Obama administration hasn’t changed Medicare’s ‘homebound’ rule
In 2008, Barack Obama and Joe Biden promised to make it easier for severely disabled Medicare patients to keep their home-health benefits.
The law required that beneficiaries be "confined to the home” to be eligible for care from home health aides or skilled health services.
While there were exceptions, such as for doctor visits or special events or trips outside the house of "infrequent or of relatively short duration,” some home health agencies interpreted the rules very narrowly — and patients would lose their coverage for leaving the house.
Obama and Biden promised to "amend the Medicare 'homebound' rule, which requires severely disabled recipients to stay in their homes to retain benefits, so that they have the freedom to leave their homes without fear of having their home-health benefits taken away.”
That campaign statement exaggerated the severity of the law — Medicare beneficiaries already had "the freedom to leave their homes” as long as it was infrequent or brief — but did reflect the reality of how the law was often applied.
Medicare contractors "sometimes try to require that those receiving home health services will be discharged and found not to need skilled care if they leave home for any reason other than a limited number of visits for a few specific purposes, such as going to a doctor,” the Kaiser Family Foundation reported in 2005.
It didn"t seem to matter that this interpretation was "at odds with the actual language of the law, which allows individuals to leave home for any reason of their choice so long as it is for an ‘infrequent or of relatively short duration,"” the foundation reported.
In 2002, the Bush administration told Medicare providers to allow patients to attend special occasions such as family reunions, graduations or funerals without risking their benefits. Such trips had led home health agencies and Medicare payment contractors in some cases to cut off patients. Health and Human Services updated the Medicare manual to clarify.
Obama and Biden promised to change the law "to remove arbitrary measures of ‘acceptable" time away from home and further ensure that individuals do not have benefits removed unfairly.”
But neither the law nor the Medicare manual has been updated, and qualifying for benefits is still a significant issue, said Brad Plebani, deputy director of the nonprofit Center for Medicare Advocacy. Medicare contractors still pounce on trips outside the home to terminate or refuse benefits even when a patient otherwise has a hard time getting around.
"Our experience is that they are construing it very narrowly," Plebani said. "... It's not surprising some people would think they could never leave home."
We gave the Centers for Medicare & Medicaid Services 10 days to respond, but it did not provide additional information.
As far as we can tell, there"s been no relevant change to the Medicare statute or manual since 2003. We rate this Promise Broken.
Email interview with Carolina Fortin-Garcia, media relations, Centers for Medicare & Medicaid Services, Nov. 27, 2012
Kaiser Family Foundation, "What is the homebound rule?" accessed Nov. 27, 2012
Interview with Brad Plebani, deputy director, Center for Medicare Advocacy, Nov. 27, 2012
Center for Medicare Advocacy, "Home Health," accessed Nov. 27, 2012
Centers for Medicare & Medicaid Services, "Medicare Benefit Policy Manual
Chapter 7 - Home Health Services," revised May 6, 2011
HHS.gov Archive, "MEDICARE ACTS TO PROTECT COVERAGE FOR HOMEBOUND BENEFICIARIES," July 26, 2002
No changes have been made to homebound rules
We couldn't find any evidence that Medicare's "homebound" rule had been amended in the way President Barack Obama talked about in this promise. So we inquired at the Centers for Medicare and Medicaid Services.
Here's the e-mail response we got from Tony Salters, a spokesman for the centers:
"We're not aware of changes under consideration, but current law, mandated by Congress, says that a patient must be homebound in order to be eligible for Medicare's home health benefit. Congress defined 'homebound' and any change to the eligibility requirement or definition would require congressional enactment."
Salter added that Obama's promise included a "confusing" definition -- that it "requires severely disabled recipients to stay in their homes to retain benefits."
"That doesn't make sense and may confuse your audience," Salter wrote. "CMS doesn't require patients to remain in the home to retain benefits. Rather, to be eligible for the home health benefit, a patient isn't able to leave the home without a considerable and taxing effort. CMS has the responsibility and makes decisions to ensure that chronically disabled people, including those who are considered to be homebound, can live a full life without the fear of losing vital benefits.
"CMS's Division of Home Health & Hospice reports that an individual is considered 'homebound' if the individual has a condition, due to illness or injury, that restricts the ability of the individual to leave their home except with the assistance of another individual or the aid of a supportive device, or if the individual has a condition that leaving the home is contraindicated and leaving the home requires a considerable and taxing effort and absences of the individual from the home (other than those approved absences defined in statute) are infrequent and of short duration."
In other words, the Obama promise is based on an oversimplification, or misunderstanding, of the definition of "homebound." In any case, as Salter noted, any changes to eligibility requirements would require congressional action, and we searched but could find no evidence of any legislative efforts along these lines.
And so we rate this promise Stalled.
E-mail interview with Tony Salters, a spokesman for the Centers for Medicare and Medicaid Services, Jan. 13, 2009