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Home health access problems have ebbed and flowed over the years, depending on the reigning payment mechanisms, systemic pressures, and misinformation about Medicare home health coverage.  Regrettably, as we’ve been reporting, access issues are on the upswing.  This is the second of several Practice Tips to help maximize Medicare-covered home care under the law.

Family Members Cannot Be Required to Provide Care as a Condition of Obtaining Medicare Home Care

Family members cannot be required to provide care for their relatives, and patients cannot be required to accept care from family members, when considering eligibility for Medicare-covered services. In fact, it is to be presumed that there is no able and willing person in the home to provide services, unless the patient or family indicates otherwise or the home health agency has first-hand knowledge to the contrary.

For example, a home health aide would be reasonable and necessary when a daughter is unwilling to bathe her elderly father and assist him with an exercise program. Further, even if a nurse trains a family member to perform dressing changes, they can continue to see the patient for the wound care that is needed during the time the family member is not available and willing to provide the dressing changes.

(See, 42 CFR §409.45(b); Medicare Claims Processing Manual, Ch. 7 Section 20.2; Medicare Claims Processing Manual, Ch. 7 40.1.1)

Additional Information

It is important for beneficiaries and advocates to know what home health care should be covered under the law, especially for those with long term, chronic, and debilitating conditions. Download our quick-reference Medicare Home Health Coverage Infographic, and, if you or someone you know has experienced home health care access issues, submit the story today.

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