Home Health & Hospice Week

CMS highlights homebound enforcement.

The Centers for Medicare & Medicaid Services has followed through on its 2011 promise to clarify the definition of "homebound" in regulation.

According to CR 8444, the new language found in the Medicare Benefit Policy Manual reads:

"For purposes of the statute, an individual shall be considered ‘confined to the home’ (homebound) if the following two criteria are met:

Criteria-One:

The patient must either:

Because of illness or injury, need the aid of supportive devices such as crutches, canes, wheelchairs, and walkers; the use of special transportation; or the assistance of another person in order to leave their place of residence

OR

Have a condition such that leaving his or her home is medically contraindicated.

If the patient meets one of the Criteria-One conditions, then the patient must ALSO meet two additional requirements defined in Criteria-Two below.

Criteria-Two:

There must exist a normal inability to leave home;

AND

Leaving home must require a considerable and taxing effort."

CMS has removed "vague terms" such as "generally speaking" that were in the old definition, it says in a related MLN Matters article. The new definition more accurately reflects the language of the Social Security Act, CMS claims.

"These clarifications to ‘confined to the home’ may lead to more restrictive applications to a Medi-care beneficiary’s homebound status by the medical contractors depending on what their understanding of the definition was prior to the issuance of CR 8444," warns the National Association for Home Care & Hospice.

The changes will "promote a clearer enforcement of the statute," CMS says in the CR.

Note: The CR is at www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R172BP.pdf and the MLN Matters article is at www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM8444.pdf.