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).
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.
- 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.
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.”
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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