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Certified Home Health Agency Program
Michael Wicks, Director of Patient Services and Home Health Supervisor
Telephone: (315)
376-5453
Hours of Operation: Monday through Friday, 8:30AM - 4:30PM
OVERVIEW:
The Lewis County Certified Home Health Agency (CHHA) program provides
confidential skilled nursing, physical therapy, home health aide and
social work services to homebound patients when services have been ordered
by a physician. The CHHA does not provide private duty nursing services,
adult sitter or respite services or housekeeping services.
Insurance Coverage:
For home health services to be covered by an insurance source, the
patient must need either skilled nursing or therapy services. Insurances
will generally pay for skilled home health services if the patient meets
insurance requirements for the ordered services. The requirements of most
insurance companies for home care services are similar to Medicare
requirements. This means at least the following conditions must be met:
- The patient must be
'essentially homebound'. This means the patient 'is unable to leave the
home due to a disease or disability except with the assistance of a
person or device' and usually does not leave the home for non-medical
reasons.
- The patient must have a
‘skilled’ nursing or physical therapy need. Skilled needs are often
primarily for care instruction, in addition to other skilled
interventions provided by the nurse and/or therapist.
- Home care services have
been ordered by a physician. Ordering physicians must be licensed in New
York State. If the ordering physician is a specialist, the patient must
also have an involved NYS licensed primary care physician.
- The services ordered by
the physician are 'medically necessary'. This means the insurer must
agree that the services ordered are justified.
- Services must be
‘intermittent’. In broad terms, this means that the needed services are
acute and short term, and are not provided continuously. Visits are
typically made a few times a week or less.
A physician must authorize
services before any service may be provided by the agency. To determine if
there is a need for services, single visit evaluations are made. There is
no charge for an evaluation as long as:
- No skilled treatment is
provided and;
- No nursing home
evaluation screen is performed by the nurse.
Insurances other than Medicare
may not cover home health visits or may have additional requirements. Some
insurances may require that services be provided instead of a hospital
stay, or must be prior approved, or there may be limits on how often or
how many times the patient may be visited. Homebound requirements may be
waived when the requested services are for wound care after surgery or for
Intra-Venous (IV) therapy at home. In addition, insurance policies often
have deductibles and co-pay requirements for home care services. CHHA
services are chargeable to all insurances. Patients who lack insurance
coverage may apply for a sliding fee scale, with fees charged being based
on their income.
Additional CHHA Services:
In addition to the services outlined above, agency CHHA nurses also
perform nursing home admission evaluations for persons requesting this
service, to facilitate nursing home placement. In this situation, the
nurse evaluates the individual's level of functioning to determine his or
her eligibility for nursing home admission. This evaluation, referred to
as a “PRI and Screen”, is required by New York State regulations prior to
nursing home placement. The PRI and Screen determines whether the physical
needs of the patient require nursing home level care. Mental debility
alone is generally not sufficient to result in a PRI and Screen score
indicating eligibility for nursing home placement, and may instead
indicate eligibility for Adult Home placement. However, adult homes,
unlike nursing homes, are typically not paid for by any insurance source
and are, therefore, privately payable. PRI and Screens are privately
payable unless the patient has Medicaid.
Other Information:
Regular office hours for the agency are Monday through Friday, 8:30 -
4:30, except official holidays. An on-call nurse is available after hours
for consultation by patients admitted to the program.
Questions about the Certified Home Health program may be directed to the
Director of Patient Services, at (315) 376-5453.
Useful links:
Medicare Information:
www.medicare.gov
New York State: www.ny.gov
NYS Health Insurance Programs:
www.nysegov.com/citGuide.cfm?superCat=106&cat=110&content=main
Disease Specific Information: www.nih.gov
