Rehab refused to release him, and told family they would have to sign AMA, which means they would get no HH benefit.[/QUOTE]
No rule that I am aware of regarding no getting home health thru Medicare if signing out AMA. They are PRIVATELY paying for rehab cause his rehab benifit ran out...guess the Rehab physicians are forcing the AMA to cover their butts as they feel he is in need of more rehab treatment. This family wants to bring hime home. Tell them to ask for a care conference including rehab discharge planner or Social worker.
Only problem as I can see it (apart of care issues) is who will sign the 485 plan of treatment (POT). Get the famly to contact patients Primary Care Physician (PCP). Have the PCP be updated by rehab staff---as long as the PCP agrees to sign the POT and family is willing to bring him home knowning the obstacles, I see no problem.
He is also eligable for SNF stay, even if rehab benefit ran out as long as he has SKILLED needs; they will pay for 29 days 100% then decreases to no coverage after 100 days. If he has secondary coverage, that usually picks up the co-pay balance for the 100 days. After that own your home until income spent down to $2,000 when eligable for Medical Assistance.
We accept AMA patients all the time with a PCP/referring doc agreeing to sign the POT. Patients have the right to refuse treatment at ANY time. AND they have often progressed faster in their own homes with adequate family support.
SNF stays require 48-72hr hospital stay: no such requirement for Rehab and homecare.
Only conditions for MC to pay for home care are:
1. Patient qualifies for Medicare.
2. Client must be under care of a physician. A plan of care is rendered under the guidance of a physician.
3. Patient requires skilled nursing, occupational therapy, physical therapy or speech therapy on an intermittent basis, less than 28hrs per week or 8 hrs in a given day.
4. Client must be homebound. Must be taxing effort to leave home with leaving of infrequent nature.
5. Care is medically reasonable and necessary.
6. Patient resides in a home or facility that does not perform skilled care (e.g., not in a nursing home or hospital).
Home Health Care
CMS (HCFA) Home Health Manual
Have the family call the NJ Office of Aging for assistance if needed:
Nationwide Toll-Free Telephone Number 1-877-222-3737
Website list of all NJ office of aging agencies:
State by state listing of Office of Aging contacts: