A looser noose: revisions in the homebound rule – news – revision in Medicare laws
Medicare benefits include home healthcare services, but only for people considered “homebound”–and federal regulations define what “homebound” means. The rules have been keeping some people with disabilities virtually under house arrest, in order not to lose personal care providers, paid for by Medicare, who dress, feed, bathe, toilet, and help them exercise.
Created 30 years ago when mobility technology was primitive, the rules were intended to prevent fraud. They require that people must have a “normal inability to leave home”–which means that going out requires “a considerable and taxing effort” such as use of a wheelchair or the assistance of another person. In addition, the outings have to be both rare and short. In many jurisdictions, people may leave home for health care, adult day care, or religious services only. Attending a child’s graduation or a family reunion has caused some people to lose their home health-services benefit.
Last summer, President Bush said, “When Americans with disabilities participate in their communities, they should not be penalized.” New guidelines issued by the Centers for Medicare and Medicaid Services add reunions, graduations, and funerals to the activities listed in the regulations–and the guidelines say that these examples are meant to be illustrations only. Theoretically, a home health-services beneficiary may now leave home for all kinds of things–to work, attend classes, shop, or eat at a restaurant.
However, a revised list of permitted activities is not part of the legislation or the formal regulations, and many people are concerned about how this will be understood by their local Medicare administrators. They fear the consequences of losing the benefit for even a short period.
The Society is supporting Senate Bill 2085 and House Resolution 1490–to end this fear and clarify the “homebound” rules. These bills do away with government-devised lists of approved activities and any consideration of the number or length of outings. Eligibility for home health services would be based solely on the existing standard: Does leaving home require “considerable or taxing effort”?
To support this reform, contact your two U.S. senators and your representative in the U.S. House. Our Advocacy Department recommends making telephone calls. You can find the local phone numbers in the government pages of your phone book. They are usually blue. To reach offices in Washington, DC, call the U.S. Capitol switchboard at 202-224-3121.
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