A home health aide is a provider who assists a member with non-skilled care to meet activities of daily living, thereby maintaining the individual in his or her home environment. The services of a home health aide are rendered in conjunction with intermittent skilled home health care services provided by a registered or licensed practical nurse, physical therapist, occupational therapist, or speech therapist.

Glossary of Terms

Table: Glossary of Terms Term Definition Home health aide Provider who assists a member with non-skilled care to meet activities of daily living, thereby maintaining the individual in his or her home environment

Scope of Policy

This Clinical Policy Bulletin addresses home health aides.

Medical Necessity

Aetna considers the services of a home health aide medically necessary in selected cases when

both

of the following criteria are met:

The services of a home health aide are rendered in conjunction with intermittent skilled home health care services provided by a licensed practical or registered nurse, occupational therapist, physical therapist, or speech therapist;

and

The services delivered by the home health aide directly support skilled home health care services. These may include:

Assisting with a prescribed exercise regimen;

Assisting with activities of daily living;

Changing non-sterile dressings that do not require the skills of a licensed nurse;

Routine care of prosthetic and orthotic devices;

Supervising the individual's adherence to prescribed, self-administered medication and/or special diets;

Taking blood pressure and other health monitoring activities.

A home health aide is a provider who assists a member with non-skilled care to meet activities of daily living, thereby maintaining the individual in his or her home environment. Generally, the following services are considered

not

medically necessary:

Babysitting services

House cleaning (except for maintaining the member's immediate area)

Transportation.

In Aetna's Beginning Right℠ maternity program, there may be members at risk who require bed rest. In these cases, Aetna may consider home health services medically necessary to help with more routine household chores.