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Home Health & Hospice Week

Coverage:

Wrap Your Brain Around This New Homebound Definition

Published on Thu May 13, 2004

In its upcoming demonstration project, as mandated by the Medicare Modernization Act of 2003, Medicare will loosen the definition of "homebound" for home care eligibility and coverage.
 
Under its new project, the Centers for Medicare & Medicaid Services says a Medicare patient will be deemed homebound, without regard to the purpose, frequency or duration of absences from the home, if the patient meets all of the following conditions:

1. Physician-certified as having a permanent and severe, disabling condition not expected to improve.

2. Dependent upon assistance from another individual with at least three out of the five activities of daily living specified in the Act (eating, toileting, transferring, bathing and dressing) for the rest of the beneficiary's life.

3. Requires skilled nursing services for the rest of his or her life, and the skilled nursing is more than medication management.

4. Requires an attendant to visit on a daily basis to monitor and treat a medical condition or to assist the beneficiary with ADLs.

5. Requires technological assistance or the assistance of another person to leave the home.

6. Does not regularly work in a paid position full-time or part-time outside the home. v

Source: CMS Change Request 3269, www.cms.hhs.gov/manuals/pm_trans/R3DEMO.pdf.

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