Home Health & Hospice Week

Docs must certify medical contraindications.

Medicare is allowing home health agencies to serve more patients in the COVID-19 crisis by broadening the definition of who counts as homebound for eligibility purposes.

“The definition of ‘confined to the home’ ...allows patients to be considered ‘homebound’ if it is medically contraindicated for the patient to leave the home,” the Centers for Medicare & Medicaid Services explains in its new interim final rule implementing a host of regulatory changes to help providers deal with the novel coronavirus pandemic. That applies when a physician has determined that it is medically contraindicated for a beneficiary to leave the home because (1) she has a confirmed or suspected diagnosis of COVID-19 or (2) the patient has a condition that may make the patient more susceptible to contracting COVID-19.

The rule, released March 30, includes examples with COPD and cancer patients.

Physician certification required: Physician documentation is key.“A patient who is exercising ‘self-quarantine’ for one’s own safety would not be considered ‘confined to the home’ unless a physician certifies that it is medically contraindicated for the patient to leave the home,” CMS stresses. The Centers for Disease Control and Prevention is advising that older adults and individuals with serious underlying health conditions stay home, the rule points out.“We expect that many Medicare beneficiaries could be considered ‘confined to the home.’” CMS says. But homebound determinations, as always, “must be based on an assessment of each beneficiary’s individual condition and care needs.”.

Also as always, patients must meet the other Medicare home health eligibility requirements — under the care of a physician; receiving services under a plan of care established and periodically reviewed by a physician; in need of skilled nursing care on an intermittent basis (or physical therapy or speech-language pathology); or in continuing need for occupational therapy, CMS reminds.

A visit to administer a COVID-19 test isn’t going to automatically qualify a patient, CMS points out.“A home health visit solely to obtain a nasal or throat culture would not be considered a skilled service because it would not require the skills of a nurse to obtain the culture,” the rule spells out. But “a home health nurse, during an otherwise covered skilled visit, could obtain the nasal or throat culture to send to the laboratory for testing,” CMS allows.

Keep in mind: The definition of who is homebound may change as the CDC changes its guidance on who is at risk.“CDC’s guidance ...is expected to continue to be updated as warranted,” CMS highlights.