HI 00610.420 Special Option While Under a Home Health Plan

A. General

There may be instances in which it will be to the patient's advantage to receive the physical therapy or speech pathology he needs as a “medical and other health service” rather than as a home health service prior to July 1, 1981, or to purchase durable medical equipment rather than to have the use of it paid for under the home health plan. In such instances the HHA will explain these options to the patient.

B. Physical therapy and speech pathology services

Prior to July 1, 1981, the HHA advises a patient who needs physical therapy or speech pathology visits in addition to skilled nursing visits that he may find it advantageous to receive the physical therapy or speech pathology services he needs as a Part B “medical and other health service” (subject to the deductible and coinsurance) thus conserving his 100 visit home health benefit (either under Part A or Part B) for the nursing visits and any other covered home health visits he may require which are not reimbursable as “medical and other health services.”

Effective July 1, 1981, the 100 visit limitation under Part A is eliminated. If entitled to services under Part A and Part B, the visits must be charged against Part A. Therefore, effective July 1, 1981, this special option would not be appropriate.

C. Use of medical appliances

A patient who is receiving home health visits (either under Part A or Part B) and who will need the use of a medical appliance over an extended period of time should be advised by the HHA of his option to choose to have the use of the appliance reimbursed under the home health plan or to have reimbursement made for the purchase of durable medical equipment from the HHA or from an independent supplier as a “medical and other health service.” Generally it is to the advantage of the home health beneficiary to choose to receive these items as home health services.


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http://policy.ssa.gov/poms.nsf/lnx/0600610420
HI 00610.420 - Special Option While Under a Home Health Plan - 07/18/2014
Batch run: 07/18/2014
Rev:07/18/2014