medical social services after the Agency indicated to the physician that the home was not well cared for, the patient/client appeared to be neglected much of the time, and the relationship between the patient/client and family was very poor. The physician and the Agency were concerned that social problems created by family caregivers were impeding the treatment of the recurring infections and ulcers. The assessment and follow-up for counseling both the patient/client and the family by a medical social worker were reasonable and necessary. Example 3: A physician is aware that a patient/client with atherosclerosis and hypertension is not taking medications as ordered and adhering to dietary restrictions because he is unable to afford the medication and is unable to cook. The physician orders several visits by a medical social worker to assist in resolving these problems. The visits by the medical social worker to review the patient’s/client’s financial status, discuss options, and make appropriate contacts with social services agencies or other community resources to arrange for medications and meals would be a reasonable and necessary medical social service. Example 4: A physician has ordered counseling by a medical social worker for a patient/client with cirrhosis of the liver who has recently been discharged from a 28 day inpatient alcohol treatment program to her home which she shares with an alcoholic and neglectful adult child. The physician has ordered counseling several times per week to assist the patient/client in remaining free of alcohol and in dealing with the adult child. The services of the medical social worker would be covered until the patient’s/client’s social situation ceased to impact on her recovery and/or treatment. Example 5: A physician has ordered medical social services for a patient/client who is worried about his financial arrangements and payment for medical care. The services ordered are to arrange Medicaid if possible and resolve unpaid medical bills. There is no evidence that the patient’s/client’s concerns are adversely impacting recovery or treatment of his illness or injury. Medical social services cannot be covered. Example 6: A physician has ordered medical social services for a patient/client of extremely limited income who has incurred large unpaid hospital and other medical bills following a significant illness. The patient’s/client’s recovery is adversely affected because the patient/client is not maintaining a proper therapeutic diet, and cannot leave the home to acquire the medication necessary to treat their illness. The medical social worker reviews the patient’s/client’s financial status, arranges meal service to resolve the dietary problem, arranges for home delivered medications, gathers the information necessary for application to Medicaid to acquire coverage for the medications the patient/client needs, files the application on behalf of the patient/client, and follows-up repeatedly with the Medicaid state agency. The medical social services that are necessary to review the financial status of the patient/client, arrange for meal service and delivery of medications to the home, and arrange for the Medicaid state agency to assist the patient/client with the application for Medicaid are covered. The services related to the assistance in filing the application for Medicaid and the follow-up on the application are not covered
