THE FOLLOWING STUDY ARTICLE IS INTENDED TO SUPPORT   AWARENESS . IT IS NOT LEGAL ADVICE.   IF THE READER SEEKS LEGAL ADVICE CONCERNING HIS OR HER PARTICULAR SITUATION, HE OR SHE SHOULD SEEK OUT AN ATTORNEY IN A LAWYER CLIENT RELATIONSHIP.

In Order To Qualify For Medicare’s Home Health Services Benefit, An Individual Does Not Have To Be Bedridden In Order To Be Considered “Confined To His Home”  Due To An Illness Or Injury .

In order for a Medicare beneficiary to qualify for the Medicare home health services benefit under Medicare Part A or B,  one criterion is that a physician must certify that the individual is  “confined to his home” See CFR § 424.22 (a) (ii)

An individual shall be considered to be “confined to his home” if the individual has a condition, due to an illness or injury, that restricts the ability of the individual to leave his or her home except with the assistance of another individual or the aid of a supportive device (such as crutches, a cane, a wheelchair, or a walker), or if the individual has a condition such that leaving his or her home is medically contraindicated. While an individual does not have to be bedridden to be considered “confined to his home”, the condition of the individual should be such that there exists a normal inability to leave home and that leaving home requires a considerable and taxing effort by the individual. See 42 USC 1395f (a)(2)(C) and 42 U.S.C. 1395n (a)(2)(A).

Any absence of an individual from the home attributable to the need to receive health care treatment, including regular absences for the purpose of participating in therapeutic, psychosocial, or medical treatment in an adult day–care program that is licensed or certified by a State, or accredited, to furnish adult day–care services in the State shall not disqualify an individual from being considered to be “confined to his home”. Any other absence of an individual from the home shall not so disqualify an individual if the absence is of infrequent or of relatively short duration. For purposes of the preceding sentence, any absence for the purpose of attending a religious service shall be deemed to be an absence of infrequent or short duration. See 42 USC 1395f (a)(2)(C) and 42 U.S.C. 1395n (a)(2)(A).

It is expected that in most instances, absences from the home that occur will be for the purpose of receiving health care treatment. However, occasional absences from the home for nonmedical 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. See Medicare Benefit Policy Manual Chapter 7 – Home Health Services Chapter 7, 30.1.1 – Patient Confined to the Home(Rev.208, Issued: 04-22-15, Effective: 01-01–15, Implementation: 05-11-15)

In determining whether the patient has the general inability to leave the home and leaves the home only infrequently or for periods of short duration, it is necessary to look at the patient’s condition over a period of time rather than for short periods within the home health stay. See Medicare Benefit Policy Manual Chapter 7 -Home Health Services Chapter 7, 30.1.1 – Patient Confined to the Home (Rev.208, Issued: 04-22-15, Effective: 01-01–15, Implementation: 05-11-15)

The aged person who does not often travel from home because of feebleness and insecurity brought on by advanced age ( i.e. rather than due to an illness or injury ) would not be considered confined to the home for purposes of receiving home health services.  See Medicare Benefit Policy Manual Chapter 7 – Home Health Chapter 7, 30.1.1 – Patient Confined to the Home (Rev.208, Issued: 04-22-15, Effective: 01-01–15, Implementation: 05-11-15)

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