Home health care PTs are incredibly familiar with the term “homebound.” It determines whether or not we can provide home-based services to a Medicare patient. Directly from CMS…

“Home health services are or were required because the individual is or was confined to the home per the criteria below (as defined in sections 1835(a) and 1814(a) of the Social Security Act).

a. Criteria-One:
The patient must

  • Because of illness or injury, need the aid of supportive devices such as crutches, canes, wheelchairs, and walkers; the use of special transportation; or the assistance of another person in order to leave their place of residence
    – OR –
  • Have a condition such that leaving his or her home is medically contraindicated. If the patient meets one of the Criteria-One conditions, then the patient must ALSO meet two additional requirements defined in Criteria-Two below.

    b. Criteria-Two:
  • There must exist a normal inability to leave home;
    – AND –
  • Leaving home must require a considerable and taxing effort”

Now, interpretation of homebound is pretty open, even though it probably isn’t supposed to be as flexible as it is typically applied.
CMS Link

The way I was taught to look at it is this:

Homebound is not a choice, it is a condition. You either have it or you don’t.

However, this has all just changed. CMS has updated the definition of “homebound” to increase their flexibility in fighting or preventing COVID-19. The new definition allows for quarantine status to be included as well as a diagnosis of COVID-19. The new definition also includes patients who would be considered by a physician as being at “high-risk” for contracting COVID-19 if they left the home.

The new definition is as follows:

“A beneficiary is considered homebound when their physician advises them not to leave the home because of a confirmed or suspected COVID-19 diagnosis or if the patient has a condition that makes them more susceptible to contract COVID-19. As a result, if a beneficiary is homebound due to COVID-19 and needs skilled services, a HHA can provide those services under the Medicare Home Health benefit.”
CMS Link

One of the biggest changes also included in this new document is that agencies or clinicians are allowed to perform initial assessments, determine appropriateness, and screen homebound status via remote video or recorded video!

Medicare has been restricted in the realm of telehealth due to statutory confinements, so this particular change is significant.

The new changes also allow for increased OASIS transmission time, POCs to be supervised by NPs and PAs.

For a full rundown of the changes allowed by this new document, check out the link.

How do you feel the change in the definition of “homebound” will impact your safety as a home health provider? Let me know in the comments!

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5 thoughts on “H.O.M.E.B.O.U.N.D.

  1. Glad they are now allowing COVID-19 to be included in homebound status. I was on a conference call with my MAC in late Feb or early March and I asked about that and was told it was not at that time. Things are constantly changing in our current pandemic state. Thanks for keeping us updated!
    I think it’s a good idea to let patients’ primary doc, NP, PA complete the face to face requirement for home health via telehealth at this time. Although CMS is not not including PT at this time and I understand the need to take extreme precautions to protect ourselves and our patients during this time, I worry that expanding into telehealth will diminish the importance of our profession. Now there are instances when it is appropriate and useful, but overall I feel we are a hands-on profession so we need to be physically present with our patients. Do you really feel you could do a thorough eval via telehealth? Personally, I do not. Majority of my career has focused on geriatrics(SNF, HHC, and OP). in the SNF, I wouldn’t feel comfortable using telehealth with any of my patients. If I can work with them remotely, shouldn’t they be home? And even with my HHC and OP, I feel I need to be present to challenge them in order to achieve their goals. A visit or 2 to check in on compliance/accuracy of HEP and/or caregiver technique.


    1. Hi MelPT! Thanks for commenting! I completely understand and agree with you on use of virtual visits. I think the first visit could be more of a screening to determine how much face to face care needs to be provided. But, yes, we are a hands on profession and need to see and feel in person to do a proper assessment. I think virtual visits have a place but I think we can definitely use it to enhance the importance of our profession if we use it wisely!


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