agency.
The definitions of the first 2 criteria have evolved to a more restrictive interpretation in recent years. However, they still must be interpreted for each individual patient. Home-bound means that the patient must be at home except to go out for doctor's visits. Skilled nursing need means that the need requires the skill level of a registered nurse.
Once these criteria are met, a range of services are available. That range of services can include home-making and nurses aide services, social work, physical and occupational therapists, medication administration and management, blood drawing for laboratory tests, blood transfusions and physical assessments and some durable medical equipment (subject to 20% copayment).
Home health companies have been reimbursed under a fee-for-service system. However, in an effort to reduce payments, Medicare is making a transition to a prospective payment system for 60-day periods of home health care. At the current time, home health agencies are required to report on the health care assessments and needs of their patients, along with their associated costs. Based on this information, the final rules for the new system will be implemented.
The focus of home health care under Medicare is increasingly on short-term interventions with a rehabilitative focus. Many would say it is increasingly difficult to use the system to pay for the costs of home care for the chronically ill with a poor prognosis.
Medicaid
Medicaid is a state-run program although it receives federal funding. Coverages for home health care vary state by state.
Commercial Insurers
Some commercial insurance plans cover home care services. This varies by plan. Some have the ability to essentially set up hospitals at home, if needed. The agency is usually reimbursed on a fee-for-service basis.
Managed Care
Many managed care companies cover home care services. However, the coverage varies by company and by plan. Increasingly, managed care negotiates contracts with preferred agencies. These are often national companies that compete on the basis of costs and quality.
Government (Veterans Affairs, Active Duty Military)
Home care has not been a focus for the government run programs. Some Veterans Administration hospitals do have a Home-Based Health Care (HBHC) program. However, the services provided are limited to assessment and monitoring services usually. They do not provide the range of services, or expertise of the usual home health care agencies.
Next, consider the financing of hospice care.
CAPC Resources:
Additional resources on "Financing US Healthcare"
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CAPCManual Attribution:
von Gunten CF,
Ferris FD,
Portenoy RK,
Glajchen M, eds.
CAPCManual: How to Establish A Palliative Care Program.
New York, NY: Center to Advance Palliative Care, 2001.
©
Center for Palliative Studies, San Diego Hospice & Palliative Care, San Diego, CA
and
The Department of Pain Medicine and Palliative Care, Beth Israel Medical Center, New York, NY, 2001
Permission to reproduce for non-commercial educational purposes with display of
attribution and
copyright is granted.
Last updated: February 20, 2002
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Elements
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Basis of Palliative Care Practice
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Palliative Care
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Differences–Hospice & Palliative Care
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Values
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Home
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Financing US Healthcare
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Home Care
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