12. Services Covered Under End Stage Renal Disease (ESRD) Program “Services that are covered under the ESRD program and are contained in the composite rate reimbursement methodology, including any service furnished to an ESRD beneficiary that is directly related to that individual’s dialysis, are excluded from coverage under the Medicare home health benefit. However, to the extent a service is not directly related to a patient’s/client’s dialysis, e.g., a nursing visit to furnish wound care for an abandoned shunt site, and other requirements for coverage are met, the visit would be covered. Within these restrictions, beneficiaries may simultaneously receive items and services under the ESRD program at home at the same time as receiving services under the home health benefit not related to ESRD”. – Medicare Benefit Policy Manual 80.5 Case Management The RN is responsible for the case management of the home health patient/client which includes: • Care coordination. • Supervision and management of patient/client care. • Required documentation. • Supervision of the LVN/LPN and home health aide. • Appropriate internal, external, and community referrals. After completing/reviewing a comprehensive assessment, the case manager will make appropriate referrals for other services, including internal (i.e., therapy, social services, or aide), external (i.e., contracted therapy), or community services (i.e., Meals on Wheels) that are needed to meet patient/client needs. An important part of case management is to coordinate care among all disciplines (PT, OT, ST, MSW, and aide) as well as with the physician, the patient/client, the caregiver/family, and other providers involved in the patient/client care. It is critical that frequent communication occur between the LVN/LPN and RN, and that care is provided within the scope of practice defined by the nurse practice act. LVN/LPN supervisory visits must be at least every 60 days at the patient’s/client’s residence. The LVN/LPN does not have to be present. Verbal orders must be signed, timed, and dated by the RN who is providing or supervising the ordered service. Any orders taken by an LVN/LPN must be co-signed by the RN. The RN is responsible for developing and overseeing the Home Health Aide Care Plan. The aide must report any problems to the RN. Home health aide (HHA) supervisory visits must be at least every 14 days at the patient’s/client’s residence. The HHA does not have to be present. Review the following policy and procedure: Online Bookmark Title of Policy Human Resources (HR) Employee Supervision
