Medicare: Home Health Utilization Expands While Program Controls Deteriorate : Report to the Chairman, Special Committee on Aging, U.S. Senate

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The Office, 1996 - 52 pages

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Page 49 - ... (1) is primarily engaged in providing to inpatients (A) skilled nursing care and related services for patients who require medical or nursing care, or (B) rehabilitation services for the rehabilitation of injured, disabled, or sick persons...
Page 3 - ... (1) part-time or intermittent nursing care provided by or under the supervision of a registered professional nurse...
Page 49 - ... (1) is primarily engaged in providing, by or under the supervision of physicians, to inpatients (A) diagnostic services and therapeutic services for medical diagnosis, treatment, and care of injured, disabled, or sick persons, or...
Page 50 - Thus, if an individual is a patient in an institution or distinct part of an institution which provides the services described in (A) or (B) above, he is not entitled to have payment made for home health services under either Part A or Part B since such an institution may not be considered his residence. When a patient remains in a participating...
Page 15 - While an individual does not have to be bedridden to be considered 'confined to his home', the condition of the individual should be such that there exists a normal inability to leave home, that leaving home requires a considerable and taxing effort...
Page 49 - Residence—A patient's residence is wherever he makes his home. This may be his own dwelling, an apartment, a relative's home, a home for the aged, or some other type of institution. However, an institution may not be considered a patient's residence if it: 1.
Page 26 - HCFA's ability to manage the program has been severely weakened by coverage changes mandated by court decisions and a decrease in the funds available to review HHAs and the care they provide. The Congress may wish to consider whether the Medicare home health benefit should continue to become more of a long-term care benefit or if it should be limited primarily to a posthospital acute care benefit. The Congress should also consider providing additional resources so that controls against abuse of the...
Page 6 - ... While Program Controls Deteriorate," points to VNAs' cost-efficiency when treating similar types of chronic and acute cases (described below). The GAO report addresses that there are justifiable reasons for the growth in the home health benefit; for example, the lawsuit filed in 1988 (Duggan v. Bowen) that struck down HCFA's interpretation of benefit coverage requirements. "As a result of the suit, HCFA revised the Medicare Home Health Agency and Medicare Intermediary manuals in 1989 so that...
Page 49 - ... home. However, since some needed services may require equipment which cannot be taken to the home, the home health agency may make arrangements with a hospital, skilled nursing facility, or rehabilitation center to provide such services on their premises. While special transportation arrangements may be necessary to bring the homebound patient to the hospital, skilled nursing facility, or rehabilitation center, the transportation itself is not reimbursable under the home health provision.
Page 17 - Up to and including- 28 hours per week of skilled nursing and home health aide services combined for less than...

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