Bush Administration Falls Short on Medicare Homebound Rule
Bob Williams and Henry Claypool
AIMMM@halftheplanet.org provide the
following two documents about the Medicare Homebound rule, the first explaining
the shortcomings in President Bush's recent announcement, the second asking you
to contact the administrator of the Center on Medicaid and Medicare Services
(CMS):
Bush Administration's Action Fails to Ease the Medicare Homebound Rule:
Introduction: The Medicare home health homebound rule is being used to imprison
thousands of people with permanent disabilities and serious health conditions in
their home each day. At a July 26th event commemorating the 12th anniversary of
the ADA President Bush announced that his Administration issued guidance that
day to "clarifying Medicare policy, so people who are considered homebound can
occasionally take part in their communities, without fear of losing their
benefits." The President stressed that the intent behind it is to ensure that
"when Americans with disabilities participate in their communities, they should
not be penalized." Unfortunately, the new program instruction to home health
agencies and Medicare carriers is even more restrictive than the already overly
restrictive homebound definition in the statute.
Current law: In order to receive Medicare home health services, a beneficiary
must have a post acute or chronic skilled care need and must be "homebound". To
be considered "homebound":
- The individual must have "a normal inability to leave home";
- "leaving home requires a considerable and taxing effort by the
individual," e.g., by relying on a wheelchair or cane or the assistance of
another person; and,
- trips outside the home must be of an "infrequent or of relatively short
duration".
The exception to this is that the law permits an individual to be absent from
their home to receive health care or to attend adult day care or religious
services at anytime The law likewise states that: "Any other absence of an
individual from the home shall not so disqualify an individual if the absence is
of infrequent or of relatively short duration." [42 U.S.C. '1395n(a)(2)(F)].
In recent years, however, individuals with severe and permanent disabilities
like ALS, muscular dystrophy, severe brain injury and quadriplegia are
increasingly being thrown off the benefit for leaving home regardless of how
short or infrequently they do so.
New Program Instruction on Homebound: In attempting to address this problem,
CMS' new guidance cites examples of when "chronically disabled individuals who
otherwise qualify as homebound should not lose home health services because they
leave their homes infrequently for short periods of time for special occasions,
such as family reunions, graduations or funerals." CMS points out that its list
of excused absences is meant to be illustrative rather than all-inclusive.
Listing examples like these, though, creates more problems than it solves. The
Medicare program should not be in the business of creating what will always be a
finite list of "permissible reasons" any beneficiary can choose to leave their
home that ultimately likely will be used to unjustly deny them their services
and/or their personal freedom.
Even under current law, a beneficiary theoretically should be able to leave home
to work, attend college, shop, go to the theater, and dine at a restaurant and a
myriad of other reasons if such "absences" are of "infrequent or relatively
short duration". But, there is the rub. No one knows what the phrase "absences
of infrequent or relatively short duration" means and any attempt to define it
would be as arbitrary and capricious as developing a list of government approved
reasons why law abiding Americans should be "allowed" to leave home and still
retain the skilled home health services they need to literally stay alive. Next
Steps: Congress and the Bush Administration should work together to enact
legislation this year to ensure that Medicare beneficiaries with permanent and
severe disabilities who require skilled home health services can leave their
homes for any reason and length of time without having to fear of being thrown
off the services.
The rationale for this is simple: When enacted about 30 years ago, the homebound
rule was a good proxy for deciding who needed the benefit and, in most cases,
this remains true today. This is because the vast majority of the estimated 2.5
million Medicare beneficiaries who receive home health services do so only for a
short time while they recover from surgery or an acute illness. For these
individuals remaining at home is likely medically necessary. Thus, in these
instances the homebound rule may make sense, albeit a minor inconvenience.
But, the homebound rule is an unfair and unnecessary life sentence for those
with serious health conditions like ALS, late stage MS and some severe spinal
cord injuries who must receive home health services for the rest of their lives.
Nationally, roughly 46 thousand beneficiaries are estimated to need skilled home
health care for a year or more due to the on going and serious nature of their
illness or disability. Skilled nursing care in the home typically ensures the
proper functioning of a tracheotomy, catheter, feeding tube and/or ventilator.
Such individuals also usually receive a couple of hours of help each day from a
home health aide with essential tasks like bathing, eating, dressing.
Particularly at this time in our history, Medicare has neither the right nor
need to force these Americans to forfeit all of their other freedoms in return.
Bob Williams and Henry Claypool, Co Directors
Advancing Independence: Modernizing Medicare and Medicaid
# # #
Two weeks prior to issuing the July 26th guidance on the homebound restriction,
Tom Scully, the Administrator of the Center on Medicare and Medicaid Services,
met with David Jayne and others working to amend the law. Mr. Scully said that
he is extremely concerned that some Medicare beneficiaries are unjustly and
wrongfully thrown off the home health benefit for so called "homebound
violations."
The CMS Administrator also asked for the disability community's help in
identifying Medicare beneficiaries who have had their home health services cut
off because of an extremely harsh interpretation of the homebound restriction.
If you or someone you know have been cut off home health for what you believe to
have been a wrongful interpretation of the homebound rule, please contact Tom
Scully by e mail at tscully@cms.hhs.gov.
In e mailing Mr. Scully be sure to:
1. Describe the circumstances surrounding why home health services were
discontinued because of an alleged "homebound violation".
2. Explain your disability or chronic illness and why you need to continue to
get Medicare home health services.
3. Include contact information (e mail, phone and mailing address) for yourself
and the home health agency so that Mr. Scully's staff can follow up.
Make sure to advise the CMS Administrator on your reactions to the July 26th
"policy clarification" as well. Please be sure to send a copy of your e-mails to
Mr. Scully to AIMMM at
AIMMM@halftheplanet.org.
Alerting the Administrator to instances of where the homebound rule is being
misapplied will provide us with further evidence and personal examples of why
the Congress and President Bush MUST amend the homebound policy this year! We
will compile as many as these personal examples of why the homebound rule is
unjust to share with the White House, the Congress and the news media.
Hence, if you have a story share with Tom Scully about how you or someone you
know has been unjustly denied Medicare home health services because of the
homebound rule please do so today. It will help make a world of difference for
you, your family and countless other Americans for whom home health should be a
lifesaver not a life sentence. Thank you.
Bob Williams and Henry Claypool, Co Directors Advancing Independence:
Modernizing Medicare and Medicaid AIMMM. . . For a Better Tomorrow
