47 Home Health Care Services Benefits are available for Covered Services performed by a Home Health Care Agency or other Provider in your home. To be eligible for benefits, you must essentially be confined to the home, as an alternative to a Hospital stay, and be physically unable to get needed medical services on an outpatient basis. Services must be prescribed by a Doctor and the services must be so inherently complex that they can be safely and effectively performed only by qualified, technical, or professional health staff. Covered Services include but are not limited to: • Intermittent skilled nursing services by an R.N. or L.P.N. • Medical / social services • Diagnostic services • Nutritional guidance • Training of the patient and/or family/caregiver • Home health aide services. You must be receiving skilled nursing or therapy. Services must be given by appropriately trained staff working for the Home Health Care Provider. Other organizations may give services only when approved by us, and their duties must be assigned and supervised by a professional nurse on the staff of the Home Health Care Provider or other Provider as approved by the Plan . • Therapy Services (except for Manipulation Therapy , which will not be covered when given in the home) • Medical supplies • Durable medical equipment • Private duty nursing services B enefits are also available for Intensive In - home Behavioral Health Services. These do not require confinement to the home. These services are described in the “Mental Health and Substance Use Disorder Services” section below . Benefits may also be available for Inpatient Services in your home. These benefits are separate from the Home Health Care Services benefit and are described in the “Inpatient Services” section below. Home Infusion Therapy Please see “Therapy Services” later in this section. Hospice Care You are eligible for hospice care if your Physician and the Hospice medical director certify that you are terminally ill and likely have less than twelve (12) months to live. You may access hospice care while participating in a clinical trial or continuing disease modifying therapy, as ordered by your treating Provider. Disease modifying therapy treats the underlying terminal illness. The services and supplies listed below are Covered Services when given by a Hospice for the palliative care of pain and other symptoms that are part of a terminal disease. Palliative care means care that controls pain and relieves symptoms but is not meant to cure a terminal illness. Covered Services include: • Care from an interdisciplinary team with the development and maintenance of an appropriate plan of care. • Short - term Inpatient Hospital care when needed in periods of crisis or as respite care. • Skilled nursing services, home health aide services, and homemaker services given by or under the supervision of a registered nurse.