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The Health Care Financing Administration says patients can still be considered homebound if they attend religious services or go to adult day care as long as they attend the day care program to receive "therapeutic, psychosocial or medical treatment."
A HCFA memo released Feb. 6 clarifies circumstances under which a patient may leave the home and still be considered homebound and eligible for Medicare home health services.
The new provision expands the list of circumstances in which absences from the home would be consistent with a determination that the patient is "confined to the home" or "homebound" for Medicare purposes. It does not change the existing homebound guidelines beyond the two specific provisions below. The new provisions include:
• Any absence of an individual from the home attributable to the need to receive health care treatment, including regular absences for the purpose of participating in therapeutic, psychosocial, or medical treatment in an adult day-care program that is licensed or certified by a state, or accredited, to furnish adult day care services in the state shall not negate the beneficiary’s homebound status for purposes of eligibility.
• Any absence for religious service is deemed to be an absence of infrequent or short duration and thus does not negate the homebound status of the beneficiary.
Home health agencies enrolling patients eligible for these new provisions are responsible for demonstrating the adult day care center is licensed or certified/accredited as part of determining whether the patient is homebound for purposes of Medicare eligibility. Examples of information that could demonstrate licensure or certification/accreditation include: The license/ certificate of accreditation number of the adult day care center, the effective date of the license/ certificate of accreditation, and the name of the authority responsible for the license/certificate
or accreditation of the adult day care center.