Missouri Department of Health and Senior Services



|The 3 Types of Care in the Home |

|A company may have one or all of these types of programs. |

|#1 |#2 |#3 |

|Commonly Called: |Commonly Called: |Commonly Called: |

|Home Health |In-Home Care |Private Duty/Private Pay |

| | | |

|Major Payer: Medicare |Major Payer: Medicaid |Major Payer: Private Fund/Insurance |

| | | |

|Services Offered: |Services Offered: |Services Offered: |

|¬ Skilled Nursing |¬ Homemaker Chore Services |¬ Provides only 1 Service |

|¬ Physical Therapy |( cleaning, cooking, laundry) |(could be nursing or aide services for personal |

|¬ Occupational Therapy |¬ Personal Care Assistance |care) |

|¬ Speech Therapy |(bathing & grooming) |¬ Provides care in Shifts (4 plus hours at a |

|¬ Medical Social Services |¬ Respite Care (caregiver relief) |time, may offer both nursing & personal care in |

|(social worker) |¬ Advance Personal Care |shifts) |

|¬ Home Health Aide- personal care |( assist with activities of daily living when assistance requires |¬ Provides Staffing (supplies |

|(bathing, dressing, hair & nail care) |devices and procedures |nurses to hospitals, etc.) |

|Not homemaker/companion care |related to altered body functions) | |

| |¬ Authorized Nurse Visits |Consumer Needs: |

|Consumer Needs: |(i.e., RN fill medicine box) |¬ No limit on amount or duration of time in the |

|¬ Short-term |¬ Adult Day Care |home (determined by the patient and/or family) |

|(usually several weeks to months) |¬ Consumer Directed |¬ No criteria needed to obtain care (determined |

|¬ Acute needs (exacerbation of illness) (care after |(Independent Living Waiver- |by patient and/or family needs) |

|surgery) |specialized medical equipment, supplies, environmental |¬ No Physician order needed |

|¬ Medicare Patient is homebound |accessibility adaptations) |for aide giving personal care , respite or |

|(for duration of care ) | |companion care |

|¬ Services ordered by Physician |Consumer Needs: | |

|¬ Part-time or Intermittent basis (visits may last |¬ Long-term (usually months to years) |Agency Criteria: |

|1-2 hours) (could be several times a week) |¬ Chronic needs |¬ NO license issued in MO for this type of |

| |(assistance needed to stay in the home) (help with activities of |company |

|Agency Criteria: |daily living) |¬ Examples follow why/ when care does not meet |

|¬ Provides two or more of the 6 services listed |¬ Services ordered by physician |the Missouri requirement for licensure |

|above | |¬ 1. Company only provides 1 service |

|¬ One service must be skilled nursing |Agency Criteria: |¬ 2. Company does supply nurse and aide (2 |

|¬ Visits must be on intermittent basis (several |¬ Provides home & community based services |services), but they do shift work of 4 plus hours|

|times a week 1-2 hours) |to elderly & disabled who meet Nursing Home Level of Care & are |¬ 3. Company provides 2 or |

|¬ Follows federal & state regulations |eligible for Medicaid |more services, (personal care, chore services & |

|¬ Requires a state home health license |¬ Follows state regulations |respite care) but only one service (aide) from |

|¬ Most likely also Medicare |¬ Requires a contract with the state |the “Home Health” list |

|Certified | | |

| |To request services - DSDS Call Center at |Oversight: |

|Oversight: |866/835/3505 |No government oversight. |

|MO Department of Health and Senior Services/Bureau of | |If company provides nursing, register complaint |

|Home Care and Rehabilitative Standards is responsible |To Report Abuse/Neglect call 800/392/0210 |with |

|for licensure and oversight. | |Missouri State Board of Nursing at |

|Telephone for questions 573/751-6336 |To request a care plan or provider change | |

| | |

| | |Issues with fraud, contact the MO Attorney |

|To voice a complaint call 800/392/0210 |Oversight: |General's Office through the (Consumer Hotline at|

| |Missouri Medicaid Audit and Compliance (MMAC) |800/392-8222.) |

| |573/751-3399 | |

| |Questions on opening an in-home /CDS agency or regarding | |

| |in-home/CDS contract) mmac.ihscontracts@dss. | |

| |IHS/CDS Proposal/Provider Enrollment Information: | |

| | | |

| |enrollment/home-and-community-based- | |

| |services/contract-proposal-information/ | |

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download