Home health care allows individuals to receive necessary medical services within their residence. This care is delivered by licensed healthcare professionals and is generally prescribed by a physician following an illness, injury, or change in medical condition. Determining whether a home health agency supplies the necessary equipment and materials is complex, as the answer depends on the specific item and the funding source covering the care. The provision of supplies is tied directly to the type of service being delivered and the regulations governing payment.
Defining the Scope of Home Health Services
Home health care is defined by the provision of skilled, intermittent services delivered under a physician-approved plan of care. These skilled services typically include part-time nursing care, physical therapy, occupational therapy, and speech-language pathology. The care must be medically necessary for a patient who is homebound, meaning they have difficulty leaving the home without assistance.
The provision of supplies is directly linked to these skilled services; any supplied item must be ordered by the physician and relate to the medical plan of care. Home health does not provide long-term custodial care, which involves assistance with daily living activities like bathing, dressing, and housekeeping. This distinction dictates which supplies are covered.
Categorizing Supplies: Agency-Provided vs. Patient-Responsibility
Supplies fall into two main categories: those bundled into the agency’s services and those considered the patient’s separate responsibility.
Agency-Provided Supplies
These supplies are necessary to perform the skilled service during the nurse or therapist’s visit. Examples include specialized wound care dressings, syringes and needles for specific injections, or intravenous therapy supplies. These are considered routine and non-routine medical supplies and are bundled into the agency’s overall payment for the episode of care.
Patient-Responsibility Supplies
These items are for ongoing daily maintenance or have long-term utility. This category includes common household items like adult diapers, nutritional supplements, and convenience items such as bath benches or grab bars. These items are not covered by the home health benefit because they do not require the skill of a licensed professional to use or manage.
Understanding Coverage and Procurement Logistics
The logistics of supply procurement are heavily influenced by the funding source, with government programs like Medicare setting the standard for coverage. Under Medicare, medical supplies integral to the plan of care are covered under the home health benefit, meaning the agency is responsible for providing them. This includes all routine and non-routine medical supplies needed while the patient is receiving skilled home health services. The reimbursement for these supplies is included in the episode payment the agency receives.
Durable Medical Equipment (DME)
Durable Medical Equipment (DME), which includes items that can withstand repeated use like hospital beds, wheelchairs, oxygen equipment, and walkers, is handled differently. DME is typically covered under a separate benefit, often Medicare Part B or a distinct benefit with private insurance. The home health agency may order the DME, but it is not the agency that physically provides the item or bills for it. Instead, a specialized, outside DME vendor handles the delivery, setup, and billing for this equipment.
The patient is often responsible for a portion of the cost for DME, which may be 20% of the Medicare-approved amount after the deductible. This procurement process requires the agency to coordinate with the separate DME supplier to ensure the equipment is available when needed. While a home health agency may facilitate the order for a hospital bed, the bed itself is delivered and managed by a different company under a different insurance benefit. Private insurance plans must be verified, as their coverage for both skilled supplies and DME can vary widely, often requiring pre-authorization.
Non-Covered Supplies and Alternative Options
When a patient needs supplies that fall outside the scope of the home health benefit or DME coverage, alternative options must be explored. Items like incontinence pads, rolled elastic bandages, or surgical face masks are disposable and are not covered by Medicare’s DME benefit. These items, along with over-the-counter supplements or specialized nutritional formulas, must be purchased out-of-pocket.
Patients can purchase these non-covered supplies directly from local pharmacies or online retailers. Some community resources, such as medical supply donation banks or local non-profit organizations, may provide certain items at a reduced cost or free of charge. Coordinating with the primary care provider is also an option, as a prescription might allow a supply to be covered under a different insurance benefit, such as a pharmacy plan.