Patient Eligibility for Home Health Services Under Medicare

In the latest Home Health news, The Centers for Medicare and Medicaid Services (CMS) recently released a more straight forward definition of the term “homebound” to be used when deciding if patients are eligible to receive home health services under Medicare.

Homebound Criteria

In the latest Home Health news, The Centers for Medicare and Medicaid Services (CMS) recently released a more straight forward definition of the term “homebound” to be used when deciding if patients are eligible to receive home health services under Medicare.

Per CMS, a patient is considered “confined to the home” or “homebound” if they meet the following two criteria:

1. A patient must either need supportive devices such as crutches, a cane, a wheelchair, a walker; special transportation; or assistance from someone else in order to leave their home due to illness, injury, OR have a condition that makes leaving the home medically inadvisable.
2. There must exist a normal inability for the patient to leave home; and additionally, leaving home must require a considerable amount of taxing effort.

The new homebound definition is intended to prevent confusion and promote a more clear enforcement of the statute, providing definitive guidance to home health agencies in order to foster compliance, according to CMS.

Home health agency documentation, such as the initial and/or comprehensive assessment of the patient, can be incorporated into the certifying physician’s medical record, and then used to support the patient’s homebound status and need for skilled care services. Documentation from the certifying physician’s medical records and/or the acute/post-acute care facility’s medical records is used to support the certification of home health eligibility. The aformentioned documentation must support the patient’s need for skilled services and homebound status.

Home health care agencies should document the homebound status frequently enough to reflect the beneficiary’s current functional status, and at a minimum, at least once per episode. The designation of “homebound” is contingent upon a patient’s individual ability, not actual caregiver support. Patients may be highly functioning due to caregiver assistance, subsequently “homebound” does not mean bedbound.

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Homebound Status Documentation

CMS recommends that homebound status be documented in clear, specific, and measurable terms. Documentation of the homebound status needs to be clear throughout the duration of care. Whether stated or implied, the homebound status must be obvious from a reviewer’s standpoint.

All homebound documentation in the Plan of Care (POC) must be supported by documentation in the medical record as well. If the POC shows “endurance” is the reason the beneficiary is homebound, the documentation in the certifying physician’s medical records and/or the acute/post-acute care facility’s medical records should state why or how the limited endurance has rendered the beneficiary homebound.

A homebound patient may still leave the home for the following without putting his/her homebound status at risk:

• The patient is seeking medical treatment,
• The patient is attending a religious service
• The patient is attending a licensed or accredited adult day care facility

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