What is Home Health Care?
According to Medicare.gov, home health care is a wide range of health care services that can be given in your home for an illness or injury. Home health care is usually less expensive, more convenient, and just as effective as care you get in a hospital or skilled nursing facility (SNF).
Medicare will pay for aide services if you require skilled care or therapy services. Medicare won't cover home health aide services unless you're also getting skilled care such as nursing care or other physical therapy, occupational therapy, or speech-language pathology services from the home health agency.
Home health care is clinical medical care provided by a registered nurse, occupational therapist, physical therapist or other skilled medical professionals, and is often prescribed as part of a care plan following a hospitalization. Home health care services include therapy and skilled nursing services.
The goal of home health care is to treat an illness or injury. Home health care helps you get better, regain your independence, and become as self-sufficient as possible. If you get your Medicare benefits through a Medicare health plan, check with your plan to find out how it gives your Medicare-covered home health benefits.
If you have a Medicare Supplement Insurance (Medigap) policy or other health insurance coverage, tell your doctor or other health care provider so your bills get paid correctly. If your doctor or referring health care provider decides you need home health care, they should give you a list of agencies that serve your area. They must tell you whether their organization has a financial interest in any agency listed.
Home Health Services Covered by Medicare
Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance) covers eligible home health services including Intermittent skilled nursing care, Physical therapy, Speech and language pathology services.
For Medicare, you can get 100% of the costs covered if your doctor deems skilled rehabilitation or nursing services necessary for the short term.
Question: Are home health services covered by Medicaid?
Answer: Texas covers home
health services under its Medicaid program. If your doctor
prescribes home health services like nursing or therapy services in
your plan of care for a particular medical condition, Medicaid will
cover those. Medicaid reviews your need for home health care every
60 days. You do not need to meet the nursing home level of care to
qualify for home health services. However, because these
Medicaid-funded home health services are related to a doctor’s plan
of care for a particular medical condition, they are generally
offered on a short-term basis.
If you otherwise qualify for Medicaid, and if your doctor says that you have a medical condition that causes you to need assistance with one or more activities of daily living, then you may qualify for Primary Home Care (PHC), a Texas program providing long-term care services at home. Activities of daily living are those like bathing, getting dressed, doing routine hair and skin care, preparing meals and eating, getting exercise, using the toilet, walking, and getting in or out of a bed, chair, or wheelchair.
If you apply to the PHC program and meet financial eligibility criteria, the state will send an assessor to meet with you and ask you about your ability to do all of the activities of daily living. Based on your answers, the state will rank your need and approve you for certain types and amounts of PHC services. PHC services include things like assistance with bathing, dressing, cooking, shopping, and escorting to medical appointments. PHC does not have a waitlist and is available statewide. For more information and to apply, contact the Texas Health and Human Services PHC Program. Medicaid covers home health care for eligible Medicaid recipients. Individuals have to meet both federal and state regulations to receive covered home health care services. Medicaid does not limit the services simply to the term “Home health care.” ... Medicaid covers a wide variety of home health-related services.
Question: Can I receive other services?
Answer: If you need in-home
nursing or rehabilitative care, you may also need help with
activities of daily living such as bathing, dressing, and light
housekeeping; these services may also be provided through a home
health agency. Some offer long-term nursing and other services on a
more permanent basis, although these services may not be covered by
Medicare or most health insurance policies.
Question: Where can I find Texas home health?
Answer: Usually, you would get a referral to a local home health care agency from your hospital or doctor. You can also check online. If you’re looking for yourself, be sure that the agency is certified by the Department of Health or the appropriate agency or organization in your state. Your Department of Health may provide a list of certified home health agencies in your state.
Question: How do I know if I need home health?
Answer: Usually, your doctor will refer you to one if you need one—and you can’t get Medicare coverage for these services without a doctor’s referral. In general, however, a home health agency’s services may be needed if you or a loved one prefers to stay home—or has been discharged from the hospital—but still needs more care than the family is capable of providing.Not all home health agencies in Texas are the same, and depending on your state, conditions may vary in terms of the types of services the agency can provide and what is covered by insurance. However, if you start with a doctor or hospital referral, you are likely to be able to find an agency that can provide you with the services you need.
Not all home health agencies in Texas are the same, and depending on your state, conditions may vary in terms of the types of services the agency can provide and what is covered by insurance. However, if you start with a doctor or hospital referral, you are likely to be able to find an agency that can provide you with the services you need.
Oversight of Home Health Agencies is Provided by the Texas Department of Aging and Disability Services.
The Texas Department of Aging and Disability Services (DADS) licenses, certifies and surveys home and community support services agencies (HCSSAs) for compliance with state and federal laws and regulations. Through these regulatory activities, DADS protects Texas citizens receiving home health, hospice and personal assistance services.Home health care provides skilled nursing and rehabilitation help for people who are homebound on a short-term basis. If you have limited mobility due to a temporary injury or illness and need in-home medical help, you could get it through a home health agency.
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