Home hemo reimbursement

I am a RN. I assist my father with home hemo three times per week. Will insurance pay for someone to come into the home if I am not available? He has Keystone 65 and is a Veteran. We live in PA.

Medicare does not pay for someone to do dialysis for a home patient. I found the Keystone 65 booklet online and this is what it says it covers – it doesn’t list a nurse or technician to do the dialysis:

Renal dialysis (Kidney)
• Outpatient dialysis services (including dialysis services when temporarily out of the service area, as explained in Sections 2 and 3).
• Inpatient dialysis treatments (if you are admitted to a hospital for special care).
• Self-dialysis training (includes training for you and for the person helping you with your home dialysis treatments).
• Home dialysis equipment and supplies.
• Certain home support services (such as, when necessary, visits by trained dialysis workers to check on your home dialysis, to help in emergencies when needed, and to check your dialysis equipment and water supply).

Source: http://www.site65.com/members/pdfs/k65_eoc.pdf

According to the VA manual:

[i]d. Home Dialysis Attendants. VA provides instruction, and may provide financial support for home dialysis attendants during the instruction period. Such support can be provided either by appointment of the attendant as a “without compensation employee” for the training period, with payment for travel and per diem during the training period, or by use of a contract with the person to be trained.
(1) VA does not encourage the use of paid home dialysis attendants in lieu of family members. However, under extraordinary circumstances, such as when a family member is not available to assist with dialysis care, use of such an attendant may be the most satisfactory alternative for the patient, and preferable to other alternatives from a cost effectiveness standpoint.
(2) In such cases, VA will continue to exercise overall professional responsibility for the patient’s care, including assessing the performance capability of the proposed attendant, and periodically monitoring and evaluating the actual performance of the home dialysis attendant.
(3) The VA patient and potential dialysis attendant should be informed that VA does not assume responsibility for the performance of the dialysis attendant or for any untoward effect (such as hepatitis) that the attendants may develop.
(a) The use of a formal agreement for the functioning of the dialysis attendant is encouraged.
(b) The patient and VA-trained attendant might properly be parties to such agreement, which should include:

  1. Provision for listing the risks to the patient entailed in dialysis,
  2. The responsibilities of the attendant, and
  3. The fact that the attendant is not considered to function as an employee of VA.
    NOTE: The Office of District Counsel is available to assist in drafting such agreements.
    (4) Dialysis attendants may be recruited directly by the patient, with assistance of the Dialysis Unit, or existing community resources may be utilized.[/i]

Source: http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=834 (page 8-7)

I’d suggest you talk with the VA. If he has a service connected disability they may be able to help.

If the VA can’t help, most people on home dialysis do backup dialysis in a dialysis clinic if their dialysis partner is gone or ill. Some hire a nurse or technician to do the home dialysis if they can afford to pay them. Clinics that train people for home dialysis have to be willing to back up someone with temporary in-center dialysis as part of their Medicare certification.

Thank you Beth for the information and links. DaVita and this web page have been so helpful. Keep up the good work. Thank you again.