Home Health Medical Social Worker
Medicare
Benefit Policy Manual (CMS Pub. 100-02, Ch. 7, § 50.3)
Home health services provided by Medical Social Workers (MSWs) are covered by Medicare as a dependent service. This means there must first be a "qualifying skilled service" in the home such as intermittent skilled nursing services, physical therapy, speech-language pathology or continuing occupational therapy services. If the qualifications are met, and the beneficiary has an impediment to his or her recovery (think of a roadblock) that takes the skills of a MSW to remove, MSW services would be covered.
The following activities are considered covered medical social services:
- Assessment of the social and emotional factors related to the beneficiary's illness, the need for care, their response to treatment, and adjustment to care
- Assessment of the relationship of the medical and nursing requirements to the home situation, financial resources, and the community resources available
- Services provided on a short-term basis (two to three visits) to a beneficiary's family member or caregiver when it is shown that a brief intervention is necessary to remove a clear and direct impediment to the effective treatment of the beneficiary's medical condition or to the rate of recovery
- Appropriate action to obtain available community resources to assist in resolving the beneficiary's problem
Exception: Medicare does notcover the services of a medical social worker to complete or assist in the completion of an application for Medicaid. Federal regulations require the state to provide assistance in completing the application to anyone who chooses to apply for Medicaid counseling services.
Reviewed: 12.10.21
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