Eli's Rehab Report

Published on Thu Oct 25, 2012 PDF

Question: Can I provide services to a patient who attends an adult day care center? What if the center provides medical care?

Answer: The Medicare Benefit Policy explains that "an adult day care center must be either licensed or certified by the State or accredited by a private accrediting body" for home care coverage, Home Health & Hospice Medicare Administrative Contractor NHIC clarified in its Aug. 15 Ask the Contractor Teleconference (ACT). "If the day care center the patient attends is indeed licensed or certified by the state or accredited by a private accrediting body, then the patient could be considered homebound," the MAC says in a question-and-answer set.

But remember: "If records are requested, you must include documentation that the agency meets the above requirement," NHIC says of the state licensure/certification or accreditation rule.

A day care center won't be able to obtain separate payment for therapy furnished there, NHIC explained in another Q&A from the ACT. That's because all outpatient therapy services are bundled into the home health episode payment. The day care may provide therapy under arrangement with the HHA, though.

As for nursing, "if the day care center has a nurse available, that would not disqualify the patient from home health services," NHIC says. "It is acceptable for the patients to receive medical care at adult day care centers."