Medicare Acts to protect coverage for homebound.....

[Guest guest]

Medicare Acts To Protect Coverage For Homebound Beneficiaries

July 29, 2002

WASHINGTON (HHS) -- The Medicare program Friday took action that will

provide reassurance to chronically disabled homebound Medicare beneficiaries

that they can continue to receive home health care even if they leave their

homes for special non-medical purposes.

In new instructions, HHS' Centers for Medicare & Medicaid Services (CMS)

directed home health agencies and the contractors that pay home health

claims to be more flexible in determining if a severely disabled individual

is qualified as homebound.

The instructions make clear that chronically disabled individuals who

otherwise qualify as homebound should not lose home health services because

they leave their homes infrequently for short periods of time for special

occasions, such as family reunions, graduations or funerals. In some

instances, home health agencies and Medicare payment contractors have

terminated home health benefits after a beneficiary attended a special

event, even though the beneficiary otherwise continued to qualify as

homebound.

" We want to make sure that every person who is covered by Medicare is

treated fairly and sensibly, " HHS Secretary Tommy G. said. " These

new instructions will help guarantee that chronically disabled Americans who

need Medicare's home health benefits will not lose their coverage if they

leave their homes for special family occasions. "

The new language in the program manual for home health agencies:

Expands the list of examples used to illustrate occasional absences from the

home and notes that the list is still not all inclusive;

Adds the late stages of amyotrophic lateral sclerosis (ALS or Lou Gerhig's

disease) or other neurodegenerative disabilities to the list of examples of

conditions that may indicate that the patient cannot leave his or her home;

and

Makes it clear that the determination as to whether a person is homebound is

one that must be made over a period of time, not on a daily or weekly basis,

so a few special trips outside the home would not be used to disqualify a

patient who has a normal inability to leave the home.

" While Congress weighs the homebound definition in current law, we have the

responsibility to make sure that chronically disabled people who are

considered to be homebound can live a full life, " CMS Administrator Tom

Scully said. " By adding these examples, we make it clear that disabled

Medicare beneficiaries can take advantage of an opportunity to go to their

child's wedding or other special family occasion without the fear of losing

vital benefits. "

Under current law, to qualify as homebound, a Medicare beneficiary does not

need to be bedridden, but must generally be confined to his or her home. If

the patient does leave the home for non-medical purposes, these absences

must be for short periods of time or infrequently. In 2000, Congress

expanded the homebound definition to allow patients to attend adult day care

programs or religious services.

Medicare's $13 billion home health benefit provides short-term health and

personal care services to beneficiaries who have a need for home health

services and qualify as homebound. An estimated 2.5 million Medicare

beneficiaries will receive home health services this year.

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[Guest guest]

Hi all,

While that is a step forward, we STILL need to remind Congress and to add " or

other neurodegenerative disabilities " to the definition of the ruling that

Altzheimer's patients can receive maintenance PT and ST.

It is time for Congress to stop singling out specific disorders to write into

law. All patients need to be treated with the same evenhandedness.

Take care, Bill Werre