MEDICARE INSURANCE

1. Skilled service is required for Medicare (Nursing or Therapy)
2. Skilled service includes but not limited to: wound care, injections, IV, physical therapy, occupational therapy
3. The patient has to be homebound. This means the patient can not drive and leaving the home takes a taxable effort.
4. We accept patients that have straight Medicare Part A as primary insurance, meaning not through an HMO Plan. This will be checked on our Medicare portal called Medicare Eligibility. Every patient has Medicare Eligibility checked, we do not start service until this is checked.
5. If the patient is receiving services through another agency, we can not see that patient. For example, if the patient is receiving physical therapy from another agency and wants us to take care of their wound care WE CANNOT. They are able to cancel the other agency and we can then provide the nursing and continue therapy for the patient or that other agency can provide both skills.
6. If the patient is receiving therapy through Medicare Part B (either a rehab facility or an at home therapist that can bill for Part B) we can not see the patient. The patient will have to stop Part B in order for Part A to become effective.
7. Medicare pays in full for an aide if the patient requires skilled care (skilled nursing or therapy service) and the aide visit lasts for 1 hour. The Home Health Aide provides personal care services, including help with bathing, toileting, dressing and light housekeeping.  Medicare will NOT pay for an aide if you only require personal care and DO NOT need skilled care.

LTC-MEDICAID INSURANCE

1. This is a program through the Medicaid division. There are several Medicaid Managed Care Insurances. We accept Humana LTC, United LTC, Sunshine and Little Havana LTC, Aetna LTC, Molina LTC, Florida Community Care LTC
2. No doctor’s prescription needed, the patient has a case manager from their specific insurance who will determine how many hours the patient will receive for the week depending on the patient’s condition and necessities.

BROWARD COUNTY VETERANS AND ELDER AFFAIRS

1. Typically we receive our patients through the County (Broward County case managers). This program is similar to the LTC-Medicaid Insurance, but these patients are on the waiting list before receiving approval of their Medicaid LTC application.
2. These patients applied for the Medicaid LTC program through Alliance on Aging.

LTC-PRIVATE INSURANCE

1. Depending on the policy there may be an elimination period. The elimination period may be satisfied through prior home health services, such as out-of-pocket assistance for ADL’s (assistance with daily living) or skilled services (ie Wound care, IV therapy, Physical Therapy) using Medicare. Also, the policy may have a clause that allows for Rehab Facility inpatient stay to be put towards the elimination period.
2. Daily benefit amount. The insurance pays out a maximum daily benefit for the policy. There are some instances where it can be paid weekly or there is a percentage paid out. For example, the insurance will pay out 80% of total billed services and 20% is the responsibility of the patient. This will be disclosed in their individual policy or if you call the benefit analysis department of the insurance company.
3. ADL’s (assistance with daily living) there are usually 2-3 ADL’s that need to be satisfied in order for the insurance to approve the claim.
4. Sometimes there are multiple insurances, some might be supplemental.

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MEDICARE and/or HUMANA TRI-CARE:
The services provided by the agency that is 100% paid for by Medicare will be intermittent. This means the amount of visits will be determined after a Registered Nurse assesses the client upon admission.

If a person is actually checked into a hospital and remains for three or more nights, they may qualify for in-home care services delivered by a Home Health Agency. To determine eligibility the client needs to know whether they were actually admitted to the hospital or were they there for “observation.” Some clients and their families are not aware of the term “admitted.” Although a client might have stayed in the hospital for a multiple of days, does not necessarily equate to a hospital admission. This significant information determines if Medicare benefits are applicable upon discharge from the hospital.

A Physician or Advanced Registered Nurse Practitioner must prescribe home health care, and Medicare must view the service as “medically necessary” by both the healthcare professional and Medicare. Since, most home care is provided as an alternative to or as an extension of skilled nursing care a client must have a medical need to recuperate, in order to receive treatments or therapies, and be capable of showing improvement in condition.

MEDICAID WAIVER (LTC/MMA) and/or COMMERCIAL INSURANCE:

The services provided by the agency that is 100% paid for by Medicaid Waiver (LTC/MMA) and/or Commercial Insurance needs to be authorized by your insurance prior to receiving services. Once approved the agency will be able to send the authorized discipline and visit amounts allowable by your insurance.

PRIVATE PAY and/or LONG TERM CARE INSURANCE:
The services provided by the agency that is paid for by either privately or through long term insurance will be as needed by the client. This means the client or family/caregiver will decide the amount of hours based upon their needs and preferences of care. However, if going through insurance the amount of hours paid through the insurance company will be determined by each insurance policy individually (each policy may vary).

Our agency provides staff as little or as much as the care is needed. These services can be HOURLY or LIVE-IN. Please call our office to find out more information 305-865-1989.

*Note: It is advisable to inquire through the agent or agency that sold you your policy. As long-term care policies are typically a type of insurance a consumer purchased many years ago, it is possible that your policy does not specifically outline coverage for home care. Regardless of when your policy was initiated, however, you may find that it includes a provision or a requirement. In such policies, it is at the discretion of the insurance company as to whether they will honor reimbursement directly to the consumer, or coverage to the provider for certain levels and amounts of home care.​

The first step to becoming a client is being seen by a physician who recommends you to be cared for by a home health agency. The physician, client and/or family/caregiver will determine which agency they choose; then, the physician will send a prescription for home health to the agency.

The next step to the process is a Registered Nurse will be sent out from the agency to conduct an assessment. The assessment is a method for gathering information to be used by the health care provider to extend care in an effective and meaningful way for the client. This is also intended to document and to highlight particular information and tasks that affect the care and interaction a caregiver or provider has with client.

A vital subject matter will be addressed specifically for those clients seeking Medicare or any other government funded service. This matter entails that you MUST be home-bound, and a doctor must certify that you’re home-bound. To be home-bound means the following:

• Leaving your home isn’t recommended because of your condition.
• Your condition keeps you from leaving home without help (such as using a wheelchair or walker, needing special transportation, or getting help from another person).
• Leaving home takes a considerable and taxing effort.
• A person may leave home for medical treatment or short, infrequent absences for non-medical reasons, such as attending religious services. You can still get home health care if you attend adult day care, but you would get the home care services in your home.

Once the Registered Nurse completes the assessment a frequency will be determined by the information gathered from the assessment. The frequency can range from daily to three times a week to once per week, these frequencies will vary depending on the client’s needs and progress.

Home care is a service offered in your own home or within an assisted living setting. These services may consist of high levels of professional medical care by nurses, therapists, and/or medical social worker. Also if upon admission it is determined that the client needs an aide, home care will provide help for hands-on care such as assistance getting dressed, taking a shower or bath, transferring, light housekeeping, or meal preparation.

The objective of in-home care is to provide enough assistance to allow a person to remain in their current living situation. These in-home services can be arranged through a licensed home health agency, such as Alliance Health Care of Miami Beach.

• Level 2 Background Screening
• Drivers License Check
• Reference Check
• Professional License Cerification
• Extensive Continuing Education
• In-services Throughout Employment