Medicare

Medicaid $ is used for ________ and also for _________, which are essentially grants for products and services in the home.

"insurance" WAIVERS

Excluded from coverage is the type of lift which

-Operates by a spring release mechanism with a sudden, catapult-like motion and jolts the patient from a seated to a standing position. -Limit the payment for units which incorporate a recliner feature along with the seat lift to the amount payable for a seat lift without this feature.

Medical necessity for a hospital bed due to one of the following reasons:

-The patient's condition requires positioning of the body in ways not feasible in an ordinary bed eg to alleviate pain*, promote good body alignment, prevent contractures, avoid respiratory infections* (have to show have done other things first) - The patient's condition requires special attachments that cannot be fixed and used on an ordinary bed

If patient's condition requires positioning for hospital bed then prescription or other documentation must describe the medical condition, e.g.

-cardiac disease -chronic obstructive pulmonary disease -quadriplegia or paraplegia -the severity and frequency of the symptoms of the condition, that necessitates a hospital bed for positioning

To lower and raise head and foot may be covered when patient's condition requires

-frequent change in body position and/or there may be an immediate need for a change in body position (i.e., no delay can be tolerated) -And the patient can operate the controls and cause the adjustments. --Exceptions may be made to this last requirement in cases of spinal cord injury and brain damaged patients

When it has been determined the patient can benefit therapeutically from use of the device.

-item is included in the physician's course of treatment -likely to effect improvement, or arrest or retard deterioration in the patient's condition, -And that the severity of the condition is such that the alternative would be chair or bed confinement.

Lift chair: Rental or purchase of a medically necessary seat lift when

-prescribed by a physician for a patient -with severe arthritis of the hip or knee and patients -with muscular dystrophy -or other neuromuscular diseases

The encounter must occur within the ________ before the order is written for the DME.

6 months

Ex of medicaid

E.G. Meals on wheels. Refer to Panel Discussion Lecture for details about the Waiver programs available

Mobility Assistive Equipment (MAE)

Includes: Canes Crutches Walkers Manual wheelchairs Power wheelchairs Scooters "This list, however, is not exhaustive."

Reasonable and Necessary for

Mobility deficit sufficient to impair their participation in mobility-related activities of daily living (MRADLs), in customary locations within the home, such as Toileting Feeding Dressing Grooming Bathing

MediCAID

Provides health insurance to persons of ultra-low income and/or persons with disabilities.

Is medically necessary and, therefore, covered, for one of the following conditions:

Severe arthritis and other injuries to lower extremities Severe cardiac conditions. Spinal cord injuries, including quadriplegic and paraplegic patients, multiple limb amputee and stroke patients. Other severely debilitating diseases and conditions

BSC (bed side commode)

The term "room confined" means - Condition is such that leaving the room is medically contraindicated - Confinement of a patient to a home where there are no toilet facilities - Medical condition confines pt to a floor of the home and there is no bathroom located on that floor

Medicare overs healthcare and also DME (durable medical equipment). Eg.

Walkers, wheelchairs, and hospital beds.

To obtain DME, the law requires that

a physician must document that a physician, nurse practitioner, physician assistant, or clinical nurse specialist has had a face-to-face encounter with the patient.

medically contraindicated

condition or factor that serves as a reason to withhold a certain medical treatment due to the harm that it would cause the patient.

Section 6407 of the ACA established a ____________ requirement for certain items of DME.

face-to-face encounter

Medicare is funded by

federal

Medicare is a

federally funded health insurance Provides health insurances to persons over 65 and those with a disability.

Severe arthritis and other injuries to lower extremities e.g

fractured hip to assist the patient to ambulate by enabling the patient to place his or her feet on the floor while sitting on the edge of the bed;

WARNING co-morbid conditions can

impact their ability to safely utilize MAE independently or to successfully regain independent function even with mobility assistance.

Hospital bed Physician's prescription:

including medical records and physicians' report

MAE examples

muscular spasticity cognitive deficits availability of a caregiver physical layout Surfaces obstacles in the beneficiary's living environment.

Coverage of seat lifts is limited to those types which

operate smoothly can be controlled by the patient and effectively assist a patient in standing up and sitting down without other assistance.

Other severely debilitating diseases and conditions,

required to assist the patient to ambulate

Medicaid is funded by

state health insurance program and federal

If the stated reason for requiring a hospital bed is the patient's condition requires special attachments:

the prescription must describe the patient's condition and specify the attachments that require a hospital bed

Severe cardiac conditions.

who are able to leave bed, but who must avoid the strain of "jumping" up or down;

Spinal cord injuries, including quadriplegic and paraplegic patients, multiple limb amputee and stroke patients.

who are able to transfer from bed to a wheelchair, with or without help; or