Home Health Care Services--tighter Fiscal Controls Needed: Report to the Congress

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Page 3 - ... (1) part-time or intermittent nursing care provided by or under the supervision of a registered professional nurse...
Page 14 - ... may provide for the use of estimates of costs of particular items or services, may provide for the establishment of limits on the direct or indirect overall incurred costs or incurred costs of specific items or services or groups of items or services to be recognized as reasonable based on estimates of the costs necessary in the efficient delivery of needed health services to individuals covered by the insurance programs established under this title...
Page 14 - If a provider of services furnishes items or services to an individual which are in excess of or more expensive than the items or services determined to be necessary in the efficient delivery of needed health services...
Page 4 - A person may qualify for home health care benefits under medical insurance (part B of Medicare), without prior hospitalization provided certain conditions are met. In such cases a person is limited to 100 home care visits in any one calendar year.
Page 4 - Home health 1/fi new spell of illness begins if a beneficiary is rehospitalized after having been out of a hospital or a skilled nursing home for at least 60 consecutive days. services provided under Medicaid have varied considerably from State to State. With the publication of Medicaid regulations on August 25, 1976, all States were required to provide nursing services, home health aide services, and medical supplies and equipment. Any person eligible for skilled nursing...
Page 48 - GAO) had not yet been audited by the Medicare intermediaries for these agencies. The Medicare cost report settlement process requires that claimed costs be reviewed by the intermediary audit staff to assure that Medicare reimburses only costs which are both reasonable in amount and necessary to the overall production of the medically necessary health care services the provider-furnished Medicare beneficiaries. This...
Page 12 - We have been aware for some time of a need for a national policy to guide intermediaries in establishing reasonable costs for home health agencies. It is obvious that many private, non-profit home health agencies are abusing the cost reimbursement provision of the program. To our knowledge the only control over the imprudent, if not irresponsible, financial management of these agencies is determining actual costs are not the reasonable cost.
Page 3 - ... under the direction of a physician; .I/Medical social services are services necessary to assist ~ the patient and his family in adjusting to social and emotional conditions related to the patient's health problem. 35-122 " - 1
Page 48 - HHA is in compliance with the regulatory requirement that the administrative and supervisory function of an HHA not be delegated to another agency or organization.
Page 1 - The Health Insurance for the Aged and Disabled Act (Title XVIII of the Social Security Act...

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