Home health services are generally limited to Frederick County. For patients
discharged directly from Frederick Health Hospital, services may be provided
up to 5 miles outside the county line if staffing allows. Referrals beyond
these boundaries may be declined. Service availability in outlying areas
is subject to staffing and the ability to meet patient needs safely and
in a timely manner.
Staffing Capacity
Referrals may be declined if the agency does not have adequate qualified
staff available to provide safe, timely, and effective care without compromising
services for existing patients.
Insurance and Authorization
Each referral is screened to confirm coverage criteria, including insurance
verification and any required pre-authorization. Referrals may be declined
if the agency is not in the patient’s insurance network or if authorization
is denied by the payer.
Age Considerations
The agency does not routinely provide care for patients under the age of
18, and any referrals for patients <18 will be reviewed case by case
prior to acceptance to assure we can safely and effectively meet the needs
of the patient. Agency will require the parent or legal guardian to always
be present during the visit. If this agreement cannot be assured, the
Agency will decline the referral.
Psychiatric, Behavioral, and Substance Abuse Referrals
Agency does not provide psychiatric, behavioral health, or substance abuse
services as the sole reason for services.
Caregiver Support Requirement
The agency cannot provide service to certain conditions, when their isn't
a caregiver support within the home.
Ventilator-Dependent Care
The agency cannot accept patients who require ventilator support, unless
the ventilator is being cared for by another provider.
Custodial and Extended Care
The agency does not provide custodial care, extended-hour care, or 24-hour services.
Visit Frequency and Daily Care
Capacity for daily wound care or infusion visits is extremely limited due
to geography and staffing. When appropriate, the agency will teach a household
caregiver to provide daily care or IV therapy.
Patient and Environmental Safety
If safety concerns arise during the referral process, the referral may
be designated high risk. The agency may require additional measures, such
as a second staff member or law enforcement accompaniment for visits.
If these measures are declined by the patient or family, or the agency
cannot support joint visits due to capacity constraints, the referral
may not be accepted.
History of Non-Compliance and Behavioral Safety Risks
Patients with a documented history of non-compliance or behavioral concerns
who have previously been discharged for causing safety risks to staff
may be refused service. If discharge occurred due to a specific event
involving safety concerns, the agency reserves the right to refuse future
referrals for patients deemed not safe for staff.
Medicare Guidelines for Home Health Care
Medicare will pay for health care services provided in a patient’s
residence
only if all of these conditions are met:
Patient is eligible for Medicare benefits
Patient needs intermittent skilled nursing or physical therapy or occupational
or speech therapy
Patient must meet homebound criteria (see definition below)
Homebound Status Defined
A homebound person is defined as one who requires considerable effort and
assistance to leave home and needs care on an intermittent basis.
Patients may be considered homebound if absences from the home are:
Infrequent
For periods of relatively short duration, or
Attributable to the need to receive medical treatment including attendance
at a psychosocial or medical day treatment program accredited, licensed
or certified by the state
Patients with a psychiatric disease or condition may be considered homebound
even if their physical ability is unimpaired, when certain conditions are met.
Generally a beneficiary will be considered to be homebound if he/she has
a condition:
Due to an illness or injury which restricts the ability to leave home except
with the aid of supportive devices (crutch, cane, wheelchair, walker)
special transportation, or another person
That is such that leaving his/her home is medically contraindicated
Patient is under the care of a doctor who:
Determines the need for home care is medically necessary and medically
reasonable
Sets up and periodically reviews a home health agency plan of care
The home health agency serving the patient is approved for payment by the
Medicare program
When in doubt about homebound status, call our intake staff and they will
be able to assist you!
