It's important to understand the difference between ‘home health’ and ‘home infusion’

In practice, you may use the terms “home health” and “home infusion” synonymously. However, when it comes to your patients’ benefits with Blue Cross Blue Shield of Michigan and Blue Care Network, these terms have very different meanings and coverage requirements.

Home health care is a benefit for members who have it as part of their plan and meet specific criteria, including being certified by a doctor as non-ambulatory or homebound. This allows them to receive certain services at home as an alternative to long-term hospital care. These services include skilled nursing, physical therapy, speech therapy, nutritional therapy, occupational therapy and social service guidance.

Some services, including the following, aren’t covered under the home health care benefit.

• Custodial care: This service is for patients in nursing homes, hospice or other facility settings who don’t need skilled medical or nursing care. It’s provided by individuals who aren’t required to have special training. Services include assistance with daily living activities, such as bathing, dressing, shopping, cleaning, cooking and laundry.
• Personal care: This is care given by certified home health aides. Services include bathing, dressing or using the bathroom.

Home infusion, a service that our Site of Care Optimization policy refers to, is an alternative to traveling to a hospital outpatient infusion center or physician’s office to receive certain medications from a health care professional. Home infusion services are included under the Blue Cross and BCN medical benefit. There’s no requirement for your patient to be deemed non-ambulatory or homebound to use a contracted home infusion provider.

Home infusion providers use specially trained nurses that travel to your patients’ homes to administer the medications you’ve prescribed. They’ll also monitor patients throughout the infusion process and for an appropriate amount of time after the infusion has been completed. Home infusion is a safe and convenient way to administer prescription medications.

For more information

• Use web-DENIS to determine whether a member has the home health benefit.
• To learn more about the home health benefit or the Site of Care Optimization policy, review our medical policies by using the Medical Policy & Pre-Cert/Pre-Auth Router.
• For information relating to medical drugs included in the Site of Care Program, follow these steps:

For Blue Cross

• From the web-DENIS homepage, click on BCBSM Provider Publications and Resources.
• Click on Newsletters and Resources.
• Click on Forms.
• Click on Physician administered medications

For BCN

• Visit the Medical Benefit Drugs – Pharmacy page in the BCN section of ereferrals.bcbsm.com.
• Under the heading For BCN HMO (commercial) members, click on Requirements for drugs covered under the medical benefit – BCN HMO