homebound status question

To be homebound you need to take a considerable taxing effort to get out of the home with or without an assistive device.

See text from the Center for Medicare Advocacy:

"Sections 501-508 of the Medicare, Medicaid and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA) amended 42 U.S.C. '' 1395f(n), 1395(n), 1395fff(b), 1395(x)(v) to modify the Medicare home health benefit. (Public Law 106-554, 12/21/2000.) The provisions discussed below clarified the threshold "homebound" criteria, making clear that individuals who attend adult day care or religious services may also qualify for Medicare home health coverage. These changes became effective upon date of enactment, December 21, 2000.

Homebound Definition

The statutory language clarified and broadened the homebound eligibility criterion in two ways:

Absences attributable to the need to receive health care treatment, including regular absences to participate in therapeutic, psychosocial, or medical treatment at a licensed or accredited adult day-care program, will not disqualify a beneficiary from being considered homebound. For many years beneficiaries who attended adult day-care programs were routinely denied home health services.

Absences for the purpose of attending a religious service are deemed to be absences of infrequent or short duration. (Generally a beneficiary whose absences from the home are not considered infrequent or of short duration will not be considered to be homebound.)

The Current Homebound Definition in the Medicare Act reads as follows (language added by BIPA is in italics):

An individual shall be considered to be "confined to his home" if the individual has a condition, due to an illness or injury, that restricts the ability of the individual to leave his or her home except with the assistance of another individual or the aid of a supportive devise (such as crutches, a cane, a wheelchair or a walker), or if the individual has a condition such that leaving his or her home is medically contraindicated. While an individual does not have to be bedridden to be considered "confined to his home", the condition of the individual should be such that there exists a normal inability to leave home, that leaving home requires a considerable and taxing effort by the individual, any absence of an individual from the home attributable to the need to receive health care treatment, including regular absences for the purpose of participating in therapeutic, psychosocial, or medical treatment in an adult day-care program that is licensed or certified by a State, or accredited, to furnish adult day-care services in the State shall not disqualify an individual from being considered to be "confined to his home". Any other absence of an individual from the home shall not so disqualify an individual if the absence is of infrequent or of relatively short duration. For purposes of the preceding sentence, any absence for the purpose of attending a religious service shall be deemed to an absence of infrequent or short duration. [42 U.S.C. '1395n(a)(2)(F)]"

.."condition, due to an illness or injury, that restricts the ability of the individual to leave his or her home except with the assistance of another individual or the aid of a supportive devise (such as crutches, a cane, a wheelchair or a walker), or if the individual has a condition such that leaving his or her home is medically contraindicated."

I think they are leaving the part about a "taxing effort"out. But, if the patient defines his efforts as taxing ;then does this not meet the rquirement if all others are met. I wonder if it's just an attempt to avoid potential litigation about denial of services for not meeting status,like a defensive practice.

Another thought,if a client states he is in pain and rates it higher than we think it should be. Pain is what the patient says it is. We are not supposed to rate pain for them. Do you think the same take should be used on "taxing" effort. Maybe this is their interpretation.

It is sad that so many Home Health Agencies have people in charge that are so poorly informed....

Today Girling H.H. notified a family that "Mom" can no longer receive Home Health due to the fact she is attending Adult Day Care...

I am nurse at Adult Day Care and we have this problem repeatedly....

Can't they read....

Reg.s clearly state pt. homebound status is not voilated by attendance to ADC that is state accredited.

However to answer your question:

Homebound staus is determined on an indiv. basis, looking at pt. as a whole.

You can be homebound without a cane if lacking the capacity to obtain health care provided outside rather than in the home.:argue:

At our agency if a pt is going to adult day care for custodial care or socialization whether accredited or not, they are not homebound, if their is a medical reason for them to go to daycare (dementia, medication, ect) then we take them onto service if they have a skilled need. Also, just because a patient does not have a means of transportation to receive medical care outside of the home does NOT make them homebound.