Qualifying Criteria

Admission for home health services requires meeting admission criteria established by Medicare, Medicaid or the patient's insurance provider.

This generally includes, but is not limited to:

  • The patient must be under the care of a physician.  All services must be ordered and approved by a physician.  Effective Jan. 1, 2011, a physician who certifies a patient as eligible for Medicare home health services must see the patient.  This requirement can be satisfied by a non-physician practitioner (NPP) if the NPP is working for or in collaboration with the physician.
  • All services ordered must be a reasonable and medically necessary for the treatment of the patient's illness or injury.
  • The patient must need a skilled primary service.
  • Skilled nursing and/or home health services must be provided on an intermittent or part-time basis unless the skilled need is therapy.
  • The patient must iive within a 50-mile radius of Hutchinson.  We serve patients in Barton, Ellsworth, Harper, Harvey, Kingma, Marion, McPherson, Pratt, Reno, Rice, Saline, Sedgwick, Stafford and Sumner counties.
  • The patient must be homebound.  A person is considered homebound if it takes a considerable and taxing effort to leave the home.  Absences from the home can only be of short duration and infrequent.
  • The patient or their family must desire services for the patient's care.
  • The patient's home must be adequate for safe and effective care.
  • Other criteria set by the patient's insurance carrier.

Paying for Hospice

Hospice is paid for through the Medicare Hospice Benefit, Medicaid Hospice benefit, and most private insurers. If a person does not have coverage through Medicare, Medicaid, or a Private Insurance company, our agency will work with the person and their family to ensure that needed services can be provided.

Medicare Hospice Benefit

  • The Medicare Hospice benefit, initiated in 1983, is covered under Medicare Part A. Medicare beneficiaries who choose hospice care receive a full scope of medical and support services for their life limiting illness. Hospice care also supports the family and loved ones of the person through a variety of services. The Medicare Hospice Benefit covers virtually all aspects of hospice care with little out-of-pocket expense to the person or family. 
  • Sometimes a person's health improves or their illness goes into remission. If that happens, their doctor may feel that the person no longer needs hospice care. Also, a person has the right to stop getting hospice care, for any reason. If hospice care is stopped, routine Medicare coverage is resumed. Hospice may be resumed again, when or if the person becomes eligible again.

The Medicare Hospice Benefit Does Not Cover the Following:

  • Treatment intended to cure your illness
    • The person will receive comfort care to help manage symptoms related to their illness. Comfort care includes mediations for symptom control and pain relief, physcial care, couseling, and hother hospice services.
  • Medications not directly related to your hospice diagnosis are not covered under the Medicare Hospice Benefit.
    • Hospice team members will consult with the physcians and will inform the patient and family which drugs and/or medications are convered and which ones are not covered under the Medicare Hospice benefit. Our agency uses medicaine, equipment, and supplies to make the patient as comfortable as possible. Under the hospice benefit, Medicare won't pay for treatment where the goal is to cure the illness.
  • Nursing Home Room and Board
    • Room and board aren't covered by Medicare. You may receive hospcie services wherever you live, even in a nursing home, however, the Medicare Hospice benefit dones not pay for nursing home, or Hospice House room and board. Room and board is applied at the Hospice House if a person is at routine care rather than an inpatient level of care.