The definition of homebound’ keeps evolving with new clarifications

HCFA weighs in

Some six months after a government-set deadline, the Health Care Financing Administration (HCFA) has given Congress a report concerning the definition of homebound eligibility for recipients of Medicare-funded home health care.

The report recommended that current policy remain unchanged but went on to suggest that some clarification was needed to improve the term’s uniform application.

Initially, HCFA suggested the definition be changed to accommodate a bright-line test (using standards for the number and duration of absences), whereby someone would be considered homebound if the patient’s total absences from home were fewer than 16 hours a month with no more than five absences of three hours each per month — something that the home care industry and organizations representing Medicare beneficiaries opposed.

In its analysis, HCFA examined the possibility of applying a standard based on a person’s functional capacity and measured by the person’s ability to carry out the activities of daily living. HCFA pointed out that individuals with vision and hearing problems, for example, who are homebound but are able to carry out daily living activities would not be eligible. Lastly, and perhaps most importantly, HCFA recommended against expanding the definition because of the additional costs it would incur.

Instead HCFA decided that retaining the current definition with some elucidation would improve the determination process while avoiding the further complications that a new definition would bring. As for the bright-line test, HCFA ruled that its disadvantages far outweighed any benefits and pointed out that a person could simply modify the frequency and duration of absences in order to comply with the new definition.

It’s expected that the chances of Congress formulating legislation to change the homebound definition are slim, in part because of the additional costs predicted by HCFA and because of the risk of excluding those currently eligible from coverage should the definition change.