Eligibility:
Review Your Homebound Status Criteria
Published on Thu Jan 01, 1970
Recent guidance from CMS regarding driving may surprise you. If your patient drove his car to pick up his prescription or grab groceries, he doesn't fit the homebound status, right? Not necessarily, says Deb-bie Dawson, a consultant with HealthCare Strate-gies in Chattanooga, TN. Guidance the Centers for Medicare & Med-icaid Services issued this year offers more insight into determining whether a patient fits the homebound definition. For example, patients don't have to be bedridden to be considered confined to their homes, CMS says in a clarification on its Web site. Similarly, a patient can drive himself to pick up his prescription and "still be homebound," Dawson says. Medicare makes a call on a case-by-case basis when driving is involved, CMS says in the frequently asked question. "Because individual circumstances can vary greatly ... we are reluctant to issue a specific policy that relates to driving in every possible occurrence," the agency says. Think of it this way: A patient who doesn't drive, but is able to get down her front steps to go shopping with her neighbor is not homebound. On the other hand, "the patient who is forced to drive to the pharmacy because she has no one to do it for her and then is exhausted from the trek is homebound," Dawson explains. What to do: Once clinicians certify that a patient is confined to his home, agencies must carefully evaluate how often each patient leaves home and how leaving home affects the patient's condition, Dawson says. If leaving home requires a "considerable and taxing effort," then the patient qualifies as homebound -- even if he leaves home by driving his car, CMS states. But in those cases, clinicians will have to take extra pains to show in documentation why the patient is still homebound even if she drives. "If the net effect of driving indicates that the individual has the capacity to get their health care routinely outside of the home, then it could challenge their eligibility," CMS cautions in the FAQ. Key: Home care workers must thoroughly document how leaving home affects their patients, Dawson encourages. Failure to note the side effects of leaving home may lead CMS to believe you haven't correctly interpreted its guidelines. Note: CMS' clarification is at
https://questions.cms.hhs.gov/cgi-bin/cmshhs.cfg/php/enduser/std_adp.php?p_faqid=9070.
