Rehab hospitals provide comprehensive, intensive rehabilitation to help patients restore lost function. At a rehab hospital you can expect to have therapy sessions twice per day for a minimum total of three hours per day. Because these facilities are hospitals, they are covered under “hospital benefits” for Medicare and most other insurances. The Center for Medicare and Medicaid Services (CMS) presently requires that 60% of rehab hospital admissions come from 13 different diagnostic categories. Because of this CMS requirement, some patients, who would have gone to a rehab hospital in past years, are now going to nursing homes for their rehabilitation.
Nursing Homes as Rehabs
At one time nursing homes were looked upon as places where old people, who had no family support, went for care until they died. In our lifetime this has changed radically. Due to changes in Medicare regulations, known as the CMS 13, many people find that their insurance will no longer pay for rehabilitation in a Rehab Hospital, but requires them to go to a nursing home for needed inpatient rehabilitation. As a result, nursing homes have been changing to meet this rehab need. Some nursing homes are setting up specific areas within their facilities just for short-term rehab cases. If you are planning for surgery, it is good to ask your surgeon if you are likely to require inpatient rehab post operatively. Since some insurance companies contract with a limited number of nursing homes, it is helpful to contact your insurance company to find out what choice of facilities you have. It is wise to plan ahead and to prioritize your preferences. In the case of a planned surgery, you may be able to schedule an admission to the facility you prefer.
Some helpful questions to ask as you check on nursing homes are:
- Are you “in network” with my insurance?
- How much of my care will be paid for by my insurance? Will I have to pay part of the cost? If so, how much?
- Do you have a separate area for short-term rehab patients?
- How many days of the week do you provide therapy?
- How much therapy can I expect to receive each day?
- What percentage of your short-term rehab cases are discharged to home?
- Will you provide transportation to follow-up visits at my surgeon’s office? Is there a charge for this?
- What discharge planning services are provided?
While hospitals have discharge planners to help you, by being informed and prepared you can help to ensure you receive the best possible rehabilitative care.
Some individuals at home need rehab services. If you can travel to and from the outpatient center, your physician can give you a prescription for outpatient therapy. These centers are normally open five days per week, but not everyone needs to go five days per week. Most insurance will cover a certain number of outpatient therapy visits each year. Outpatient rehab centers can be found by looking under “Rehabilitation Services” or “Physical Therapists” in the yellow pages of your phone book. If you have a Medicare Advantage insurance, or another type of managed care insurance plan, check with your company to see if you need a referral from your primary care physician and if you need to use an in-network therapy provider.
Home Based Rehabilitation
Some individuals at home in need of rehabilitation cannot travel to an outpatient center, and they are what insurance companies call, “homebound.” Home Health agencies have physical, occupational, and speech therapists that can come to your home several times a week. A physician must order the therapy. If you have a Medicare Advantage or managed care insurance, be sure to check if you need a referral from your primary care physician and if you need to use an in-network provider.