Referral Sources

Medicare Guidelines used to establish coverage

The following items are required for Medicare to pay for your home health care services:

• You are homebound. This means that due to your illness or injury it takes a considerable taxing effort for you to leave your home and your absences are infrequent or of relatively short duration. You can still be considered homebound if you leave your home to attend religious service; to receive health care treatment, including regular absences to participate in therapeutic, psychosocial or medical treatment in a state licensed/certified and/or accredited adult day-care program; or to attend unique or infrequent special events (family reunion, funeral, graduation, etc.). If you are able to drive, then you probably do not meet the homebound requirement.
• You have had a recent illness or injury (or worsening of a condition) which requires Skilled Nursing Care on an intermittent basis (other than solely venipunctures), or Physical Therapy, SpeechLanguage Pathology or have a continuing need for Occupational Therapy.
• You are an eligible Medicare beneficiary and under the care of a doctor who has ordered the treatment or services we are providing. If the services are not reasonable or medically necessary and specifically ordered by your doctor, Medicare will not pay for those services.
• Care is provided on an intermittent basis. This means Medicare will not pay for our health care staff to stay with you for an extended period of time. We will only visit you for the length of time it takes to provide the specific treatment ordered by your doctor.

If all of these requirements are met, Medicare will also pay for medically necessary Occupational Therapists, Medical Social Services, Home Health Aides and medical supplies.

Discharge, Transfer and Referral

Discharge, transfer or referral from this agency may result from several types of situations including the following:

• Treatment goals achieved;
• The level of care you need changes;
• Agency resources are no longer adequate to meet your needs;
• Situations may develop affecting your welfare or the safety of our staff,
• Failure to follow the attending physician's orders;
• Nonpayment of charges;
• Failure to meet Medicare and other insurance coverage guidelines.

You will be given timely advance notice of a transfer to another agency or discharge, except in the case of an emergency. If you should be transferred or discharged to another organization, we will provide the information necessary for your continued care, including pain management.

All transfers or discharges will be documented in the patient chart on a discharge summary. When a discharge occurs, an assessment will be done and instructions provided for any needed ongoing care or treatment. We will coordinate your referral to available community resources as needed.

If you elected to transfer from another agency and were under an established plan of care, Medicare requires us to coordinate the transfer. The initial home health agency will no longer receive Medicare payment on your behalf and will no longer provide you with Medicare-covered services after the date of your elected transfer to our agency.

Notice of Medicare Provider Non-Coverage: You and your authorized representative will be asked to sign and date a Notice of Medicare Provider Non-Coverage at least two days before your covered Medicare services will end. If you or your authorized representative is not available, we will make contact by telephone, and then mail the notice. If you do not agree that your covered services should end, you must contact the Quality Improvement Organization (QIO) no later than noon of the day before your services are to end and ask for an immediate appeal.