Will Medicare pay for IV antibiotics with a PICC line for my mom in an Assisted Living facility?


She is currently in the rehab section in the same facility and they say she must stay there until her 100 days are up and then private pay. There is no other reason for her to have skilled care except for PT which she can continue on an in-home basis or out-patient going down the hall to the same PT room.

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Current Medicare Coverage Policies
Private insurers and major Medicare Advantage health plans (Medicare Part C) currently recognize that home infusion therapy is a
cost-effective, clinically effective treatment option and provide comprehensive coverage of this therapy. In contrast, the Medicare
fee-for-service program is the only major health program in the country that does not provide meaningful coverage of infusion therapy
in a patient’s home. Rather, Medicare Parts A, B and D provide inadequate, piecemeal coverage of elements of infusion therapy administered
in a patient’s home.
Most infusion drugs are covered by Medicare Part D. Medicare Part D reimburses providers for the drugs and a retail-based dispensing
fee, which falls short of covering the costs associated with the safe provision of home infusion drugs. Importantly, Medicare
Part D does not cover the specialized infusion-related services, equipment and supplies, and it is for this reason that most Medicare
beneficiaries do not have access to infusion drugs in the home, despite that the drugs are in fact covered in that setting.
Medicare Part B provides coverage under the durable medical equipment benefit for a limited number of drugs that are administered
using a mechanical or electronic external infusion pump. Unfortunately, only a few drugs are covered under this benefit, such as some
anti-viral drugs, chemotherapy drugs, inotropic therapies, pain management drugs, and immune globulin administered subcutaneously.
The home nursing visits for the small number of beneficiaries receiving home infusion therapy may be covered by the Medicare Part
A home health benefit if the beneficiary meets the applicable criteria, i.e., is homebound and is in need of intermittent home nursing
services. Some Medicare fee-for-service beneficiaries who do not qualify for the Medicare home health benefit may have other insurance
that covers some of the costs of home infusion that are not reimbursed by Medicare.
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Just as she is eligible to receive PT in a homecare environment, she can recieve homecare for her IV antibiotics. There are two things that have to happen: 1. you would have to have the antibiotics administered at times when a homecare nurse can home to her apartment (inthe AL) and 2. You would have to make sure that it is a type B assisted living and they will allow her to have her therapy there through a homecare agency. As long as she is not a threat to herself or othes and she is in the proper type of facility and the care is being provided by a homecare agency, then I suggest that you talk to the Assisted Living Director of Wellness for consideration of the arrangment.
Helpful Answer (2)

Yes, Medicare will pay for the IV antibiotics, but are you asking about whether Medicare will pay for your mom to live in AL while receiving IV antibiotics? Probably not. I don't know what state you're in (or even if it varies state to state), but the ALs I'm familiar with won't administer IV antibiotics to a resident. You'd have to have skilled nursing do it. Maybe your mom could go "home" to the AL or IL portion of the community and then have a visiting nurse administer the IVs. Maybe Medicare would pay for some or all of an arrangement like that. It depends though on whether she needs 24/7 nursing care while she's receiving the IVs.
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If a patient in an Assisted Living facility needs IV antibiotics, then the staff will transfer the pateint to a hospital. Yes, Medicare should pay for the IV's.
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If she has a PICC Line they will pay for all the meds. and nursing services at home.
Helpful Answer (2)

antibiotics are a medication, so if her other medications are being covered by Medicare Part D, then the antibiotics should be covered also.
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