CMS Clarifies Homebound Criteria

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Homebound Criteria

New homebound definition designed to prevent confusion and foster compliance among health care providers.

The Centers for Medicare and Medicaid Services (CMS) released a clearer definition of homebound to be used when deciding if patients are eligible for home health services under Medicare.

Patients are considered “confined to the home” or “homebound” if they meet these two criteria:

  1. Patients either need supportive devices such as crutches, canes, wheelchairs, and walkers; special transportation; or help from someone else in order to leave their home because of illness or injury, OR have a condition that makes leaving the home medically inadvisable.

2. “There must exist a normal inability to leave home; and leaving home must require a considerable and taxing effort.”

The new definition, which goes into effect November 19, 2013, will prevent confusion, promote a clearer enforcement of the statute, and provide more definitive guidance to home health agencies in order to foster compliance, CMS says.

View Change Request 8444.

Tips to Remember:

*The designation of homebound is contingent upon a patient’s individual ability – not caregiver support. [Patients may be highly functioning due to caregiver assistance.]

*Homebound does not mean bedbound.

Homebound criteria applied to psychiatric patients:

*Illness is manifested by a refusal to leave the home (e.g., severe depression, paranoia, agoraphobia).

*Due to illness it would be unsafe for the patient to leave the home (e.g., hallucinations, violent outbursts).

NOTE: Psychiatric patients may have no physical limitations.