Written By: Joann Parliament, MS, BSN – Director of Operations, Tender Loving Care, an Amedisys Certified Home Care Agency
What is a Certified Home Health Agency?
A Certified Home Health Agency (CHHA) is a Medicare certified home care provider that provides intermittent skilled services to patients in their homes. Skilled Services include Nursing, Physical Therapy, Speech Therapy, and Occupational Therapy. Ancillary services offered when a skilled service is in place include Medical Social Worker and Home Health Aide.
Who Qualifies to Receive Services from a CHHA and What Services are Provided?
Patients who qualify for these services include those who have had a recent change in their condition. This change could have been brought on by a hospitalization or short -term rehabilitation stay, or a noted change by their physician who is requesting care in the home to prevent decompensation. In addition to this change, there are several criteria that need to be in place in order to qualify for care in the home that would be covered by insurance (Medicare, Managed Medicare or private insurance). These criteria include the following:
- Homebound Requirement – “it is a taxing effort to leave the home independently” or the physician has ordered the patient to remain home for medical reasons temporarily. Patients can leave their homes for physician visits, hair appointments, or church services with the assistance of a caregiver.
- Services are to be ordered by a physician who has had a face-to-face encounter with the patient 90 days prior to services or within 30 after services have started related to the reason for the home care services. This referral can be made by a physician in the hospital or rehabilitation facility, or the community physician. The face-to-face encounter, if made by a community physician, can be made via tele-video if needed.
- There must be a community physician who will be collaborating the treatment plan set up by the home care clinicians. This physician will be available to the clinicians to review changes, updates, and sign required physician orders.
- Skilled services provided are short-term and intermittent. Clinicians are visiting for a period to work on goals and treatment plans. The clinicians will perform skilled services such as wound care, vital sign monitoring, or injections for example. In addition, a large component of the treatment plan is around education – educating the patient and/or caregiver to provide care to the patient and understand their disease management with a goal of maintaining quality of life and avoidance of unplanned hospitalizations.
The following is a review of the services provided and what to expect from these services:
- Skilled Nursing – the nurse as discussed above can provide hands on treatment such as care of tubes, injections, and wound care for example. The nurse will also be education and promoting independence in the care of any hands-on care provided, as well as educating why it is done and proper techniques. Education is a huge component of the care: education regarding medications – how, why and when to take; side effects and interactions; how to manage chronic or acute illnesses and to be aware of signs of decompensation to avoid a hospitalization if they can; educating caregivers on how to provide care and how to manage the patients care needs at home.
- Physical Therapy (PT)– the goal of the therapist is to ensure safety in the home by making recommendations for modifications to the environment and to educate the patient on exercises to strengthen, improve balance, mobility, and conserve energy. The goal is to progress to their pre-illness function or to maintain at home with a best quality of life possible.
- Occupational Therapy (OT)- the OT works on Activities of Daily Living (bathing, dressing, feeding, for example) and Instrumental Activities of Living (cooking, household management) to increase independence as best as possible.
- Speech Therapy (ST) – The ST works on swallowing techniques for those with swallowing difficulties as well as diet modifications to avoid aspiration if indicated. This therapist will also work on communication for those patients who may have had deficits related to neurological events such as a stroke causing aphasia, as well as cognitive therapy.
- Medical Social Worker- Social Work is an ancillary service that can only be provided in conjunction with the skilled services listed above. The Social Worker can provide short term counseling for those patients who require assistance in dealing with a new diagnosis or chronic illness. They also work with caregivers and patients on short and long-term planning on how to manage at home, ie. Accessing community resources or evaluating eligibility for Medicaid and advising on how to proceed if needed to maintain safely at home especially when the homecare services are ended.
- Home Health Aide – The Aide is also an ancillary service and can only be provided in conjunction with a skilled service. The aide provides personal care to the patient such as assisting with bathing, dressing and personal care.
All the skilled services listed can be provided individually or together as required and ordered by the physician. The home care team works collaboratively to ensure the patients plan of care is adequate and meeting their goals. They work together with the physician as well to modify the treatment plan if needed to progress to the goals set out. Patients are discharged from services once the goals are met, or the patient has progressed as far as they can. Services can last a couple of weeks up to several months based on the need.
How would someone who is interested in home care obtain this service and what to expect:
- Hospital or Skilled Nursing Facility – If you are in-patient, the facility discharge planner or social worker should be meeting with you or your family member/significant other to discuss discharge plans. You can discuss at that time whether a home care referral is indicated. The facility can assist with the transition to a homecare provider upon your discharge. You should be offered a choice of providers from the facility.
- Physician in the community – your physician can contact a homecare provider directly by faxing in a referral – he/she can fax the home care provider the most visit office visit or tele-video visit made addressing the homecare needs with orders regarding what is indicated
- Consumers can call homecare providers if they have questions regarding eligibility – the provider can reach out to the community physician to obtain orders if you are deemed eligible. .
- Once the referral is made to the agency of your choice and accepted, you will be contacted by that provider upon return home from the hospital or if you are already home. A skilled clinician will visit you at home and will discuss a treatment plan based on an assessment provided, and discussion with your physician for approval.
Are there any fees involved in this service?
Medicare will cover this service at 100% if the eligibility criteria are met and sustained. Patients must remain homebound and qualify for a skilled service to have the services covered while on program.
Managed Care plans: Medicare Managed Care Plans and Private insurances may have copays or coinsurance fees attached to the services. Some may have deductibles or out of pocket expenses that need to be met before services are paid for. Also, some of the managed care plans have restrictions to the number of visits provided, as well as a requirement of updates from the provider for approvals periodically. Familiarize yourself with your benefits if you have a plan outside of traditional Medicare.
Other homecare providers
- Licensed agencies – these agencies provide services on a private pay basis (some insurance such as long-term insurance or Medicaid may cover some of these) – this care can be assistance with personal care in addition to custodial and supervisory care. Private duty nurses can also be hired from some of these providers
- Non-medical providers – these agencies provide caregivers who offer non-medical care such as custodial supervision for safety, and household management.
- Registries – these agencies connect you directly with a provider and usually require a “finder’s fee” to set up services.
- Medicaid Providers – Medicaid offer services through Managed Long Term Care contracts either from Licensed agencies or Consumer Directed services (hiring someone who is supervised by the family or patient)
- Outpatient Rehabilitation at Home – Medicare Part B will cover Physical Therapy, Occupational Therapy, and Speech Therapy in the home. Patients do not have to meet the requirements of the CHHA services. There is a limitation to the number of visits provided per year, and a copay may be incurred.
If you have any questions regarding our services, please contact the Amedisys office at 914-205-5708.