Common use of Home Care Services Clause in Contracts

Home Care Services. Health Services performed by a Home Health Care Agency or other Provider in Your residence. Home Health Care includes professional, technical, health aide services, supplies, and medical equipment. The Enrollee must be confined to the home for medical reasons, and be physically unable to obtain needed medical services on an Outpatient basis. Covered Health Services include the following.  Intermittent Skilled Nursing Services by an R.N. or L.P.N.  Medical/Social Services.  Diagnostic Health Services.  Nutritional Guidance.  Home Health Aide Services. The Enrollee must be receiving skilled nursing or therapy. Health Services must be furnished by appropriately trained personnel employed by the Home Health Care Provider. Other organizations may provide Health Services only when approved by Us, and their duties must be assigned and supervised by a professional nurse on the staff of the Home Health Care Provider.  Therapy Services (except for Massage, Music, and Manipulation Therapy which will not be Covered when rendered in the home). Home Care Visit limits specified in the Schedule of Benefits for Home Care Services apply when Therapy Services are rendered in the home.  Private Duty Nursing. Non-Covered Home Health Care Services include the following.  Food, housing, homemaker services and home delivered meals.  Home or Outpatient hemodialysis services as such services are Covered under Therapy Services.  Helpful environmental materials such as hand rails, bath stools ramps, telephones, air conditioners, and similar services, appliances and devices.  Services provided by registered nurses and other health workers who are not acting as employees or under approved arrangements with a contracting Home Health Care Provider.  Services provided by a member of the patient’s immediate family.  Services provided by volunteer ambulance associations for which patient is not obligated to pay, visiting teachers, vocational guidance and other counselors, and services related to outside, occupational and social activities. Home infusion therapy will be paid only if Your Provider obtains prior approval from Our Home Infusion Therapy Administrator. Benefits for home infusion therapy include a combination of nursing, durable medical equipment and pharmaceutical services which are delivered and administered intravenously in the home. Home IV therapy includes but is not limited to injections (intra-muscular, subcutaneous, continuous subcutaneous), Total Parenteral Nutrition (TPN), Enteral nutrition therapy, Antibiotic therapy, pain management and chemotherapy.