homebound rules

[Guest guest]

: In 2000, Congress passed a law that further clarifies the Medicare definition of homebound.

Medicare law requires that a physician certify a beneficiary as

homebound before the patient is eligible to receive home health

benefits. The revision to the law expands the list of circumstances in

which patients can leave their home and still be classified as

homebound to include participating in adult care and attending

religious services.

The revised definition, which took effect in February 2001, appears below (revised text is indicated in bold):

An individual does not have to be bedridden to be considered

confined to his home. However, the condition of these patients should

be such that there exists a normal inability to leave home and,

consequently, leaving the home would require a considerable and taxing

effort. Any absence of the 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 the State should not disqualify an individual from being

considered confined to his home. Any other absence of an individual

from the home shall not so disqualify an individual if the absence is

infrequent or of relatively short duration. For the purpose of the

preceding sentence, any absence for the purpose of attending a

religious service shall be deemed to be an absence of infrequent or

short duration.

The revision states that occasional absences from the home for

nonmedical purposes (a trip to the barber, a walk around the block or a

drive) will not necessarily disqualify a beneficiary from being

classified as homebound. However, the absences must be infrequent or of

a relatively short duration. Long, frequent absences indicate to HCFA

that the patient has the capacity to access health care outside the

home.

Generally speaking, beneficiaries will be considered homebound if

they have an illness or injury that restricts their ability to leave

their residence except with the aid of supportive devices (canes,

wheelchairs and walkers), special transportation or another person.

Beneficiaries with conditions for which leaving home is medically

contraindicated are also considered homebound.

The following are examples of homebound patients:

Beneficiaries paralyzed from a stroke and confined to a wheelchair or requiring crutches to walk.Blind or senile beneficiaries who require another person's assistance to leave their residence.

Beneficiaries

who have lost the use of their upper extremities and are unable to open

doors, use stairway handrails, etc., and therefore require another

person's assistance to leave their residence.Beneficiaries

recently released from the hospital following surgery, who may be

suffering from resulting weakness and pain, and whose activity is

restricted by their physician to certain specified, limited activities

(such as getting out of bed only for a specified period or walking

stairs only once a day).Beneficiaries with arteriosclerotic heart disease of such severity that they must avoid all stress and physical activity.Beneficiaries

with a psychiatric problem that is manifested in part by a refusal to

leave their home environment or that makes it unsafe for them to leave

their home unattended, even if they have no physical limitations.

Elderly beneficiaries who do not often travel from their home

because of feebleness and insecurity brought on by advanced age would not meet

Medicare's criteria for homebound unless their condition is analogous to those

above.

Nita, my understanding is that Medicare pays for house calls if they are " justified " . I have patients sign an ABN.

Lack of transportation is usually not a justifiable reason. medicaer assumes someone is alive who can drive them.

To:

Sent: Thursday, October 30, 2008 1:41:00 AMSubject: Re: Publicity opportunity for IMPs doing house calls

I was contacted by an elderly patient who wondered if I could do house visits for her since she did not drive and lived with her daughter and family (who worked long hours and could not bring her to doctor's appointments) . Is it justifiable to do house calls under such circumstances and does insurance/Medicare pay for house calls on patients for such reasons?

Thanks.

Nita

From: Lynette Iles <liles64gmail (DOT) com>To: Practiceimprovement 1yahoogroups (DOT) comSent: Wednesday, October 29, 2008 1:48:31 PM

Subject: Re: [Practiceimprovemen t1] Publicity opportunity for IMPs doing house calls

When I was first starting my IMP, I was contacted by an older lady who wanted to switch to me if I'd do house calls, as her oxygen dependent CHF and obesity made it very difficult for her to get to the doctor's office. Since I live in a small town, this was no problem (everything is 5 minutes away). During my first, get to know you visit in August, her daughter and granddaughter stopped by to meet me also. Shortly afterwards, the tornado siren went off and we ended up spending the next hour in the basement. I had my tablet with me, so the granddaughter could draw, etc, I got to hear stories about my patient when she was younger, and generally got to know the family better. I didn't charge her for the extra time spent in the basement ;-).

Lynette I Iles MD 301 South Iowa Ste 2Washington IA 52353 Flexible Family Care'Modern medicine the old-fashioned way' This e-mail and attachments may contain information which is confidential and is only for the named addressee. If you have received this email in error, please notify the sender immediately and delete it from your computer.

-- If you are a patient please allow up to 12 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD

ph fax

[Guest guest]

I was looking into this issue a month or so ago when asked to provide visits in an assisted living facility. If the patient is under home health care services, then they must be homebound by the definition has provided. My understanding is that for ALF visits and home visits by physicians, the homebound status does not apply. Here is a quote from the CMS claims manual:

B. Homebound Status

Under the home health benefit the beneficiary must be confined to the home for services to be covered. For home services provided by a physician using these codes, the beneficiary does not need to be confined to the home. The medical record must document the medical necessity of the home visit made in lieu of an office or outpatient visit.

What becomes sticky is that I cannot find an guidelines as to what documents the medical necessity of the home visit.. Could it simply be that the provider does not have an office? That there is no reasonable transportation?

In the same chapter of the manual, they address "gang visits" to nursing homes- suggesting that providers might make unneeded visits in nursing homes so they are on the lookout for multiple visits made on the same day in one facility. They do NOT address this in an ALF- but I would think it would apply....

the site is:

http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf

the section I quoted from is 30.6.14

Carla Gibson FNP

Missoula Montana