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Homebound Status
Updated Q&A about
homebound status (updated November 2009):
Question: Could you clarify CMS’ policy about the
homebound status of home health patients who can drive?
Answer: The Benefit Policy Manual (Internet-Only
Manual 100-02, Chapter 7, Section 30.1.1) explains in detail what it
means to be homebound. While we have excerpted portions below, please
see the manual for full details.
“In order for a patient to be eligible to receive covered home health
services under both Part A and Part B, the law requires that a physician
certify in all cases that the patient is confined to his/her home. An
individual does not have to be bedridden to be considered confined to
the home. However, the condition of these patients should be such that
there exists a normal inability to leave home and, consequently, leaving
home would require a considerable and taxing effort.
If the patient does in fact leave the home, the patient may nevertheless
be considered homebound if the absences from the home are infrequent or
for periods of relatively short duration, or are attributable to the
need to receive health care treatment.”
A patient’s homebound status is not violated by attendance of religious
services or attendance at a State licensed, State certified, or State
accredited medical adult day care center.
“Occasional absences from the home for non-medical purposes, e.g., an
occasional trip to the barber, a walk around the block or a drive,
attendance at a family reunion, funeral, graduation, or other infrequent
or unique event would not necessitate a finding that the patient is not
homebound if the absences are undertaken on an infrequent basis or are
of relatively short duration and do not indicate that the patient has
the capacity to obtain the health care provided outside rather than in
the home.”
In addition to the information given in our Benefit Policy Manual, we
have also addressed this question in a response to an inquiry back in
April of 2003. We responded to the query with the following information:
“Homebound status is determined on an individual basis, looking at the
patient as a whole. If the net effect of driving indicates that the
individual has the capacity to get their health care routinely outside
of the home, then it could challenge their eligibility. The fact that a
patient is fit enough to drive raises questions as to whether the basic
statutory requirement is met. Because individual circumstances can vary
greatly, necessitating determinations on a case-by-case basis, we are
reluctant to issue a specific policy that relates to driving in every
possible occurrence. Inherent in such a policy would be judgments about
the particular circumstances under which it may be appropriate for an
individual to operate a motor vehicle. We believe that such
determinations must continue to be made on a case-by-case basis.”
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