since they must be provided by the state agency free of charge, and hence the patient/client has no obligation to pay for such assistance. Example 7: A physician has ordered medical social services for an insulin dependent diabetic whose blood sugar is elevated because she has run out of syringes and missed her insulin dose for two days. Upon making the assessment visit, the medical social worker learns that the patient’s/client’s daughter, who is also an insulin dependent diabetic, has come to live with the patient/client because she is out of work. The daughter is now financially dependent on the patient/client for all of her financial needs and has been using the patient’s/client’s insulin syringes. The social worker assesses the patient’s/client’s financial resources and determines that they are adequate to support the patient/client and meet her own medical needs but are not sufficient to support the daughter. She also counsels the daughter and helps her access community resources. These visits would be covered, but only to the extent that the services are necessary to prevent interference with the patient’s/client’s treatment plan. Example 8: A wife is caring for her husband who is an Alzheimer’s patient/client. The nurse learns that the wife has not been giving the patient/client his medication correctly and seems distracted and forgetful about various aspects of the patient’s/client’s care. In a conversation with the nurse, the wife relates that she is feeling depressed and overwhelmed by the patient’s/client’s illness. The nurse contacts the patient’s/client’s physician who orders a social work evaluation. In the social worker’s assessment visit, the social worker learns that the patient’s/client’s wife is so distraught over her situation that she cannot provide adequate care to the patient/client. While there, the social worker counsels the wife and assists her with referrals to a support group and her private physician for evaluation of her depression. The services would be covered. Example 9: The parent of a dependent disabled child has been discharged from the hospital following a hip replacement. Although arrangements for care of the disabled child during the hospitalization were made, the child has returned to the home. During a visit to the patient/client, the nurse observes that the patient is transferring the child from bed to a wheelchair. In an effort to avoid impeding the patient’s/client’s recovery, the nurse contacts the patient’s/client’s physician to order a visit by a social worker to mobilize family members or otherwise arrange for temporary care of the disabled child. The services would be covered. Social Worker Requirements The Medicare Conditions of Participation (CoP) require medical social workers in home care to have a Master of Social Work degree and one year of healthcare experience. Social worker assistants should have a Bachelor of Social Work degree, one year of healthcare experience, and must be supervised by an LMSW.
