Consumer Resources

What Are my Rights as a Patient?

Federal law requires that all individuals receiving home care services be informed of their rights as a patient. Following is a model patient bill of rights the National Association for Home Care (NAHC) has developed, based on the patient rights currently enforced by law.

Home care patients have the right to:

  • be fully informed of all his or her rights and responsibilities by the home care agency;
  • choose care providers;
  • appropriate and professional care in accordance with physician orders;
  • receive a timely response from the agency to his or her request for service;
  • be admitted for service only if the agency has the ability to provide safe, professional care at the level of intensity needed;
  • receive reasonable continuity of care;
  • receive information necessary to give informed consent prior to the start of any treatment or procedure;
  • be advised of any change in the plan of care, before the change is made;
  • refuse treatment within the confines of the law and to be informed of the consequences of his or her action;
  • be informed of his or her rights under state law to formulate advanced directives;
  • have health care providers comply with advance directives in accordance with state law requirements;
  • be informed within reasonable time of anticipated termination of service or plans for transfer to another agency;
  • be fully informed of agency policies and charges for services, including eligibility for third-party reimbursements;
  • be referred elsewhere, if denied service solely on his or her inability to pay;
  • voice grievances and suggest changes in service or staff without fear of restraint or discrimination;
  • a fair hearing for any individual to whom any service has been denied, reduced, or terminated, or who is otherwise aggrieved by agency action. The fair hearing procedure shall be set forth by each agency as appropriate to the unique patient situation (i.e., funding source, level of care, diagnosis);
  • be informed of what to do in the event of an emergency; and
  • be advised of the telephone number and hours of operation of the state’s home health hot line, which receives questions and complaints about Medicare-certified and state-licensed home care agencies.
  • NAHC’s affiliate, the Hospice Association of America, has developed the following model bill of rights for all individuals receiving hospice care. It also is based on the patient rights currently enforced by law.

Hospice patients have the right to:

  • receive care of the highest quality;
  • have relationships with hospice organizations that are based on ethical standards of conduct, honesty, dignity, and respect;
  • in general, be admitted by a hospice organization only if it is assured that all necessary palliative and supportive services will be provided to promote the physical, psychological, social, and spiritual well-being of the dying patient. However, an organization with less than optimal resources may admit the patient if a more appropriate hospice organization is not available, but only after fully informing the client of its limitations and the lack of suitable alternative arrangements;
  • be notified in writing of their rights and obligations before their hospice care begins. Consistent with state laws, the patient’s family or guardian may exercise the patient’s rights when the patient is unable to do so. Hospice organizations have an obligation to protect and promote the rights of their patients;
  • be notified in writing of the care the hospice organization will furnish, the types of caregivers who will furnish the care, and the frequency of the services that are proposed to be furnished;
  • be advised of any change in the plan of care before the change is made;
  • participate in the planning of the care and in planning changes in the care, and to be advised that they have the right to do so;
  • refuse services and to be advised of the consequences of refusing care;
  • request a change in caregiver without fear of reprisal or discrimination;
  • confidentiality with regard to information about their health, social, and financial circumstances and about what takes place in the home;
  • expect the hospice organization to release information only as consistent with its internal policy, required by law, or authorized by the client;
  • be informed of the extent to which payment may be expected from Medicare, Medicaid, or any other payor known to the hospice organization;
  • be informed of any charges that will not be covered by Medicare, and the charges for which he or she may be liable;
  • receive this information orally and in writing within 15 working days of the date the hospice organization becomes aware of any changes in charges;
  • have access, on request, to all bills for service the patient has received regardless of whether they are paid out of pocket or by another party;
  • be informed of the hospice’s ownership status and its affiliation with any entities to whom the patient is referred;
  • be informed of the procedure they can follow to lodge complaints with the hospice organization about the care that is, or fails to be, furnished, and regarding a lack of respect for property;
  • know about the disposition of such complaints;
  • voice grievances without fear of discrimination or reprisal for having done so; and
  • be told what to do in the case of an emergency.

How Do I Select the Right Home Care Provider?

  • Once you acquire the names of several providers, you will want to learn more about their services and reputations. Following is a checklist of questions to ask providers and other individuals who may know about the provider’s track record. Their insight will help you determine which provider is best for you or your loved one.
  • How long has this provider been serving the community?
  • Does this provider supply literature explaining its services, eligibility requirements, fees, and funding sources? Many providers furnish patients with a detailed “Patient Bill of Rights” that outlines the rights and responsibilities of the providers, patients, and caregivers alike. An annual report and other educational materials also can provide helpful information about the provider.
  • How does this provider select and train its employees? Does it protect its workers with written personnel policies, benefits packages, and malpractice insurance?
  • Are nurses or therapists required to evaluate the patient’s home care needs? If so, what does this entail? Do they consult the patient’s physicians and family members?
  • Does this provider include the patient and his or her family members in developing the plan of care? Are they involved in making care plan changes?
  • Is the patient’s course of treatment documented, detailing the specific tasks to be carried out by each professional caregiver? Does the patient and his or her family receive a copy of this plan, and do the caregivers update it as changes occur? Does this provider take time to educate family members on the care being administered to the patient?
  • Does this provider assign supervisors to oversee the quality of care patients are receiving in their homes? If so, how often do these individuals make visits? Who can the patient and his or her family members call with questions or complaints? How does the agency follow up on and resolve problems?
  • What are the financial procedures of this provider? Does the provider furnish written statements explaining all of the costs and payment plan options associated with home care?
  • What procedures does this provider have in place to handle emergencies? Are its caregivers available 24 hours a day, seven days a week?
  • How does this provider ensure patient confidentiality?
  • In addition, ask the home care provider to supply you with a list of references, such as doctors, discharge planners, patients or their family members, and community leaders who are familiar with the provider’s quality of service.
  • Contact each reference and ask:
  • Do you frequently refer clients to this provider?
  • Do you have a contractual relationship with this provider? If so, do you require the provider to meet special standards for quality care?
  • What sort of feedback have you gotten from patients receiving care from this provider, either on an informal basis or through a formal satisfaction survey?
  • Do you know of any clients this provider has treated whose cases are similar to mine or my loved one’s? If so, can you put me in touch with these individuals?

Primary Accrediting Agencies

Accreditation Commission for Health Care, Inc.
919/872-8609

Community Health Accreditation Program
212/363-5555 or 800/669-1656, ext. 242

Joint Commission on Accreditation of Healthcare Organizations
630/792-5000

What Are The Standard Billing and Payment Practices?

When services are covered by Medicare and/or Medicaid, home care providers must bill their fees directly to the payor to Medicare or Medicaid. Providers often will bill other third-party payors directly as well. Any uncovered costs are later billed to the client. However, if a client receives services from a registry or independent provider, he or she must pay the provider directly. Later the client may file for reimbursement from the insurance company if the services qualify as covered benefits. Payment options are detailed below.

Home Health Agencies

Medicare, Medicaid, and most private insurance plans pay for services that home health agencies deliver. Payment from these sources depends on whether the care is medically necessary and the individual meets specific coverage criteria. Individuals may opt to pay out of pocket for services that are not covered by other sources. Some agencies receive special funding from state and local governments and community organizations to cover the costs of needed care when other options are not available.

Hospices

Coverage for hospice care is available through Medicare, Medicaid programs in 38 states, and most private insurance plans. If insurance coverage is insufficient or unavailable, the patient and his or her family may pay for services out of pocket. Most hospices may provide free services to individuals who have limited or no financial resources.

Homemaker and Home Care Aide Agencies

Individual consumers usually pay for services from homemaker and HCA agencies. However, some states contract with these agencies to deliver personal care and homemaker services within their social services and medical assistance programs. On rare occasions, commercial insurers may pay for a portion or all of the costs of these services. Some agencies draw assistance from charitable community funds when other sources of payment are not available.

Staffing and Private-duty Agencies

Typically, the individual or his or her commercial insurance carrier pays for services provided by staffing and private-duty agencies, provided that the insurance policy’s coverage requirements are met. Some staffing agencies contract with state Medicaid programs to provide nursing and personal care services.

Pharmaceutical and Infusion Therapy Companies

Pharmaceutical and infusion therapy supplies and services are almost always paid for by commercial insurance companies and Medicaid. Medicare covers the cost of nutritional supplements and certain medications when the situation meets strict coverage criteria.

Durable Medical Equipment and Supply Dealers

Fees for durable medical equipment and supplies are usually covered by Medicare, Medicaid, and commercial insurance programs, provided that the products are ordered by a physician and are medically necessary to treat an illness or injury.

Registries

The individual client generally pays for registry services. In some cases, commercial insurance companies may reimburse a portion or all of these costs.

Independent Providers

Usually the individual pays for services rendered by independent providers. Some commercial insurance policies will provide reimbursement if the services qualify as covered benefits