Understanding Medicare Private Fee-for-Service Plans
Private fee-for-service (PFFS) plans are a way to give private insurance companies access to the vast Medicare market and are...Read more
[This article was originally published on July 31, 2002. The links were updated on August 16, 2018.]
Medicare officials have issued "more flexible" guidelines aimed at reassuring chronically disabled homebound Medicare beneficiaries that they can continue to receive home health care even if they leave their homes for special non-medical purposes.
One of the criteria for the chronically disabled to receive home health services paid for by Medicare is that the recipient be confined to his or her home, meaning that leaving it to receive services would be a "considerable and taxing effort." The Medicare law also stipulates that absences from the home be of "infrequent and of short duration." In the past, there have been cases of Medicare beneficiaries losing home health care benefits simply because they attended, for example, a relative's funeral or wedding.
The new instructions--from the Centers for Medicare & Medicaid Services (CMS) to home health agencies and the contractors that pay home health claims--make clear that chronically disabled individuals who otherwise qualify as homebound should not lose home health services because they leave their homes infrequently for short periods of time for special occasions, such as family reunions, graduations or funerals. In addition, the new guidelines expand the list of reasons for occasional absences from the home and include late stages of amyotrophic lateral sclerosis (Lou Gehrig's disease) or other neurodegenerative disabilities as examples of conditions that would "indicate that a patient cannot leave his or her home."
The new guidelines come at a time that Congress is considering legislation to revise the homebound requirement. The Homebound Clarification Act of 2001 (HR 1490), also known as the David Jayne Amendment to the Medicare reform bill, drafted by Rep. Ed Markey (D-Mass.) and Sen. Susan Collins'' (R-Maine), would base the homebound determination solely on the existing standard of whether leaving home requires "considerable and taxing effort," eliminating the number or length of absences as criteria. (See ElderLawAnswers news article, 'Dole Calls for Change in Medicare's 'Homebound' Rule,' June 27, 2002).