Source: http://staging.medicareadvocacy.org/news/publications/brief-description-of-medicare-home-health-coverage-under-the-medicare-act/
Timestamp: 2017-12-16 09:08:13
Document Index: 506661694

Matched Legal Cases: ['§40', '§40', '§20', '§40', '§40', '§40', '§40', '§40', '§40', '§40', '§40', '§40', '§40']

Brief Description of Medicare Home Health Coverage Under the Medicare Act | The Center for Medicare Advocacy
Published May 3, 2017 in
This is Part Two of a Ten-Part CMA Issue Brief Series to examine, and inform work to resolve, the growing crisis in access to Medicare home health coverage and necessary care. We invite you to follow this Series and provide Medicare home health stories at http://www.esurveyspro.com/Survey.aspx?id=b17a6403-cedd-4ee9-ba6d-9aa0f453ad2a.
Medicare coverage for home health care is available to people who have a normal inability to leave home (aka “homebound”) and require skilled nursing and/or therapies. Six disciplines are coverable (Skilled Nursing, Physical Therapy, Occupational Therapy, Speech Language Pathology, Home Health Aide and Medical Social Services). Legally, there are no limitations to the duration or amount of covered services, except that skilled nursing and home health aide services are generally limited to a combined 35 hours per week. The beneficiary must meet certain qualifying criteria to obtain these benefits. Qualifying criteria will be discussed in Part Three of this CMA Issue Brief Series.
Medicare home health coverage is often misunderstood and misstated. Thus, we are providing key provisions of the relevant law, regulations and policies to inform home health advocacy and decision-making.
MEDICARE HOME HEALTH CARE – LAW AND CITATIONS
MBPM, Chapter 7, §40 to §40.1.3Skilled nursing includes care to maintain an individual’s condition or slow decline. MBPM, Chapter 7, §20.1.2, §40.1, §40.1.1
This includes therapy to maintain an individual’s function or slow decline. MBPM, Chapter 7, §40.2 to §40.2.2E
This includes services to maintain an individual’s condition or slow decline. MBPM, Chapter 7, §40.2, §40.2.1, §40.2.1(d)(2) and (3)
This includes therapy to maintain an individual’s condition or slow decline. MBPM, Chapter 7, §40.2, §40.2.1, §40.2.1(d)(2) and (3)
Be fully informed of care and treatment: Individuals have the right to be fully informed in advance of care and treatment, changes to care and treatment, and to participate in planning or changes of care and treatment.
The Medicare home health benefit is often misunderstood and misrepresented, including by the Centers for Medicare & Medicaid Services (CMS) and home health care providers. This misinformation exacerbates the crisis in access to coverage. Beneficiaries and their advocates should know what is actually available under the Medicare law in order to fully advocate for themselves and others.
Future topics in this CMA Issue Brief Series will examine how misinformation is one of the key reasons beneficiaries are losing access to their lawful benefits, and to necessary care.