CMS Redefines ‘Homebound’ for Medicare-Eligible Services

The Center for Medicare & Medicaid Services (CMS) has released a clarified definition of ‘homebound’ regarding eligibility for Medicare-reimbursable services.

Individuals can be considered “confined to the home,” or homebound, if they meet two criteria that more closely align the Benefit Policy Manual to the Social Security Act’s definition, says CMS.

The first criteria requires patients to either need supportive devices such as crutches, canes, wheelchairs, and walkers; special transportation; or help from someone else in order to leave their home because of illness or injury, or have a condition that makes leaving the home medically inadvisable. 

Patients that meet one of Criteria One’s conditions must also meet two additional requirements defined in Criteria Two: “There must exist a normal inability to leave home; and leaving home must require a considerable and taxing effort.” 

The new definition will prevent confusion, promote a clearer enforcement of the statute, and provide more definitive guidance to home health agencies in order to foster compliance, CMS says. 

The newly clarified definition, published in Change Request 8444, will take effect Nov. 19 after two years of preparation. The Home Health Prospective Payment System rules for 2012, which included a proposal to provide an updated definition, was published in July 2011. 

View Change Request 8444

Written by Alyssa Gerace 

Alyssa Gerace