Homebound guidelines

[cny4rn]

I have worked in home health for about 8 years now. Most as a part time RN in the field but some as a full time case manager. Recently I refused to recert a patient that had current medical changes but was driving daily. I was told by my supervisor that it was within medicare guidelines for a patient to do this. Please let me know if this is correct. I feel if a patient is able to drive without exerting a taxing effort and is able to do this on a daily basis then they do not need home health care.

[nurse42long, RN]

Your supervisor is wrong, driving at all, let alone daily is not homebound per Medicare guidelines. Medicare auditors will pounce on this one.

[cny4rn]

I am being told they can drive short distances to visit the doctor, church, etc. but I didn't feel good about it and am glad I refused to recert the patient.

[HmarieD]

I have a copy of a letter that was sent from CMS to NAHC, which states, in part,

"If the net effect of driving indicates that the individual has the capacity to get their health care routinely outside the home, then it could challenge their eligibility....Because individual circumstances can vary greatly, necessitating determination on a case-by-case basis, we are reluctant to issue a specific policy that relates to driving in every possible occurrence."

This would seem to indicate that driving does not automatically negate homebound status. I think the key points to remember are that leaving the home must occur infrequently, for short periods of time, and require a great and taxing effort. If a pt has no other way to obtain groceries or other essentials, and these factors are present, they could drive and still be considered "homebound".

I'm not sure that the pt you described would fit these criteria, though.

[caliotter3]

I am not homebound and find driving to be a taxing activity, so I agree with your decision to not recertify. I think I would consider how often it done. Any regularity at all, no. Rarely, due to unavoidable circumstances, maybe.

[tewdles, RN]

I agree that you are correct to question the recertification of a patient who is able and willing to drive on a regular basis. Your assessment that the patient is driving daily clearly suggests that he may not meet a basic requirement for CHC.

[erroridiot]

CMS clarification of homebound status for medicare home health care is here:

http://questions.cms.hhs.gov/cgi-bin/cmshhs.cfg/php/enduser/std_adp.php?p_faqid=9070&p_created=1207329475

[cny4rn]

Thank you all for your replies. The patient I was concerned with does not require a taxing effort for her to drive or leave her home. I know I did the right thing. It was interesting that after I said I didn't feel right recerting this patient the supervisor sent another RN out to do it. Then she told me there wouldn't be enough parttime visits any more for me...........but this week that supervisor was fired! So I have my job back. The truth always prevails in the end.

[tewdles, RN]

Unfortunately, I find that the truth does NOT always prevail in matters such as this. Particularly in for-profit home care agencies.

[cny4rn]

You know you're right actually. The truth should always prevail but it doesn't. She was let go for not doing her job .......the owner just took a while to figure that out. She wouldn't have lost her job over recerting someone that wasn't homebound. Sad but true. Medicare fraud in for profit home health agencies is common isn't it?

[DesertwindRN, ADN, RN]

Good for you OP.

This is typical fraud and is happening as we write.

This is a typical patient found often in HH agencies and are often seen parimarily by LPNs and have frequent changes in case managers to keep them by the companies because they have daily (often) visits. Just awful.

[cny4rn]

The owner told us at the mandatory meeting we had when he announced the other superivisor being let go, that our goal was to get the patient to a level of health and independence to be discharged in a timely manner. Of course some of our patients are so unstable this isn't going to happen, but for the ones that are stable this is refreshing to hear the owner and new supervisor say...........we will see. I think of getting out of home health due to these issues but I truly love my patients and the ones that need us deserve good care.