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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. Thompson 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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