Policy Manual sample

MDT Home Health Care Agency, Inc. FINANCIAL ELIGIBILITY CRITERIA Financial eligibility criteria differs with the individual payment source. The need for service criteria (such as needing skilled care) will be the same for all patients as will the requirement that the service be under the direction of a physician’s plan of care. The sources of payment for therapeutic services are as follows: 1. Private payment--all eligible 2. Private insurance--Patient policy criteria determines coverage. 3. Champus (Military Medicare)--patient cleared through military business office. 4. Medicare--physician must certify that the patient is homebound, has a changing medical status and is in need on an intermittent basis of skilled home health services (i.e., skilled nursing, physical therapy, speech therapy) with review and renewal of patient care plans and certification at least every two months (60 days) and possible more frequently as the patient’s condition requires. 5. Title XIX(Medicaid)--patient must have approval of payment, i.e., current medicaid care cleared through local DSS Health and Welfare Office prior to coverage. 6. Veterans Administration Hospital--by arrangement of VA hospital for specific service connected conditions. 7. Partial payment or free service--financial inability to pay full fee, such as no insurance, does not qualify for Medicare or Medicaid. Financial information form must be completed and reviewed by the Administrator prior to sliding fee application. Home Health Agency Overall Plan and Budget F-10