Clarification of the Homebound Definition

As defined by Medicare, “homebound” is that “there exists a normal inability to leave home and, consequently, leaving home would require a considerable and taxing effort.” The new provision broadens the list of circumstances in which absences from the home would be consistent with a determination that the client is “homebound” or “confined to the home.” For Medicare purposes, it does not change the existing homebound guidelines beyond the specific provisions outlined below. The new provision includes that the client must either:

  • Because of illness or injury, need the aid of supportive devices such as canes, wheelchairs, 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 as that leaving his or her home is medically contradicted.

Physician certification that the beneficiary is confined to his or her home is an eligibility requirement for all home health services. Home health eligibility is periodically reviewed by a physician and requires demonstration of a client’s need for skilled nursing (other than solely venipuncture) on an intermittent basis, or having a continuing need for occupational therapy, physical therapy, or speech-language pathology.

Should your condition improve to the point that you are no longer confined to your residence, please promptly report this change in condition to a Dignity Home Health of Utah representative or contact our office at 801-492-4892.

Please feel free to contact us today for more information about home health eligibility in Utah or if you would like clarification of the homebound terminology.