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 Article of Interest - Medicare "Homebound" Rule Update

David Jayne, NCAHB Founder

Submitted to bridges4kids by Brunhilde Merk-Adam.


Dear friends of NCAHB,

I am very pleased to inform you that President Bush announced today during the ADA anniversary ceremony, a clarification of Medicare policy to ensure that people with severe disabilities considered "homebound" under Medicare home health requirements are able to leave their homes occasionally without the risk of losing their Medicare coverage. This is a good start, but we still need a legislative remedy.


While in Washington I met with Tom Scully, the Administrator of the Center on Medicare and Medicaid Services, which is the federal agency responsible for overseeing the Medicare home health benefit. Mr. Scully said that he is extremely concerned that some Medicare beneficiaries are unjustly and wrongfully thrown off the home health benefit for so called homebound violations.  He said he has personally restored home health services to those who lost theirs due to an overly restrictive interpretation of the homebound rule.


The CMS Administrator also asked for NCAHB's help in identifying Medicare beneficiaries who have had their home health services cut off because of an extremely harsh interpretation of the homebound restriction. If you or someone you know have been cut off home health for what you believe to have been a wrongful interpretation of the homebound rule, I urge you to contact me


Describe the circumstances surrounding why home health services were discontinued because of an alleged homebound violation. Explain your disability or chronic illness and why you need to continue to get Medicare home health services. Include contact information (e mail, phone and mailing address) for yourself and the home health agency so that Mr. Scully's staff can follow up.


Below is a press release from CMS on today's events.



Friday, July 26, 2002 (202) 690-6145



The Medicare program today took action that will provide reassurance to 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.


In new instructions, HHS Centers for Medicare & Medicaid Services (CMS) directed home health agencies and the contractors that pay home health claims to be more flexible in determining if a severely disabled individual is qualified as homebound.


The instructions 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 some instances, home health agencies and Medicare payment contractors have terminated home health benefits after a beneficiary attended a special event, even though the beneficiary otherwise continued to qualify as homebound.


"We want to make sure that every person who is covered by Medicare is treated fairly and sensibly," HHS Secretary Tommy G. Thompson said. "These new instructions will help guarantee that chronically disabled Americans who need Medicare's home health benefits will not lose their coverage if they leave their homes for special family occasions."


The new language in the program manual for home health agencies:


Expands the list of examples used to illustrate occasional absences from the home and notes that the list is still not all inclusive; Adds the late stages of amyotrophic lateral sclerosis (ALS or Lou Gerhig's disease) or other neurodegenerative disabilities to the list of examples of conditions that may indicate that the patient cannot leave his or her home; and Makes it clear that the determination as to whether a person is homebound is one that must be made over a period of time, not on a daily or weekly basis, so a few special trips outside the home would not be used to disqualify a patient who has a normal inability to leave the home. "While Congress weighs the homebound definition in current law, we have the responsibility to make sure that chronically disabled people who are considered to be homebound can live a full life," CMS Administrator Tom Scully said. "By adding these examples, we make it clear that disabled Medicare beneficiaries can take advantage of an opportunity to go to their child's wedding or other special family occasion without the fear of losing vital benefits."


Under current law, to qualify as homebound, a Medicare beneficiary does not need to be bedridden, but must generally be confined to his or her home. If the patient does leave the home for non-medical purposes, these absences must be for short periods of time or infrequently. In 2000, Congress expanded the homebound definition to allow patients to attend adult day care programs or religious services.


Medicare's $13 billion home health benefit provides short-term health and personal care services to beneficiaries who have a need for home health services and qualify as homebound. An estimated 2.5 million Medicare beneficiaries will receive home health services this year.


Note: All HHS press releases, fact sheets and other press materials are available at


Honoring the Anniversary of the Americans with Disabilities Act


Today's Presidential Action: In an East Room ceremony marking the 12th anniversary of the enactment of the Americans with Disabilities Act, President George W. Bush: Announced a clarification of Medicare policy to ensure that people with severe disabilities considered "homebound" under Medicare home health requirements are able to leave their homes occasionally without the risk of losing their Medicare coverage; and Called on Congress to fund his New Freedom Initiative budget requests, including $145 million for: (1) competitive grants to provide additional transportation services for Americans with disabilities, increasing their access to the job market; and (2) a pilot program to demonstrate innovative solutions for transportation problems that prevent many people with disabilities from living more independently. President Bush also praised the work of the Commission on Excellence in Special Education, which recently recommended improvements in the education of students with disabilities to Congress and the President. These recommendations will help Congress as it considers the reauthorization of the Individuals with Disabilities Education Act (IDEA). President Bush has made funding for special education a high priority. In each of the President's two budget requests, he has asked Congress for an additional $1 billion in IDEA Part B State Grants funding, the largest increases ever requested in history by any president. Background on Today's Presidential Action: On February 1, 2001, President Bush announced the New Freedom Initiative - a comprehensive program to promote the full participation of people with disabilities in all areas of society by increasing access to assistive and universally designed technologies, expanding educational and employment opportunities, and promoting increased access into daily community life. The Administration is committed to the full enforcement of the Americans with Disabilities Act. The ADA prohibits discrimination on the basis of disability in:


Places of public accommodation, including all hotels, restaurants, retail stores, theaters, health care facilities, convention centers, parks, and places of recreation; Activities of state and local governments, including public transportation and employment; and


Employment practices of private employers with 15 or more employees. The New Freedom Initiative also increases technical assistance to help small businesses comply with the ADA. The President believes that the most efficient way to promote compliance with the Act is to give businesses and local governments the information they need to better understand their obligations. Examples of the Administration's innovative efforts to promote compliance with the ADA include the Department of Justice's "ADA Business Connection," which is increasing compliance by fostering an ADA dialogue within the business community and increasing the flow of ADA information to business decision makers. Additionally, the Equal Employment Opportunity Commission is providing ADA training to small businesses throughout the country. For a full progress report on the implementation of the New Freedom Initiative, please visit more information on the President's initiatives, please visit


Best regards,

David Jayne

NCAHB Founder

115 Hayes Circle

Rex, Georgia 30273


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