According to the National Association for Home Care and Hospice, home care began in the US in the 1880’s. Approximately 12 million individuals currently receive care from more than 33,000 providers. In 2009, annual expenditures for home health care were projected to be $72.2 billion.
Some of these organizations are Medicare certified, which allows providers to bill Medicare for reimbursement.
Non-certified home care agencies, home care aide organizations, and hospices that remain outside of Medicare do so for a variety of reasons. Often they do not provide the breadth of services that Medicare requires, such as skilled nursing care.
Medicare is the largest single payer of home health care services. In 2009, Medicare spending accounted for approximately 41 percent of home health expenditures.
Medicaid payments for home care are divided into three main categories: the mandatory traditional home health benefit, and two optional programs, the personal care option and home and community-based waivers.
Together, these three home care service categories represent a relatively small but growing portion of total Medicaid payments.
Health care services in the United States are increasingly financed through managed care organizations. Managed care organizations, including health maintenance organizations (HMOs), typically finance health care services through a negotiated, prepaid rate to health care providers.
Formal caregivers include professionals and paraprofessionals who are compensated to provide in-home health care and personal care services.
Home care is a cost-effective service for individuals recuperating from a hospital stay and for those who, because of a functional or cognitive disability, are unable to take care of themselves. Home care reinforces and supplements care provided by family members and friends and maintain the recipient’s dignity and independence. Patients who received home care services were also less likely to be readmitted for hospital care.
In 2011 the industry faced a new challenge. Medicare beneficiaries are required to see a doctor 90 days before or 30 days after starting home health services in order for the home health agency to get reimbursed. Under the old law, a doctor could prescribe home health care for patients to receive services, but the physician didn't have to see a patient to make that determination.
Under the new rule, doctors have to fill out a form certifying that they or another health care provider such as a nurse practitioner had seen a patient for the specific purpose of determining the patient's need for home care. This is in addition to doctors' current duties of prescribing home health care and signing off on a care plan, which is typically developed by the home health agency.