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I briefly looked into this last year when my mom fell& became 100% bedfast @ her NH and was evaluating just what to do for her long term care plan.
Now for ENT @ a NH or in a hospital, it is covered under Medicare Part A and that seems to be pretty straightforward for Medicare to pay if all the medical necessity requirements are filled out by their MD's. Now my mom is in her 90's and has dementia, so for her doing ENT does not make sense and so she instead went onto the hospice benefit of Medicare. Been on hospice for about a year now.
But it seemed to me, that if I was looking for ENT to be paid for by Medicare under Part B (which covers stuff @ home), it can be kinda hard to provide the justification for medical necessity. You have to have the MD's clearly document the need for the whole system - which is very expensive. The example I was given was that say the patient had jaw or neck cancer and had basically none of that part of their body intact, then they would qualify for ENT under Medicare (these would be far gone cancers from smoking usually); and even then, it would be provided just until the time they got reconstructive surgery done. BUT if it was the case where they had dementia and could not cognitively understand to eat and you are wanting the ENT system done to make "feeding" them easier, then those would not qualify for ENT. They would instead be better on hospice (another Medicare benefit). There are just a few providers of the machines & the liquids that have to be used in the machines too, and none of this is cheap or easily available to buy. So you need to make sure that it is approved and cleared by Medicare before you get the equipment otherwise you will have to private pay for all.
If the patient is on Hospice, all decisions are made by the Hospice team. Generally they do NOT approve fluid therapy or feeding tubes.
I don't know how a younger patient who could not take oral nutrition for example from an injury would be treated. Private insurance will vary greatly but over 65 Medicare is always primary.