Question

What are home health care and the types of services they provide?

The range of home health care services a patient can receive at home is limitless. Depending on the individual patient's situation, care can range from nursing care to specialized medical services, such as laboratory workups. You and your doctor will determine your care plan and services you may need at home. At-home care services may include:

• Doctor care. A doctor may visit a patient at home to diagnose and treat the illness(es). He or she may also periodically review the home health care needs.

• Nursing care. The most common form of home health care is some type of nursing care depending on the person's needs. In consultation with the doctor, a registered nurse will set up a plan of care. Nursing care may include wound dressing, ostomy care, intravenous therapy, administering medication, monitoring the general health of the patient, pain control, and other health support.

• Physical, occupational, and/or speech therapy.Some patients may need help relearning how to perform daily duties or improve their speech after an illness or injury. A physical therapist can put together a plan of care to help a patient regain or strengthen the use of muscles and joints. An occupational therapist can help a patient with physical, developmental, social, or emotional disabilities relearn how to perform such daily functions as eating, bathing, dressing, and more. A speech therapist can help a patient with impaired speech regain the ability to communicate clearly.

• Medical social services. Medical social workers provide various services to the patient, including counseling and locating community resources to help the patient in his or her recovery. Some social workers are also the patient's case manager--if the patient's medical condition is very complex and requires the coordination of many services.

• Care from home health aides. Home health aides can help the patient with his or her basic personal needs such as getting out of bed, walking, bathing, and dressing. Some aides have received specialized training to assist with more specialized care under the supervision of a nurse.

• Homemaker or basic assistance care. While a patient is being medically cared for in the home, a homemaker or person who helps with chores or tasks can maintain the household with meal preparation, laundry, grocery shopping, and other housekeeping items.

• Companionship. Some patients who are home alone may require a companion to provide comfort and supervision. Some companions may also perform household duties.

• Volunteer care. Volunteers from community organizations can provide basic comfort to the patient through companionship, helping with personal care, providing transportation, emotional support, and/or helping with paperwork.

• Nutritional support. Dietitians can come to a patient's home to provide dietary assessments and guidance to support the treatment plan.

• Laboratory and X-ray imaging
  Certain laboratory tests, such as blood and urine tests, can be performed in the comfort of the patient's home. Also, portable X-ray machines allow lab technicians to perform this service at home.

• Pharmaceutical services. Medicine and medical equipment can be delivered at home. If the patient needs it, training can be provided on how to take medicines or use the equipment, including intravenous therapy.

• Transportation. Some companies providetransportation to patients who require transportation to and from a medical facility for treatment or physical exams.

• Home-delivered meals. Often called Meals-on-Wheels, many communities offer this service to patients at home who are unable to cook for themselves. Depending on the person's needs, hot meals can be delivered several times a week.

Describe the reimbursement process for home health agencies by Medicare.

Under prospective payment, Medicare pays home health agencies (HHAs) a predetermined base payment. The payment is adjusted for the health condition and care needs of the beneficiary. The payment is also adjusted for the geographic differences in wages for HHAs across the country. The adjustment for the health condition, or clinical characteristics, and service needs of the beneficiary is referred to as the case-mix adjustment. The home health PPS will provide HHAs with payments for each 60-day episode of care for each beneficiary. If a beneficiary is still eligible for care after the end of the first episode, a second episode can begin; there are no limits to the number of episodes a beneficiary who remains eligible for the home health benefit can receive. While payment for each episode is adjusted to reflect the beneficiary's health condition and needs, a special outlier provision exists to ensure appropriate payment for those beneficiaries that have the most expensive care needs. Adjusting payment to reflect the HHA's cost in caring for each beneficiary including the sickest, should ensure that all beneficiaries have access to home health services for which they are eligible.

What is the purpose of the Medicare Home Health Face-to-Face requirement?

The Medicare Face-to-Face Home Health requirement, a regulation by the Affordable Care Act, requires an in-person physician’s visit to certify a patient’s home health benefit, according to cms.gov. This means that under the law, a physician must assess and document a patient’s condition and provide a brief narrative verifying their eligibility for the home health Medicare benefit. While revisions to this requirement were later made, some important initial provisions of this requirement are as follows:

• A physician or allowed non-physician practitioner (NPP) must document having met with a patient face-to-face and certify them for Medicare home health benefits

• The certification for service eligibility must be related to the physician’s assessment of a patient’s clinical condition

• Patients beginning care on or after January 1, 2011, require this documentation on their certification

• The visit must occur within 90 days before, or within 30 days after the beginning of home health care

Provide 2-3 solutions CMS should implement to ensure that all patients that need a face-to-face encounter receive one?

Under the law, insurance companies and group health plans will provide consumers with a concise document detailing, in plain language, simple and consistent information about health plan benefits and coverage. This summary of benefits and coverage document will help consumers better understand the coverage they have and, for the first time, allow them to easily compare different coverage options. It will summarize the key features of the plan or coverage, such as the covered benefits, cost-sharing provisions, and coverage limitations and exceptions. People will receive the summary when shopping for coverage, enrolling in coverage, at each new plan year, and within seven business days of requesting a copy from their health insurance issuer or group health plan.

This summary of benefits and coverage will include a new, standardized health plan comparison tool for consumers called “coverage examples,” much like the Nutrition Facts label required for packaged foods. The coverage examples would illustrate how a health insurance policy or plan would cover care for common benefits scenarios. Using clear standards and guidelines provided by the Center for Consumer Information and Insurance Oversight (CCIIO), plans and issuers will simulate claims processing for each scenario so consumers can see an illustration of the coverage they get for their premium dollar under a plan. The examples will help consumers see how valuable the health plan will be at times when they may need the coverage.

Thanks to the Affordable Care Act, consumers will also have a new resource to help them understand some of the most common but confusing jargon used in health insurance. Insurance companies and group health plans will be required to make available upon request a uniform glossary of terms commonly used in health insurance coverage such as “deductible” and “co-payment”.

Answer 1

Each paragraph paraphrases in side the bracket below

What are home health care and the types of services they provide?

The range of home health care services a patient can receive at home is limitless. Depending on the individual patient's situation, care can range from nursing care to specialized medical services, such as laboratory workups. You and your doctor will determine your care plan and services you may need at home. At-home care services may include:

( in this they were explaining health care services people get at home. According to the clients needs and physical condition )

• Doctor care. A doctor may visit a patient at home to diagnose and treat the illness(es). He or she may also periodically review the home health care needs.

( doctor will visit the client at his/her home and plan the treatment according to condition and review will be done timely)

• Nursing care. The most common form of home health care is some type of nursing care depending on the person's needs. In consultation with the doctor, a registered nurse will set up a plan of care. Nursing care may include wound dressing, ostomy care, intravenous therapy, administering medication, monitoring the general health of the patient, pain control, and other health support.

( Nursing care done according to the patients condition, registered nurse plan the care. Do the care of wounds, IV therapy if it is needed, Catheter care ostomy care , medication administration etc. she will aseess the general health of the patient , do pain control and health support)

• Physical, occupational, and/or speech therapy. Some patients may need help relearning how to perform daily duties or improve their speech after an illness or injury. A physical therapist can put together a plan of care to help a patient regain or strengthen the use of muscles and joints. An occupational therapist can help a patient with physical, developmental, social, or emotional disabilities relearn how to perform such daily functions as eating, bathing, dressing, and more. A speech therapist can help a patient with impaired speech regain the ability to communicate clearly.

( Provide a occupational therapist services at home. It will help to relearn how to perform daily duties or improve their speech after an injury or some sort of illness. physical therapist will help to do physiotherapy at home, strengthen the use of muscels and joints. An occupational will help to over come physical, social , and emotional disabilities. teach them to do eating, bathing, dressing and more by them after injury or illness. speech therapy help for effective communication)

• Medical social services. Medical social workers provide various services to the patient, including counseling and locating community resources to help the patient in his or her recovery. Some social workers are also the patient's case manager--if the patient's medical condition is very complex and requires the coordination of many services.

(Medical social workers provide their service at home , including counselling. They will co ordinate as patient case manager , do the cordination of many services.)

• Care from home health aides. Home health aides can help the patient with his or her basic personal needs such as getting out of bed, walking, bathing, and dressing. Some aides have received specialized training to assist with more specialized care under the supervision of a nurse.

( Home heath aids help them to meet personal needs such as getting out of bed, toiletting, bathing, dressing, etc)

• Homemaker or basic assistance care. While a patient is being medically cared for in the home, a homemaker or person who helps with chores or tasks can maintain the household with meal preparation, laundry, grocery shopping, and other housekeeping items.

( A home maker should do the meal preparation, laundry , grocery shopping, and other house hold works )

• Companionship. Some patients who are home alone may require a companion to provide comfort and supervision. Some companions may also perform household duties.

( A person should maintain clients comfort and supervision also perform house hold dities)

• Volunteer care. Volunteers from community organizations can provide basic comfort to the patient through companionship, helping with personal care, providing transportation, emotional support, and/or helping with paperwork.

(From the community an Volunteer help the patient personal care, providing transportation, emotional support, and/or helping with paperwork. )

• Nutritional support. Dietitians can come to a patient's home to provide dietary assessments and guidance to support the treatment plan.

( dietician do visit the patient at home , assessment do and plan his treatment plan to support his health status)

• Laboratory and X-ray imaging
  Certain laboratory tests, such as blood and urine tests, can be performed in the comfort of the patient's home. Also, portable X-ray machines allow lab technicians to perform this service at home.

(A phlebotomist visit patients home and collect blood and urine for labortary tests . also a portable x ray can be done at home to avoid unnessary visit to the hospital )

• Pharmaceutical services. Medicine and medical equipment can be delivered at home. If the patient needs it, training can be provided on how to take medicines or use the equipment, including intravenous therapy.

( pharmacy services can be offered at door steps. A pharmacist can provide training how to make medications and use of any equipments EG Nebulizer )

• Transportation. Some companies provide transportation to patients who require transportation to and from a medical facility for treatment or physical exams.

( certain companies provide transportation for the patient from home to hospital for physical examinations)

• Home-delivered meals. Often called Meals-on-Wheels, many communities offer this service to patients at home who are unable to cook for themselves. Depending on the person's needs, hot meals can be delivered several times a week.

( prepaired meals are delivered at home if the patient is unable to cook . provided as per patient's wish)

Describe the reimbursement process for home health agencies by Medicare.

Under prospective payment, Medicare pays home health agencies (HHAs) a predetermined base payment. The payment is adjusted for the health condition and care needs of the beneficiary. The payment is also adjusted for the geographic differences in wages for HHAs across the country. The adjustment for the health condition, or clinical characteristics, and service needs of the beneficiary is referred to as the case-mix adjustment. The home health PPS will provide HHAs with payments for each 60-day episode of care for each beneficiary. If a beneficiary is still eligible for care after the end of the first episode, a second episode can begin; there are no limits to the number of episodes a beneficiary who remains eligible for the home health benefit can receive. While payment for each episode is adjusted to reflect the beneficiary's health condition and needs, a special outlier provision exists to ensure appropriate payment for those beneficiaries that have the most expensive care needs. Adjusting payment to reflect the HHA's cost in caring for each beneficiary including the sickest, should ensure that all beneficiaries have access to home health services for which they are eligible.

( medicare provide a reimbursement process for HOME HEALTH Agencies (HHAs) . They pay an advance base payment to HHAs. The payment is adjusted for the health condition and care needs of the patient. also adjusted for the geographic diffrences accross the contry. They will provide HHAs every 2 months payment of care of each patient.If the patient is still elegible for care after the end of 2 months, a second episode starts , in that time no limit s to number of episodes according to patient needes payment provided by the Medicare if the client is eligible. But the payments shows in patients health cards in Medicare. Also adjusting payment reflects the HHAs cost in caring for each patient including the sickest ,should ensure that all Patients have access to home health services for which they are eligible.)

What is the purpose of the Medicare Home Health Face-to-Face requirement?

The Medicare Face-to-Face Home Health requirement, a regulation by the Affordable Care Act, requires an in-person physician’s visit to certify a patient’s home health benefit, according to cms.gov. This means that under the law, a physician must assess and document a patient’s condition and provide a brief narrative verifying their eligibility for the home health Medicare benefit. While revisions to this requirement were later made, some important initial provisions of this requirement are as follows:

• A physician or allowed non-physician practitioner (NPP) must document having met with a patient face-to-face and certify them for Medicare home health benefits

• The certification for service eligibility must be related to the physician’s assessment of a patient’s clinical condition

• Patients beginning care on or after January 1, 2011, require this documentation on their certification

• The visit must occur within 90 days before, or within 30 days after the beginning of home health care

( To get the medicare payment assistance a doctor or non physician practioner should assess the patient , it is mandatory by the low. The elegibility related to the doctors assessment of patients clinical condition.The visit must occur within 90 days before, or within 30 days after the beginning of home health care )

Provide 2-3 solutions CMS should implement to ensure that all patients that need a face-to-face encounter receive one?

Under the law, insurance companies and group health plans will provide consumers with a concise document detailing, in plain language, simple and consistent information about health plan benefits and coverage. This summary of benefits and coverage document will help consumers better understand the coverage they have and, for the first time, allow them to easily compare different coverage options. It will summarize the key features of the plan or coverage, such as the covered benefits, cost-sharing provisions, and coverage limitations and exceptions. People will receive the summary when shopping for coverage, enrolling in coverage, at each new plan year, and within seven business days of requesting a copy from their health insurance issuer or group health plan.

This summary of benefits and coverage will include a new, standardized health plan comparison tool for consumers called “coverage examples,” much like the Nutrition Facts label required for packaged foods. The coverage examples would illustrate how a health insurance policy or plan would cover care for common benefits scenarios. Using clear standards and guidelines provided by the Center for Consumer Information and Insurance Oversight (CCIIO), plans and issuers will simulate claims processing for each scenario so consumers can see an illustration of the coverage they get for their premium dollar under a plan. The examples will help consumers see how valuable the health plan will be at times when they may need the coverage.

Thanks to the Affordable Care Act, consumers will also have a new resource to help them understand some of the most common but confusing jargon used in health insurance. Insurance companies and group health plans will be required to make available upon request a uniform glossary of terms commonly used in health insurance coverage such as “deductible” and “co-payment”.

(Under the low insurance companies summerize the key features of the plan , coverage they have and it will help them to compare with other agencies coverage. Clients get a summery after the insurance purchase for coverage, enrolling in coverage and each new year plan with in seven days of purchase.Affordable Care Act helps the clients will also have a new resource to help them understand some of the most common but confusing jargon used in health insurance)