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:
1. The Member is unable to leave home due to his/her health problem or illness. Unwillingness to travel and/or arrange for transportation does not constitute inability to leave the home.
2. The Member requires intermittent skilled home health care services, as described below.
3. A GHC Provider has determined that such services are Medically Necessary and are most appropriately rendered in the Member's home. For the purposes of this section, “skilled home health care” means reasonable and necessary care for the treatment of an illness or injury which requires the skill of a nurse or therapist, based on the complexity of the service and the condition of the patient and which is performed directly by an appropriately licensed professional provider.
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. • 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 benefits cover inpatient and outpatient services for patients certified by a Physician as terminally ill. Your Contract ...
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:
1. Skilled Nursing Services of a Registered Nurse (RN) or Licensed Practical Nurse (LPN);
2. Physical Medicine, Speech Therapy and Occupational Therapy Services;
Home Health Care Services. See Section 15, Utilization Management, for Covered Services that require prior authorization.
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:
a. Visits by registered nurses and licensed practical nurses;
b. Physician or nurse practitioner home and office visits;
c. Visits by a registered physical, speech, occupational, inhalation, and dietary therapist;
d. Supportive services, including prescription drugs, medical and surgical supplies, and oxygen, but only to the extent that such services would have been covered if you remained in the Hospital; and
e. Visits by home health aides under the supervision of a registered nurse.
Home Health Care Services. See the Prior Authorization Amendment for Covered Services that may require prior authorization.
7.1 Covered Home Health Care Services Benefits are provided for:
A. Continued care and treatment provided by or under the supervision of a Registered Nurse (RN) or Licensed Practical Nurse (LPN). Services of a home health aide, medical social worker, or registered dietician may be provided, but must be performed under the supervision of a licensed professional (RN or LPN) nurse.
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:
1. Skilled Nursing Services of a Registered Nurse (RN) or Licensed Practical Nurse (LPN);
2. Physical Medicine, Speech Therapy and Occupational Therapy Services;
3. Medical and surgical supplies provided by the Home Health Care Agency or Hospital Program for Home Health Care;
4. Oxygen and its administration;
5. Medical social service consultations; and
6. Health aide Services to a Member who is receiving covered nursing Services or Habilitative and Rehabilitative Services or Therapy Services.
7. No Home Health Care benefits will be provided for:
a. Dietitian Services;
b. Homemaker Services;
c. Maintenance therapy;
d. Dialysis treatment;
e. Custodial Care; and f. Food or home delivered meals.
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 Community Health Options, and then provide the services approved by Community Health Options. The Plan does not provide Benefits for Home Health Services that include custodial care. The home health care services covered by the Plan include:
1. Visits by registered nurses and licensed practical nurses;
2. Physician or nurse practitioner home and office visits;
3. Visits by a registered physical, speech, occupational, inhalation, and dietary therapist;
4. Supportive services, including prescription drugs, medical and surgical supplies, and oxygen, but only to the extent that such services would have been covered if you remained in the Hospital; and
5. Visits by home health aides under the supervision of a registered nurse.
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. Covered Services include services given to the Insured in his home by a licensed Home Healthcare Provider or an approved Hospital program for Home Healthcare. Such services are covered when: such care is given in place of Inpatient Hospital or Skilled Nursing Facility care and/or; the Insured is not physically able to obtain Medically Necessary care on an outpatient basis; and/or the Insured is under the care of a Physician; and/or the Insured is homebound for medical reasons. NOTE: The Insured is responsible for one cost-share per day per Home Healthcare agency. Covered Services and supplies provided by a Home Health Care agency include: Professional services of a registered nurse, licensed practical nurse or a licensed vocational nurse on an intermittent basis. Physical therapy, speech therapy and occupational therapy by a licensed therapist. Medical and surgical supplies that are customarily furnished by the Home Health Care agency or program for its patients. Prescribed drugs furnished and charged for by the Home Health Care Provider or program. Prescribed Drugs under this provision do not include Specialty Prescription Drugs. One (1) medical social service consultation per course of treatment. One (1) nutrition consultation by a certified registered dietitian. Health aide services furnished to Insured only when receiving nursing services or therapy.
