Medicare Home Health Agencies and Medical Social Services (MSS)

Let’s talk about the role of the medical social worker in the home health setting. In these tougher economic times, are agencies seeing a growing need for MSS? Have social and emotional factors risen? What MSS skills are necessary to best serve the patient? How can the MSS best assist your agency?

The patient Plan of Care must identify the skilled services needed that will be provided by MSS. Under the Medicare Home Health Benefit 42 CFR 409.45(c), Medicare Benefit Policy Manual Chapter 7, Section 50.3, and Medicare Conditions of Participation 42 CFR 484.34 Publication 100-07, Appendix B, Medical Social Services is described as a dependent service that is only covered in a certified home health agency when the patient is already ordered and receiving skilled nursing, physical therapy, occupational services, or speech/language therapy. Think of Medical Social Worker as providing services that will provide intervention or resolution of emotional or social issues that might impact unfavorably on the patient’s recovery. Agencies are citing increasing patient challenges in a struggling economy especially with the housing challenges that are so prevalent. If you believe those issues could impede progress in care outcomes, then MSS should be considered.

The frequency and duration of the services are necessary to be quantified just as with other skilled services and the delineated services must be provided by a Masters or Bachelors prepared social worker. The MSW is also required to have one year of social work experience in a health care setting prior to working in home health care. The Social Work Assistant must have a bachelor degree in social work, psychology, or sociology. The bachelor prepared assistant works under supervision of the MSW in accordance with the patient Plan of Care.

The Assessment and MSS

The MSS assessment of the patient is completed by the Masters prepared social worker (MSW). Medical Social Services works with the patient and family to use community resources, provides short-term intervention skills, assists to design a plan of care to deal with chronic conditions such as Alzheimer’s disease. Additionally, as with other skilled services, medical social services are supported by OASIS answers:

  • M1018 identifies medical condition change

Are the patient and caregiver coping with the change of condition?

  • M1022-24 sequences diagnoses
  • M1032 states risk for hospitalization

Is there emotional, social, or financial risks that necessitate MSS intervention?

  • M1034  cites overall status
  • Look at reduced functional status
  • Identify any medication issues
  • M1100 looks at patient living situation

Is the living situation impeding patient progress?

  • Look at the safety evaluation

Is the patient at risk for abuse? Is there risk for emotional issue exacerbation?

  • M2100 sources and types of assistance

Medical Social Services and the Challenges in Home Health

Involving MSS can assist to reduce the hospital readmission and assist the patient with a positive adjustment to the home health experience. Medical Social Services can provide family and caregiver support services. The MSS can facilitate access to needed medications, supplies, and DME, as well as aiding in removing barriers to transportation access.

The MSS can assist with case coordination with all disciplines addressing social and environmental factors while skilled nursing addresses the medical and nursing factors. The MSS can document patient and family challenges so the physician has a better “view” of how the patient interacts with their home environment.

The social worker can assist the family with referral services and act as a liaison for that care. The MSS can provide patient counseling. Brief Counseling or Cognitive Restructuring Therapy may be needed for the depressed patient. The MSS can liaison at both the macro and micro patient care level; addressing patient specific needs.  Medical Social Services can add value and positive customer satisfaction. Think patient satisfaction calls. A strong social work program can aid in reducing the number of clinical visits needed, improve customer relations, support team members, and increase referrals to your agency. This is usually an under-utilized valuable service benefiting patients, employees, and the agency.