Common use of Home Health Benefits Clause in Contracts

Home Health Benefits. The following services are covered when rendered by a Participating home health care agency. Pre- authorization must be obtained from the Member’s attending Participating Physician. HMO shall not be required to provide home health benefits when HMO determines the treatment setting is not appropriate, or when there is a more cost effective setting in which to provide appropriate care. 1. Skilled nursing services for a Homebound Member. Treatment must be provided by or supervised by a registered nurse. 2. Services of a home health aide. These services are covered only when the purpose of the treatment is Skilled Care. 3. Medical social services. Treatment must be provided by or supervised by a qualified medical Physician or social worker, along with other Home Health Services. The PCP must certify that such services are necessary for the treatment of the Member’s medical condition. 4. Short-term physical, speech, or occupational therapy is covered. Coverage is limited to those conditions and services under the Outpatient Rehabilitation Benefits section of this Certificate. Coverage is subject to the maximum number of visits, if any, shown on the Schedule of Benefits.

Home Health Benefits. The following services are covered when rendered by a Participating home health care agency. Pre- authorization must be obtained from the Member’s attending Participating Physician. HMO shall not be required to provide home health benefits when HMO determines the treatment setting is not appropriate, or when there is a more cost effective setting in which to provide appropriate care. 1. Skilled nursing services for a Homebound Member. Treatment must be provided by or supervised by a registered nurse. 2. Services of a home health aide. These services are covered only when the purpose of the treatment is Skilled Care. 3. Medical social services. Treatment must be provided by or supervised by a qualified medical Physician or social worker, along with other Home Health Services. The PCP must certify that such services are necessary for the treatment of the Member’s medical condition. 4. Short-term physical, speech, or occupational therapy is covered. Coverage is limited Services are subject to those conditions and services under the Outpatient limitations listed in the Rehabilitation Benefits section of this Certificate. Coverage is subject to the maximum number of visits, if any, shown on the Schedule of Benefits.

Home Health Benefits. The following services are covered when rendered by a Participating home health care agency. Pre- authorization must be obtained from the Member’s attending Participating PhysicianProvider. HMO shall not be required to provide home health benefits when HMO determines the treatment setting is not appropriate, or when there is a more cost effective setting in which to provide appropriate care. 1. Skilled nursing services for a Homebound Member. Treatment must be provided by or supervised by a registered nurse. 2. Services of a home health aide. These services are covered only when the purpose of the treatment is Skilled Care. 3. Medical social services. Treatment must be provided by or supervised by a qualified medical Physician or social worker, along with other Home Health Services. The PCP must certify that such services are necessary for the treatment of the Member’s medical condition. 4. Short-term physical, speech, or occupational therapy is covered. Coverage is limited Services are subject to those conditions and services under the Outpatient limitations listed in the Rehabilitation Benefits section of this Certificate. Coverage is subject to the maximum number of visits, if any, shown on the Schedule of Benefits.