SOCIAL SERVICES

 

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 not cover 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.

The role of the medical social worker is to assist the patient to resolve social or

emotional problems that exist or are expected to be an impediment to the

effective treatment of the patient's medical condition or their rate of recovery.