HealthTeam Advantage debuted a new benefit—Custodial Care—for 2021. Custodial care is a service to support a safe and smooth transition of the member to their home following an acute care hospital inpatient or observation stay, inpatient rehab, or skilled nursing facility inpatient stay.
The benefit includes activities of daily living support such as dressing and bathing, light housework, and medication assistance. They must be performed by a professional agency (licensed or certified home care or home health provider). The services must be initiated within 30 days of discharge.
Unlike the home health benefit, members are not required to be homebound to take advantage of custodial care. They can use both benefits concurrently, but both require separate authorization requests. There’s a 90-day window for use of the 20 custodial care hours. Authorization requests must be submitted within seven days of the start and retro authorizations are not allowed.
The benefit is for a max of 20 hours per discharge (can be requested for three separate discharges for a total of 60 hours per calendar year). Unused hours cannot be used for another discharge or roll over to the next year. There is a $0 copay to members for this service in-network and $30 for out-of-network.
HealthTeam Advantage is the only plan in the area that covers custodial care. We hope you’ll encourage your patients to take advantage of it and make the most of their benefits.
Click here for more information about the custodial care benefit, billing codes, claims submission procedures, and more.