At Home Nursing Care or Other Assistance
As an overview, there are certain requirements which must be met to provide At-Home Nursing Care covered by Medicare. Please note that Medicare imposes strict limits in this area since it has a great potential for abuse. Currently, Medicare is limited to coverage for nursing care, physical, speech and vocational therapy and certain home health aides. All of the nuances of the various regulations, both federal and state, are subject to change each year. For specifics, please contact member services to be connected to the proper attorney.
- The patient must be "homebound," which means that the patient requires assistance to leave the house
- The patient must need some type of "skilled nursing care" at least once a day for the covered period, which is defined as at least 60 days
- The patient must be under the treatment of a "plan of care" prescribed by a physician, and the agency providing the At Home Nursing Care must be a licensed and certified Medicare provider
If these requirements are met, Medicare will pay for up to 35 hours per week of such care. In addition, other items covered include Medical Equipment and such related expenses. Medical Equipment must be prescribed by a physician.
Medicare coverage will not extend to certain functions that are some of the most necessary to patients who may have trouble leaving the house. That is, cooking, cleaning, laundry, bathing, toiletries and related necessities are not covered by Medicare, nor is coverage contemplated under Medicare.