Tuesday, August 22, 2017
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HOME BOUND CRITERIA:

Did you know that homebound criterion is mandated by payer source (Medicare) and not a regulation for all private insurances?

What is Homebound?

  • Patient must be homebound due to medical reasons:
    • Often requires supportive assistive devices such as wheel chair, canes, walkers, etc
    • Needs assistance by others.
    • Has a medical condition in which they should limit exposure to the community (for example, open surgical wound or infection).
  • Patient is not required to be bed ridden.
  • Condition of patient should be such that there exists a normal inability to leave home.
  • Patient would require a “considerable and taxing effort" when leaving home.
  • If patient does leave home, it must be infrequently for short durations.

Homebound Criteria Reminders that Continue:

Patient can have occasional absences from the home, can leave home for short duration, but infrequently:

  • can go to medical appointments
  • can go to church
  • can go to social day care program
  • can attend a funeral
  • can attend a family reunion

Determining Whether Patient is Homebound:

In determining whether the patient has the general ability to leave home and leaves home only infrequently or for periods of short duration, it is necessary (as is the case in determining whether skilled nursing services are intermittent) to look at the patient’s condition over a period of time rather than for short periods within the home health stay.

For example, a patient may leave the home (under the conditions described above, with a taxing effort) more frequently during a short period when, for example, the presence of visiting relatives provides a unique opportunity for such absences, than normally the case. So long as the patient’s OVERALL condition and experience is such that he or she meets these qualifications, he or she should be considered confined to home.

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