The Home Care Network - Impact of Available Caregiver

Whether or not there is a caregiver available in the home to provide services to the patient does not usually affect the patient’s eligibility for Medicare covered services. (One exception is when services are to provide normally self-injected medications, i.e., insulin injections. A nurse can go out daily indefinitely to administer insulin if the client is not able to self administer and there is no one else willing to give the injection.)
When a caregiver is providing a service which adequately meets the patient’s needs, it is not reasonable and necessary for the home health agency to provide the same service.
The patient’s eligibility for reasonable and necessary home health services is not affected by the fact that he/she may qualify for care in another setting, i.e., hospital, skilled nursing facility.
The patient’s eligibility for reasonable and necessary home health services is not affected by any supplemental services the patient may receive that do not meet Medicare’s definition of skilled nursing or home health aide services.