Care at Home, UVM Health - Home Health & Hospice

Home Health & Hospice works with all private insurance companies to achieve the best outcome for your patients. Our insurance specialists work with private insurers on a daily basis and can help answer questions about what services can be covered and what, if any, liability your patient may incur. We will also obtain prior authorization if needed.

Understanding Medicare Coverage for Home Health

 Medicare pays 100% of home health care and services when the patient requires skilled care and is considered homebound. If you have questions about eligibility, we encourage you to contact our Intake and Referral staff at 802-658-1900. We can arrange an evaluation visit with your patient to determine coverage. We will do our best to ensure patients receive the care and services they need. 

What are examples of skilled care?

• Management and assessment of health condition by a registered nurse
• Rehabilitative therapies provided by physical, occupational or speech therapists
• Wound, ostomy, IV, tube feedings and continence care/education
• Social work and an LNA may be provided only when nursing or therapy care is required in the plan of care

What qualifies a person as homebound?

• The patient has a condition due to an illness or injury that restricts the ability to leave home
• Leaving home requires a considerable and a taxing effort
• Absences from the home are infrequent, for relatively short duration or are to receive healthcare treatment

Understanding Medicare Coverage for Hospice

Medicare pays 100% of hospice services provided in a patient’s home when the patient is considered clinically eligible. Hospice patients do not need to be home bound to be considered clinically eligible for hospice care. Eligibility for hospice care is dependent upon two factors:

1. Certification of Illness

A person is eligible for hospice if they have been diagnosed with a terminal illness and given a life expectancy of six months or less if the disease runs its expected course. The hospice medical director must agree with the doctor’s assessment.

2. Focus on Comfort Rather than Cure

The terminally ill person seeking hospice care or their representative must provide consent in writing that it is their intention to seek palliative care instead of curative care.

Hospice Care at the McClure Miller Respite House

Very short term stays at the McClure Miller Respite House for acute symptom management or a limited stay for caregiver respite are included in the Medicare Hospice Benefit; eligibility is determined on a case-by-case basis as part of a patient’s Hospice Plan of Care.

The Medicare Hospice Benefit does not include facility “room and board,” or residency fees for patients who choose to receive their routine hospice care in a setting other than a private residence. Receiving your hospice care at the McClure Miller Respite House may be subject to daily residency fees. Residency fees are determined on sliding scale, and financial aid is available. The McClure Miller Respite House accepts Medicaid Long Term Care, commercial insurance as applicable and private pay for residency.