HHS Secretary Tommy G. Thompson has announced the three states where Medicare will conduct a demonstration project involving a new definition for homebound that would allow Medicare beneficiaries receiving home health benefits to leave their home more frequently and for longer periods without risking the loss of those 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 allow greater mobility to 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," Secretary Thompson said. "It represents another step forward in President Bush's New Freedom Initiative, which is breaking down barriers to community living for people with disabilities and addressing the needs of persons with disabilities. They should not fear that they will lose home-based services that they depend on just because they try their best to have lives outside the home."
Current rules used to determine who qualifies for Medicare payment of 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 persons that they will lose their home-based care if they attempt to take advantage of activities outside the home.
"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, M.D., Ph.D., administrator of CMS, the agency that oversees the program. "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. 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: