Who Defines "Homebound"

Confusion around the definition of homebound sometimes prevents eligible patients form receiving beneficial home health services. Read on and you will see that Medicare's definition of homebound is less strict than the word itself may imply and that you or a loved one may be eligible for medically necessary home health services.

Did you know that none of the following outings will necessarily disqualify a person from home health services?

Medicare deems the following groups of people to be homebound:

• People requiring the use of crutches, canes, wheelchairs, walker, or human assistance to leave the home
• Senile Patients
• Patients who have lost the use of an upper extremity and may be limited in the use of stair handrails
• Patients with limited ability for ambulation due to pain and or weakness
• Patients with heart disease who must avoid stress
• People for whom outings may be medically contraindicated as determined by the physician

Medicare even allows for temporary increases in the number of outings a patient may have. For instance, if family visits from out of town and provides unusual opportunity for the patient to get out more often, the activity does not disqualify the patient from home health services. Medicare instructs care planners to consider a patient's ability to leave the home as it exists over the entire plan of care, and to allow for short-term exceptions.

Definitions of "Homebound"

Medicare: "...there exists a normal inability to leave home and, consequently, leaving home would require a considerable and taxing effort." (Medicare COP, 2009, www.cms.gov)

Medicaid: Medicaid has removed all language regarding homebound requirements from coverage limitations. As long as the physician feels that the home is the most appropriate environment for the care in question, Medicaid covers medically necessary home health.

Private Insurance: Other insurance usually follows Medicare. However, the exact definition may vary from company to company. Many times, private insurance will consider patients on a case-by-case basis and will authorize home health services when the agency can demonstrate that home health will be the most cost efficient or the most appropriate provider. If you would like to see if a private health insurance company would authorize home health services, simply make a referral to Mercer Health Home Care. Mercer Health Home care will take time to pre-authorize the service and notify the physician and/or patient of any financial considerations as soon as possible - usually before care begins.

When doctors' offices have concerns about whether a patient will meet homebound criteria or whether homebound criteria apply, they can make a simple call to Mercer Health Home Care for knowledgeable answers. Doctors also have the comfort of knowing that an RN visits the patient at home and verifies homebound status before the physician is ever asked to sign a plan of care.

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