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New CMS Proposed Homebound Policy Would Leave Medicare Beneficiaries Without Coverage

Medicare only covers home health care if, among other requirements, the beneficiary is homebound. As of Nov. 19, 2013, the Centers for Medicare & Medicaid Services (CMS) will require new criteria for purposes of meeting the homebound requirement. These new requirements will leave many Medicare beneficiaries without access to the medically reasonable and necessary home care coverage. The new policy states: For purposes of the statute, an individual shall be considered "confined to the home" (homebound) if the following two criteria are met:

  • The patient must either 1) because of illness or injury, need the aid of supportive devices such as crutches, canes, wheelchairs, and walkers; the use of special transportation; or the assistance of another person in order to leave their place of residence; OR 2) have a condition such that leaving his or her home is medically contraindicated.

    If the patient meets one of the criteria in Criteria-One, then the patient must ALSO meet two additional requirements:

    • There must exist a normal inability to leave home; AND leaving home must require a considerable and taxing effort.

Two years ago, on Nov. 4, 2011, CMS published this new proposed policy as "Clarification to Benefit Policy Manual Language on 'Confined to the Home' Definition." Unfortunately, the proposed policy change was included with unrelated materials and went unnoticed by beneficiary and consumer advocates until Nov.1, 2013.

Source/more: Center for Medicare Advocacy

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