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HealthPartners

Coverage criteria policies

Maintenance care

These services may or may not be covered by your HealthPartners plan. Please see your plan documents for your specific coverage information. If there is a difference between this general information and your plan documents, your plan will be used to determine your coverage.

Administrative Process

Maintenance care is not covered and prior approval is not applicable.

Coverage

Rest, respite, custodial and non-rehabilitative care are not covered.

Definitions

Maintenance care is non-rehabilitative care and supportive services, including skilled or non-skilled nursing care for a member whose condition has not significantly improved or deteriorated over a measurable period of time (generally a period of time of two months from establishing a functional goal). It applies to any care rendered regardless if that care is skilled (requires professional judgment for delivery of care) or is non-skilled. Maintenance care is one of the criteria that is considered in determining whether a health care service is eligible for coverage for a specific benefit under a member contract. When care is determined to be custodial or non-rehabilitative, the coverage decision applies to the health care service and all care related to that service. It applies to care, drugs, and equipment in an inpatient hospital setting, skilled nursing facility, or any other health care setting.

Rehabilitative care is a restorative service, which is provided for the purpose of obtaining significant functional improvement, within a predictable period of time (generally within a period of two months) toward a patient's maximum potential ability to perform functional daily living activities.

Custodial care is supportive services focusing on activities of daily life that do not require the skills of qualified technical or professional personnel, including but not limited to, bathing, dressing, and feeding.

Products

This information is for most, but not all, HealthPartners plans. Please read your plan documents to see if your plan has limits or will not cover some items. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage. These coverage criteria may not apply to Medicare Products if Medicare requires different coverage. For more information regarding Medicare coverage criteria or for a copy of a Medicare coverage policy, contact Member Services at 952-883-7979 or 1-800-233-9645.

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Policy activity

  • 04/30/1994 - Date of origin
  • 04/30/1994 - Effective date
Review date
  • 03/2018

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