Home Health Care Services. The Plan provides Benefits for home health care services when services are performed and billed by a Home Health Care Agency. These services are covered if hospitalization or confinement in a residential treatment facility would otherwise have been required. A Home Health Agency must submit a written plan of care order by a Provider to Health Options, and then provide the services approved by Health Options. The home health care services covered by the Plan include:
Home Health Care Services. Services rendered by a Home Health Care Agency or a Hospital program for Home Health Care for which benefits are available as follows:
Home Health Care Services. Home health care services, as set forth in this section, shall be covered when provided by and referred in advance by a GHC Provider for Members who meet the following criteria:
Home Health Care Services. Home Health Care provides a program for a Member’s care and treatment in the home. Your coverage is outlined in the Summary of Benefits and Coverage. A visit consists of up to four hours of care. The program consists of required intermittent skilled care, which may include observation, evaluation, teaching and nursing services consistent with the diagnosis, established and approved in writing by the Member’s attending Physician. These services have calendar year visit limits. Plan limits are outlined in the Summary of Benefits and Coverage. Note: Covered Services available under Home Health Care do NOT reduce outpatient benefits available under the Physical, Occupational, or Speech Therapy sections shown in this Contract. Some special conditions apply: • The Physician’s certification statement and plan of care. • Claims will be reviewed to verify that services consist of skilled care that is medically consistent with the diagnosis. • A Member must be essentially confined at home. Covered Services: • Visits by an RN or LPN-Benefits cannot be provided for services if the nurse is related to the Member. • Visits by a qualified physiotherapist or speech therapist and by an inhalation therapist certified by the National Board of Respiratory Therapy. • Visits by a Home Health Care Nursing Aide when rendered under the direct supervision of an RN. • Administration of prescribed drugs. • Oxygen and its administration. Covered Services for Home Health Care do not include: • Food, housing, homemaker services, sitters, home-delivered meals; Home Health Care services which are not Medically Necessary or of a non-skilled level of care. Services and/or supplies which are not included in the Home Health Care plan as described. • Services of a person who ordinarily resides in the patient’s home or is a member of the family of either the patient or patient’s spouse. • Any services for any period during which the Member is not under the continuing care of a Physician. • Convalescent or Custodial Care where the Member has spent a period of time for recovery of an illness or surgery and where skilled care is not required or the services being rendered are only for aid in daily living, i.e., for the convenience of the patient. • Any services or supplies not specifically listed as Covered Services. • Routine care of a newborn child. • Dietitian services. • Maintenance therapy. • Private duty nursing care. HOSPICE CARE SERVICES Hospice benefits cover inpatient and outpatient serv...
Home Health Care Services. See Section 15, Utilization Management, for Covered Services that require prior authorization.
Home Health Care Services. See the Prior Authorization Amendment for Covered Services that may require prior authorization.
Home Health Care Services. See the Prior Authorization Amendment for Covered Services that may require prior authorization. CareFirst BlueChoice provides coverage for the services listed below in a Member’s home by a Contracting Provider Home Health Agency when authorized or approved by CareFirst BlueChoice.
Home Health Care Services. 1. The following services provided to an essentially homebound Insured by a Hospital program for Home Health Care or Community Home Health Care Agency, provided such program or agency is Plan approved and the care is prescribed by a Physician.
Home Health Care Services. Home health care services, as set forth in this section, shall be covered (1) under the MHCN option, when provided by MHCN's Home Health Services or referred in advance by a MHCN Personal Physician to a MHCN-authorized home health agency, or (2) under the Community Provider option, when provided by a State-licensed home health agency, prescribed by a Community Provider and authorized in advance by GHO’s Medical Director, or his/her designee. In order to be covered, the following criteria must be met:
Home Health Care Services. Intermittent or part-time nursing services provided by a registered nurse or licensed practical nurse, or personal care services provided by a licensed home health aide, with accompanying necessary medical supplies, appliances, and durable medical equipment. Such services must be provided in accordance with the policy and service provisions specified in the Medicaid Home Health Coverage and Limitations Handbook.
