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How Does Medicare Handle Transitions Between Home Health Care and Facility Care?
Date Updated: December 13, 2024
Written by:
Ashlee Shefer is a freelance copywriter, content writer, and digital marketer who specializes in senior care, mental health, health care, and other wellness-related topics. She has one year of experience writing both short- and long-form content related to senior resources, assisted living, nursing homes, and home care, including blog posts, research-based articles, resource guides, product reviews, facility blurbs, finances, and care costs.
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Kristi Bickmann, a licensed Long-Term Care Specialist, represents top-rated "Traditional" & "Hybrid" LTC companies. Serving associations such as the American Nurses Association, she's a licensed insurance agent in 27 states. Specializing in insurance products for seniors, Kristi helps hundreds of families every year protect assets, retirement, and loved ones. She understands aging concerns firsthand, having assisted her own parents. Kristi ensures accuracy on topics about senior long-term care and its consequences.
Medicare handles transitions between home health care and facility care by communicating with each provider and the patient to coordinate services. Under Medicare Part A, individuals receive either home health or inpatient care if they have a qualifying condition. However, they must meet with a doctor to determine a medical necessity for care.
What Specific Care Options Does Medicare Part A Cover?
Medicare Part A covers a variety of care options, including:
- Inpatient hospital care
- Skilled nursing facility care
- Nursing home care
- Hospice care
- Home health care
Each option has specific eligibility requirements. For example, transitioning to a skilled nursing facility involves a three-day qualifying hospital stay and a certification of care from a doctor. The patient must also have an ongoing condition the facility treated during their stay or a new condition they developed while in residence. To qualify for inpatient hospital care, an individual must receive an official doctor's order and receive services in a hospital that accepts Medicare.
Some care options only cover part-time, intermittent or short-term services. Speaking with a doctor or other health care provider can illuminate how to choose an appropriate option and find local Medicare-certified providers.
What Does the Transition Process Look Like Between Care Types?
Medicare follows specific procedures to handle transitions between care types. First, a representative verifies the patient's enrollment in the appropriate Medicare plan and reviews the doctor's orders for care. Medicare then coordinates communication between the patient or their caregiver, their primary care doctor, the current facility or agency administering care and the new provider. This is key in ensuring the proper transfer of medical records and continuity of care.
After the transition, the new provider monitors the patient's condition and reports to their doctor to discuss concerns or care plan adjustments as needed. If a person transfers from a facility to home health care, Medicare covers transitional care management services. This guarantees the patient an in-person office visit within two weeks of returning home and other resources, including scheduling assistance and provider referrals for follow-up care.