"Health care in America has gone full circle," said Senator Collins. "People are spending less time in institutions, and recovery and care for patients with chronic diseases and conditions have increasingly been taking place in the home. The highly skilled and often technically complex care that our home health agencies provide have enabled millions of our most vulnerable older and disabled individuals to avoid hospitals and nursing homes and stay just where they belong-in the comfort and security of their own homes."
Under current law, a Medicare patient must be considered "homebound" if he or she is to be eligible for home health services. While an individual is not actually required to be bedridden to qualify for benefits, his or her condition must be such that "there exists a normal inability to leave home." The statute only allows for imprecisely defined absences. This has allowed for wide variations in interpretation.
"There have been far too many instances where an overzealous or arbitrary interpretation of the definition of ‘homebound' has turned elderly or disabled Medicare beneficiaries, who are dependent upon Medicare home health services and medical equipment for survival, into virtual prisoners in their own home," said Senator Collins. "I have heard disturbing accounts of individuals on Medicare who have had their home health benefits terminated for leaving their homes to visit a hospitalized spouse or to attend a family gathering, including, in one case, to attend the funeral of their own child.
"The homebound criterion may have made sense thirty years ago, when an elderly or disabled person might expect to live in the confines of their home, but it fails to reflect the technological and medical advances that have been made in supporting individuals with significant disabilities and mobility challenges. It also fails to recognize the benefits of social interactions outside the home to both the mind and body."
The David Jayne Medicare Homebound Modernization Act of 2002 will amend the homebound definition to base eligibility for the home health benefit on the patient's functional limitations and clinical condition, rather than on an arbitrary limitation on absence from the home. It will provide a specific, limited exception to the homebound rule for individuals who:
▸ Have been certified by a physician as having a permanent and sever condition that will not improve;
▸ Need assistance form another person with three or more of the five activities of daily living and require technological and/or personal assistance with the act of leaving home;
▸ Have received Medicare home health services during the previous 12 month period; and
▸ Are only able to leave home because the services provided through the home health benefit makes it possible for them to do so.
"This legislation gives people who are already eligible for home healthcare the benefit of their freedom," said Senator Collins.
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