| Home Health Certification |
Medicare Carrier's manual 2051.1
Definition of Homebound Patient.--An individual does not have to be bedridden to be considered as confined to his home.
However, the condition of these patients should be such that there exists a normal inability to leave home and, consequently, leaving their home would require a considerable and taxing effort. If the patient does in fact leave the home, the patient may nevertheless be considered homebound if the absences from the home are infrequent or for periods of relatively short duration. It is expected that in most instances absences from the home which occur will be for the purpose of receiving medical treatment. However, occasional absences from the home for non-medical purposes, e.g., an occasional trip to the barber, a walk around the block, or a drive would not necessitate a finding that the individual is not homebound so long as they are undertaken on an infrequent basis or are of relatively short duration and do not indicate that the patient has the capacity to obtain the health care provided outside rather than in the home.
Generally speaking, a beneficiary will be considered to be homebound if he has a condition due to an illness or injury which restricts his ability to leave his place of residence except with the aid of supportive devices such as crutches,canes, wheelchairs, and walkers, the use of special transportation, or the assistance of another person or if he or she has a condition which is such that leaving his or her home is medically contraindicated.
The following are some examples of homebound patients: \
A beneficiary paralyzed from a stroke who is confined to a wheelchair or who requires the aid of crutches in order to walk; A beneficiary who is blind or senile and, therefore, requires the assistance of another person in leaving his or her place of residence; A beneficiary who has lost the use of his or her upper extremities and, therefore, is unable to open doors, use handrails on stairways, etc., and therefore, requires the assistance of another individual in leaving his or her place of residence.
A beneficiary who has just returned from a hospital stay involving surgery who may be suffering from resultant weakness and pain and, therefore, his or her actions may be restricted by his or her physician to certain specified and limited activities such as getting out of bed only for a specified period of time, or walking stairs only once a day.
A beneficiary with arteriosclerotic heart disease of such severity that he or she must avoid all stress and physical activity; and A beneficiary with a psychiatric problem if his or her illness is manifested in part by a refusal to leave his or her home environment or it is not considered safe for him or her to leave his or her home unattended, even if he or she has no physical limitations. The aged person who does not often travel from his or her home because of feebleness and insecurity brought on by advanced age is not considered confined to his or her home for purposes of this reimbursement unless his or her condition is analogous to those above.
If for any reason a question is raised as to whether an individual is confined to his or her home, request the physician to furnish the information necessary to establish if the beneficiary is homebound, as defined above.