Home Health Care and Hospice Services

Clients must be homebound, have a skilled need for nursing, physical, speech, or ongoing occupational therapy. Home care aides, medical social services, and medical supplies necessary to the plan of care, are covered only when skilled services are involved.

Medicaid for Home Health Patients

Home Health starts immediately following hospitalization, if the discharging M.D. documents an order for home health services. When there has been no hospitalization, prior authorization must be obtained from Medicaid. Services may not begin until approval is obtained. Indiana Medicaid Managed Care, requires home care authorization by Primary Care Case Management, (PCCM), or Risk Based Managed Care, (RBMC).

Hospice Medicare/Medicaid Benefit

If ordered on the Hospice plan of care, nursing, personal care, social services, spiritual counseling, short-term inpatient stays for caregiver respite, symptom control, medication, medical equipment/supplies, continuous home care during brief periods of crisis, therapy, and dietary consultation are covered by a per diem payment.

Commercial Insurance

Employer and private insurance plan, home health care and along with fee for service or managed care coverage often covers Hospice. Per visit coverage, rather than per diem, may limit the frequency and type of service covered. The Care Coordinator contacts the insurance company to verify coverage and negotiates care arrangements with insurance case managers, when necessary. The client is informed of insurance benefits, deductibles, and co-payment responsibilities.

Private Pay

Clients may arrange with the billing department for private pay services. Hoosier Uplands will work to find a funding source for those without means to pay for needed services.

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