Understanding Homebound Status

For a patient to be eligible for Medicare coverage of home health services, the law requires that a physician certify in all cases that the patient is confined to his/her home. For the purposes of the statute, an individual shall be considered "confined to the home" (homebound") if the following two criteria are met:

Criteria One

The patient must either:

Because of illness or injury, need the aid of supportive devices such as crutches, canes, wheelchairs, and walkers; the use of special transportation; or the assistance of another person in order to leave their place of residence.

OR

Have a condition such that leaving his or her home is medically contraindicated.
If the patient meets one of the Criteria-One conditions, then the patient must ALSO meet two additional requirements defined in Criteria-Two below.

Criteria Two

• There must exist a normal inability to leave home.

AND

• Leaving home must require a considerable and taxing effort.

  If the patient does in fact leave the home, the patient may nevertheless be considered homebound if the absences from the home are infrequent or for periods of relatively short duration. 

  These requirements do not apply to:

• Attendance at a state licensed adult day care facility.
• Attendance at a religious service.
• Absences for medical treatment.

Determining Homebound Status

In order to determine whether your patient is homebound or not, ask them questions about previous outings. This approach provides more accurate results compared to asking your patient about their perception of their own abilities.

Some questions to ask your patients:

"Where did you go?"

Regular trips to receive medical treatment not available in the home or to an adult day care facility are acceptable under homebound status. Trips to attend religious services also do not disqualify a patient from homebound status.

"How long were you gone?"

Trips that do not fall under the above categories should be infrequent and of relatively short duration. Examples are a walk around the block or an occasional trip to the barber.

"How did you get there?"

If your patient is leaving their place of residence, they should require the aid of medical devices, such as crutches, canes, wheelchairs or walkers, the use of special transportation, or the assistance of another person.  Trips out of their place of residence should require considerable effort.

"How does your illness or condition impact your ability to leave home?"

The difficult nature of leaving their place of residence should be directly related to your patients’ illness or injury and not based on choice or normal aging.

Examples of People who are Homebound

• A patient who needs assistance from a caregiver because weakness in the hand, arm, or shoulder prevents the safe use of handrails.
   
• A patient who has been weakened by illness, surgery, or an extended inpatient stay.
   
• A stroke survivor who now needs crutches or is confined to a wheelchair.
   
• A blind person who needs help leaving home.
   
• A patient with heart disease so serious that he or she must avoid stress and physical activity.
   
• A person with a psychiatric illness that causes a refusal to leave the home.