WC Funding Flashcards
Medicare: ___ Funding
Medicaid: ___ Funding
Federal
State
Medicare Eligibility
65+ years old
At least 2 years with medically diagnosed disability
WC Referral Documentation: Medicare
1st time purchased vs modification / upgrade (N/A for equipment NOT purchased by Medicare)
Manual vs. Power (must rule out lower level equipment before qualifying for a power chair - starting with cane / walker)
Change (decline or increase) of function (less than 5 years): needs new diagnosis and MD documentation
What is required for the patient to receive ANY equipment under Medicare?
Referral / order
Face-to-face physician eval
Under Medicare, a rental WC becomes a purchase WC after ___ months. What does this mean?
13
Funding source will not purchase another chair for 5 years unless there is a change in the patient’s functional / medical status
Medicaid Eligibility
Can apply as soon as you get disabled (retroactive)
Income ~23,265.00/year (before taxes)
$2,000 or less total resources (bank account, retirement, etc.)
1 car only allowed
Lose benefit when they start working and making >902.00/month
Medicaid WC Documentation
Title XIX - functions as prescription (vendors responsibility)
THSteps-CCP/Home Health - letter of justification for purchase equipment (manual and power WC) only
Medicaid as co-pay (will pay what Medicare doesn’t cover after deeming equipment medically necessary)
WC Modification: Medicaid
May be made if a change occurs in patient’s needs / capabilities / physical, mental status that cannot be anticipated
Document all projected changes in client’s mobility needs / age of current equipment / cost of purchasing new equipment vs. modifying current equipment
WC Adjustment / Repair: Medicaid
Adjustments may be authorized when the equipment is no longer under warranty
Repairs may be authorized (rentals payable during period of repair / rental equipment maintenance is provider’s responsibility)
Medicaid will pay for a rental WC up to ___ months. What about after that?
6
If patient requires it >6 months, refer to seating clinic to complete a seating evaluation for custom WC and seating system
Comprehensive Rehabilitation Services (CRS)
Last resort for funding / client must exhaust all personal medical benefit first
Client w/ traumatic BI or SCI (THHS defines traumatic as a result of external physical force - fall / assault / violence / car accident + sports injury)
CRS Qualifications
Have TBI / SCI caused by external physical force which significantly affect ability to function within home or community in terms of self care, function, mobility
Be at least 15 years of age
Be US citizen or lawful permanent resident / Texas resident
Be willing to participate in services
Be medically stable to participate in rehabilitation
Worker’s Compensation
Medical benefits to employees injured in the course of employment
Benefits vary based on size of company
