Providing Home Health Aide services when patient has hired caregiver

Posted
by swilliams1970 swilliams1970 (New) New

Just wondering what other agencies do when a patient has a hired caregiver and still wants home health aide services? Is this allowed under Medicare guidelines? I referred to the HIM11 but the answer is still unclear to me. Just wondering what other agencies are doing.

Thanks

caliotter3

38,333 Posts

Can't the client do what they please with their own funds? I've worked with a client who paid out of pocket for years for nurses the agencies could never provide. They also had relatives do shifts.

Sorry, don't know the rules.

tabster224

tabster224

Specializes in Home health, Cardiac Tele, Doc's office. Has 24 years experience. 51 Posts

I was told at my old job that Medicare guidelines no matter what you have to offer home health aide care. Even if they are in assisted living where the facility gives showers twice a week. I also (in the old job) had patients that had paid caregivers and home health aides through the agency and lived in ALF's that had HHA's. I am not sure if that is correct, but like I said they said no matter what, you have to offer HHA according to Medicare.

Gommer

Gommer

Specializes in Home care, case management. Has 13 years experience. 8 Posts

My understanding is that there is no conflict here. I have provided HHa services for clients with paid chore providers, etc etc. The HHABN states that ifa client qualifys for HHA services, but wants services above and beyond what Medicare will pay for, they can have it of they want to pay out of pocket. Just make sure the client understand that 80% of you aides time MUST be spent on personal care, or your agency could get a citation.

KateRN1

KateRN1

Specializes in COS-C, Risk Management. Has 20 years experience. 1,191 Posts

You also have to look at what is reasonable and necessary. If the patient has a privately-hired caregiver (CNA or equivalent, not homemaker chore) then would an aide provided by the agency be reasonable and necessary? No, it would be a duplication of services. We do not provide aides for patients who have privately paid caregivers who are capable of doing baths, although we always check with the agency providing the aide to make sure that this is a task they are allowed and trained to do.

Gommer

Gommer

Specializes in Home care, case management. Has 13 years experience. 8 Posts

Hmm, that's interesting. I always figured duplication of services applied to a client having a duplicate service where BOTH are being paid for by Medicare.

tabster224

tabster224

Specializes in Home health, Cardiac Tele, Doc's office. Has 24 years experience. 51 Posts

Hmm, that's interesting. I always figured duplication of services applied to a client having a duplicate service where BOTH are being paid for by Medicare.

That's is also what I thought. How is it a duplication if the patient is paying for the caregiver. Medicare is only paying once. I guess I just don't understand how it could be considered duplication of services.

KateRN1

KateRN1

Specializes in COS-C, Risk Management. Has 20 years experience. 1,191 Posts

It's a duplication anytime Medicare is being asked to pay for services that the patient already receives. For example, we have many dual-enrolled patients who receive Medicare and Medicaid. If the patient is receiving home health aide services through the Medicaid waiver or nursing home diversion programs, we will not provide a home health aide as that service is already in the home.

Medicare is intended for short-term care only, not for long-term services. We are always very careful about putting in a home health aide, they must have OT in as well to address functional deficits with ADLs. The OT should be addressing the long-term goal of the patient ultimately becoming independent with bathing while the HHA is there to assist with the short term goal of hygiene needs being met. The HHA will also assist family members to learn how to safely bathe a patient by demonstration or assistance.

HmarieD

HmarieD

280 Posts

Medicare does not consider HHA services medically necessary if there is a "willing and able" c/g in the home, even if that c/g is a family member, as Kate said it's a duplication of services.

R*Star*RN

R*Star*RN, BSN, RN

Specializes in LTC, Med-Surg, IMCU/Tele, HH/CM. 225 Posts

I am still fairly new at this, but I have had patients that had a hired "caregiver" and a HHA. My manager explained to to me like this, which could be way off base. . . so correct my if my thinking is wrong here.

So the hired caregiver, wether it be from a state agency or nonprofit orginization, generally helps the patient with things like. . meals, cleaning, maybe some ADLs. Our HHAs mainly do bathing assist 3x/week, potentially linen changes and assist with dressing. So since our HHA does bathing, and the hired caregiver does not do bathing, it is a different service.

KateRN1

KateRN1

Specializes in COS-C, Risk Management. Has 20 years experience. 1,191 Posts

It depends on the scope of the other aide. Some are not able to do ADLs, they only do IADLs per their written care plan, which is why it is important to coordinate with the other agency. If, however, the other agency has decided not to include ADLs with their careplan because "the patient has home health care" that is not acceptable and I will discuss with the care manager at the other agency having that service added. Medicaid waiver and and diversion programs generally have no problem with this. If the other aide is through a private duty agency, then most likely they cannot do ADLs anyway and it's a moot point. Make sense?