Academic journal article Health Care Financing Review

Medicare Acts to Protect Coverage for Homebound Beneficiaries. (Recent Health Care Developments)

Academic journal article Health Care Financing Review

Medicare Acts to Protect Coverage for Homebound Beneficiaries. (Recent Health Care Developments)

Article excerpt

The Medicare Program recently took action that will provide reassurance to chronically disabled homebound Medicare beneficiaries that they can continue to receive home health care even if they leave their homes for special non-medical purposes.

In new instructions, CMS directed home health agencies (HHAs) and the contractors that pay home health claims to be more flexible in determining if a severely disabled individual is qualified as homebound.

The instructions make clear that chronically disabled individuals who otherwise qualify as homebound should not lose home health services because they leave their homes infrequently for short periods of time for special occasions, such as family reunions, graduations, or funerals. In some instances, HHAs and Medicare payment contractors have terminated home health benefits after a beneficiary attended a special event, even though the beneficiary otherwise continued to qualify as homebound.

The new language in the program manual for HHAs:

* Expands the list of examples used to illustrate occasional absences from the home and notes that the list is still not all-inclusive.

* Adds the late stages of amyotrophic lateral sclerosis (Lou Gehrig's disease) or other neurodegenerative disabilities to the list of examples of conditions that may indicate that the patient cannot leave his or her home.

* Makes it clear that the determination as to whether a person is homebound is one that must be made over a period of time, not on a daily or weekly basis, so a few special trips outside the home would not be used to disqualify a patient who has a normal inability to leave the home. …

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