Download CUSTODIAL CARE ADM1001.014 - Blue Cross and Blue Shield of

CUSTODIAL CARE
ADM1001.014
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COVERAGE:
Custodial Care defined as care which does not require the continuous
services of skilled or trained medical, paramedical, or allied health
professional personnel is not a covered benefit by most health care
contracts as these services are generally nonmedical in nature.
Medically necessary care provided by a physician or other qualified
health care professional to a patient in a custodial care facility is
eligible for coverage.
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DESCRIPTION:
Custodial Care means care which does not require the continuous
services of skilled or trained medical, paramedical, or allied health
professional personnel.
Essentially custodial care is designed to assist patients in meeting
the activities of daily living and to maintain life and/or comfort
with no reasonable expectation of cure or improvement of sickness or
injury. Examples of custodial care include, but are not limited to:
•
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Help in walking or getting in or out of bed;
Assistance in bathing, dressing, feeding, and using toilet
facilities;
• Preparation of diets and nutritional supplements,
• Supervision over medication preparation and administration and
treatments that are self administered;
• Provision of socially necessary services such as room and board; or
• Services as a result of court-ordered confinements, during which the
patient’s ongoing medical treatment is continued but is secondary to
the court ordered confinement.
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RATIONALE
None
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DISCLAIMER
State and federal law, as well as contract language, including
definitions and specific inclusions/exclusions, takes precedence over
Medical Policy and must be considered first in determining coverage.
The member’s contract benefits in effect on the date that services are
rendered must be used. Any benefits are subject to the payment of
premiums for the date on which services are rendered. Medical
technology is constantly evolving, and we reserve the right to review
and update Medical Policy periodically.
HMO Blue Texas physicians who are contracted/affiliated with a
capitated IPA/medical group must contact the IPA/medical group for
information regarding HMO claims/reimbursement information and other
general polices and procedures.
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Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company*
Southwest Texas HMO, Inc.* d/b/a HMO Blue Texas
* Independent Licensees of the Blue Cross and Blue Shield Association
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Posted Jan. 7, 2003