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Home Health Medical Social Worker

Home health services provided by Medical Social Workers (MSWs) are covered by Medicare as a dependents service. This means there must first be a “qualifying skilled service” in the home, such as intermittent skilled nursing services, physical therapy, speech-language pathology, or continuing occupational therapy services. If the qualifications are met, and the beneficiary has an impediment to his or her recovery (think of a roadblock) that takes the skills of an MSW to remove, MSW services would be covered.

The following activities are considered covered medical social services:

  • Assessment of the social and emotional factors related to the beneficiary’s illness, the need for care, their response to treatment, and adjustment to care.
  • Assessment of the relationship of the medical and nursing requirements to the home situation, financial resources, and the community resources available
  • Services provided on a short-term basis (two to three visits) to a beneficiary’s family member or caregiver when it is shown that a brief intervention is necessary to remove a clear and direct impediment to the effective treatment of the beneficiary’s medical condition or to the recovery rate.
  • Appropriate action to obtain available community resources to resolve the beneficiary’s problem.

Exception: Medicare does not cover the services of a medical social worker to complete or assist in completing an application for Medicaid. Federal regulations require the state to provide assistance in completing the application to anyone who chooses to apply for Medicaid counseling services.

The following types of MSW activities are not covered under the Medicare home health benefit:

  • Services furnished are of a type directed toward minimizing the problems an illness may create for any beneficiary and family members
  • Preventive counseling, such as financial planning
  • The sole purpose of a visit is to assist the beneficiary or significant other to fill out routine forms (e.g., completing advance directives)
  • Follow-up visits that do not require a home visit (e.g., arrangements via telephone)
  • Routine evaluations at start of care where no problems are documented and no follow-up is necessary (There should be no automatic assessment or routine evaluation.)
  • Orders for assessment of social/emotional factors, financial assessment, long-term planning, and counsel without identifying specific reason or problem to warrant these services
  • Services can be handled by a lay person or other disciplines (i.e., if the only documented service is calling Meals on Wheels, this would not be a covered visit, since this call could be placed by any individual)
  • Problems are related to a normal stress situation and a normal adjustment period required by any type of illness

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