Three states in demonstration project
Medicare officials recently announced the three states where Medicare will conduct a demonstration project involving a new definition of "homebound" that would allow Medicare beneficiaries receiving home health benefits to leave their homes more frequently and for longer periods without risking the loss of benefits.
The demonstration in Missouri, Colorado, and Massachusetts will mark an important step in identifying strategies to promote greater freedom and independence for people with disabilities who require daily assistance. As part of the three-state demonstration, which was authorized by the Medicare modernization legislation enacted last year, Medicare will use a more liberalized definition of homebound to facilitate greater mobility for those receiving home-based services.
"This demonstration will give those with chronically disabling conditions a chance to live full lives and contribute to their communities while still receiving services in their homes," said Tommy G. Thompson, secretary of the Department of Health and Human Services (HHS).
Current rules used to determine who qualifies for Medicare payment for services at home require that any time away from home must be "infrequent or of short duration." Congress and the Centers for Medicare & Medicaid Services (CMS) have refined this definition in recent years by clarifying that leaving home for adult day care or religious services is allowed. The demonstration project removes a limitation based on actual time spent away from home, eliminating the concern among many homebound people that they will lose their home-based care if they attempt to take advantage of activities outside the home.
Participants must meet needs-based criteria
"This evaluation of a less restrictive definition of homebound for Medicare coverage is an important step toward achieving our goal of greater freedom and independence for people with disabilities," said Mark B. McClellan, MD, PhD, administrator of CMS, the agency that oversees Medicare. "By eliminating current restrictions, this group of persons who require substantial daily assistance will have access to more normal lives in their own communities."
Up to 15,000 beneficiaries will be eligible to enroll in the two-year demonstration, which will begin in the fall of 2004. To qualify for the demonstration, Medicare beneficiaries must have a permanent, severe disability that is not expected to improve. In addition, the individual must meet each of the following needs-based criteria:
- Needs permanent help with three of five activities of daily living (ADLs), such as bathing, dressing, eating, toileting, and transferring.
- Needs permanent skilled nursing care, and daily attendant visits to monitor, treat, or provide ADL assistance.
- Requires assistance to leave home.
- Is not working outside the home.
The goal of the demonstration is to determine the cost impact of the changed definition for patients with chronic illnesses, a population that otherwise may be at risk for costly institutional care. As part of the process of addressing this question, CMS plans to host an Open Door Forum on June 25 specifically to solicit input from interested groups to discuss the major features of the demonstration.
"As we move forward on implementing this important demonstration program, we will work with home health professionals and advocates for disabled beneficiaries to make sure we do so effectively," McClellan said. "We need to find the best, least costly ways to provide more freedom for beneficiaries with severe disabilities."
HHS has played a critical role in advancing the New Freedom Initiative since its launch on Feb. 1, 2001. To date, about 60,000 people with disabilities now have Medicaid health coverage through the Ticket to Work and Work Incentive Improvement Act Medicaid Buy-in Program. HHS also has approved waivers for nine states that give about 22,000 individuals with disabilities the option to direct their own health care.
In addition, the HHS fiscal year 2005 budget plan would authorize more than $2.2 billion in new spending over the next five years to build on and expand the New Freedom Initiative to promote greater independence for Americans of all ages with a disability or long-term illness.