About Home Care2

Home health therapies are services provided within the array of Home Health Care that are provided to individual clients in their homes by licensed Home and Community Support Services Agencies. Services are prescribed on a “per visit” basis. As a consequence, a therapist must travel to the client’s home to treat them one on one. More than 80% of home health services are covered only by Medicare or Medicaid, making the home health industry largely dependent upon government payment sources. In Texas, the expansion of home care over the years has been driven because it has consistently proved to be the most cost-effective treatment method in a preferred treatment setting.

Although both Medicare and Medicaid cover therapy services provided to individuals in their homes, for children the funding is almost exclusively Medicaid.

What types of therapy must be delivered to children in the home?

  • Medicaid covers pediatric physical, occupational and speech therapy through the Early and Periodic, Screening, Diagnosis and Treatment (EPSDT) program; what Texas calls the Comprehensive Care Program (CCP).
  • The EPSDT provisions of the Medicaid Act make clear that children are entitled to a broad array of medical services, including therapy.
  • The provision of medically necessary home care physical therapy, occupational therapy, and services for individuals with speech, hearing, and language disorders, are part of the array of services children are eligible to receive under Medicaid to ameliorate a defect, physical and mental illness or condition.

Must a child be homebound to receive therapy in the home?

  • No. Federal law does not allow states to apply homebound restrictions to any Medicaid beneficiary.
  • Under EPSDT the state must provide all medically necessary services in the least restrictive and most appropriate environment possible.

What are the demographics of the children that receive home health therapy?

  • Children who receive home health therapy primarily have complex medical conditions or disabilities that require medical therapy intervention.
  • The type of therapy delivered under CCP is primarily ongoing and habilitative, rather than shortterm and restorative.
  • The four most common diagnoses are cerebral palsy, failure to thrive, developmental delay, and preterm birth, accounting for approximately 15 percent of the pediatric home health population.
  • ** Many children live for months in the hospital and home care is their only alternative. Many children will outgrow their dependence on full-time medical care but need care for several years. Below are two actual cases of therapy delivered in the home.

**American Academy of Pediatrics

Can medically necessary home care therapy services be denied because the child is receiving services through ECI or SHARS?

  • No. The State may not deny medically necessary services simply because the child receives similar services through ECI or SHARS.
  • The Medicaid act specifically states “Nothing in the SSA shall be construed as prohibiting or restricting or authorizing the secretary to prohibit or restrict, payment under subsection (a) for a medical assistance for covered services furnished to a child with a disability because such services are included in the child’s individualized education program established pursuant to part B of the IDEA or furnished to an infant or toddler with a disability because such services are included in the child’s individualized family service plan adopted pursuant to part C of the Act”.
  • Home health therapy is furnished to correct a child’s medical need vs. SHARS or ECI that addresses a child’s therapy needs as they relate to school.

2“Introduction to Home Health Therapy.” Texas Association for Homecare and Hospice (n.d.): 1-2. TAHC-Issues. Texas Association for Homecare and Hospice, 7 Nov. 2013. Web. 7 Nov. 2013. <http://www.congressweb.com/tahc>.

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