1. How does the managed-care organization check accreditation of home health-care providers? Federal and state rules that govern care in nursing homes don’t apply in private homes. The Joint Commission on Accreditation of Healthcare Organizations based in Oakbrook Terrace, Illinois (www. jcaho.org) accredits home health-care providers, but accreditation is voluntary. Many managed-care organizations are now pressuring home health-care providers to provide accreditation and other credentials.
2. What home health-care services are provided?
Many policies cover skilled nursing care. Find out if your policy also covers such services as physical, occupational, speech and respiratory therapies, home-health aides, and such medical equipment as wheelchairs, adjustable beds and traction devices.
3. Are there limits to the amount of services a patient can receive?
Some policies have dollar limits per episode or per year.
4. What are the grievance procedures?
Representatives of the organization should provide satisfactory responses to patients and patient advocates concerning coverage of home health-care services.