Home Health Care
(5/8/08)- New York State Attorney General Andrew M. Cuomo's office announced that it had brought a criminal indictment against one of the state's largest Brooklyn based home health care employment agencies. The indictment alleges that the company, Nursing Personnel Home Care, coordinated with corrupt training programs to certify prospective aides without requiring them to complete training as required under the state law for certification.
Under the state law, aides must complete 65 hours of training, including 16 hours of supervised practical training conducted by a registered nurse, but there is no central registry in the state to account for who has been accredited.
The company and its president Walter Greenfeld, are charged with first-degree grand larceny and offering a false instrument for filing. Mr. Cuomo also filed a civil lawsuit against the company and its shareholders to recover what he said was more than $30 million in improperly billed Medicaid funds. In addition to Mr. Greenfeld, the suit names the principal owner, Isaac Schwartz, and others associated with the company. Both the criminal indictment and the civil lawsuit were filed in State Supreme Court in Brooklyn.
(11/1/07)- According to the 2008 edition of Medicare & You, Home Health Services are: "Limited to reasonable and necessary part-time or intermittent skilled care or continuing need for physical therapy, occupational therapy, or speech-related pathology ordered by the doctor and provided by a Medicare-certified home health agency. Home health services may also include medical social services, home health aide services, or other services, durable medical equipment (such as wheelchairs, hospital beds, oxygen and walkers), and medical supplies for use at home".
You pay nothing for home health care services, but you are responsible for 20% of the cost of the Medicare-approved amount for durable medical equipment.
(10/12/07)- Please also see our article: "Are Home Care Aides Exempt from the Minimum Wage and Overtime Laws"
4/24/00)-The Congressional Budget Office has just released data showing that the spending by Medicare for home health care has dropped by 45% in the last 2 fiscal years. In 1999 the spending dropped to $9.7 billion, from $14.9 billion in 1998 and from $17.5 billion in 1997. The sharp decline in spending has been attributed to the changes that Congress adapted in Medicare spending under the Balanced Budget Act of 1997. The changes, which we discuss below limited payments to home care agencies that provide medical and social services to homebound people. The question now arises have these cutbacks been too severe and therefore are they too harmful? About 3 million people received home health care services in 1998 down from 3.6 million in 1997.
Senator Sue Collins (Rep.-Me.) is leading a bipartisan effort to eliminate the 15% automatic cut that is due to go into effect this year. Similar legislation has been introduced in the House by Representative Wes Watkins (Rep.-Wis.) and William J. Jefferson (Dem.-La.). A federal district court ruled last month that home health agencies in 9 states have improperly reduced or terminated home health benefits for thousands of Medicare patients without giving them any notice of the cutbacks or of their right to appeal. Home health care agencies have reported that they have been avoiding sicker patients who have chronic costly conditions because they do not receive adequate reimbursements under the new system. They do not want to accept patients who have costly long-term needs. Before the change in the law the CBO had predicted that Medicare would spend $127 billion on home health care from 1998 to 2002. It now estimates that Medicare will spend only $58 billion during that same period of time.
Medicare officials stated that under a proposed new payments system this would change. Under the "episode of care" system home health care agencies would get a fixed amount of money for each 60 day period with payments adjusted to reflect the severity of a person's illness.
Many Medicare beneficiaries would prefer to remain at home rather than be treated in a hospital or skilled nursing facility. This is an option that is available to the beneficiary, if and only if he/she meets the requirements that have been established for this benefit.
Medicare will pay for home health visits only if:
Both the physician and the certified home health agency draw up the plan of care. It specifically states the type, frequency and length of care that you need. It covers everything from your diet to the type of home medical equipment that you need. The plan can last for a maximum of 62 days. It than is renewed at expiration if there is a new plan.
If you are enrolled in a Medicare HMO, your choice of home health agency is limited to those certified agencies that are affiliated with the HMO.
Effective October 1, 1997, Medicare will pay for covered home health service as long as it is considered medically reasonable and necessary. There are however limits on the number of days and hours of care that you can receive in any week for certain types of services. The services are covered on either of one of two basis:
The home health agency will send your claim to Medicare. If you are enrolled in both Medicare Part A and Part B the first 100 home health visits are paid under Medicare Part A, if you have had at least a 3 day consecutive day stay in a hospital. You must start home health services within 14 days of discharge from the hospital for Medicare Part A to pay. After using up the 100 visits under Part A, Medicare part B will pay if you still meet the coverage guidelines.
If you meet all the requirements for coverage, Medicare will cover the following types of services:
Medicare does not pay for custodial care unless you are also getting skilled care such as nursing or therapy and the custodial care is related to the treatment of your illness or injury.
You are responsible for the costs that Medicare does not cover and a 20% co-insurance payment on Durable Medical Equipment, if you need it. The home health agency must tell you orally and in writing how much of the bill will be covered by Medicare, and how much you are responsible for yourself. If the physician spends extra time overseeing the plan of care he can charge you for doing it.
Much of the information for this article was obtained from the booklet "Medicare Home Health Benefits"
FOR AN INFORMATIVE AND PERSONAL ARTICLE ON PRACTICAL SUGGESTIONS WHEN SELECTING A NURSING HOME SEE OUR ARTICLE "How to Select a Nursing Home"
By Allan Rubin
Updated May 8, 2008
http://www.therubins.com
To email: hrubin12@nyc.rr.com or rubin@brainlink.com