June 8, 2004

The movement to more fully integrate individuals with severe disabilities into their communities inched forward another notch with the announcement of the three states that will take part in a test project liberalizing Medicare homebound regulations.

Missouri, Massachusetts and Colorado will begin enrolling up to 15,000 people this fall into a two-year “demonstration project” designed to test the effect of loosening restrictions on patients receiving Medicare home health care services.

“This demonstration will give those with chronically disabling conditions a chance to live full lives and contribute to their communities while still receiving services in their homes,” Secretary of Health and Human Services Tommy G. Thompson said.

Redefining “homebound”

Under current Medicare regulations, people who qualify for home-health services must be “homebound” except for brief, infrequent absences, such as to go to the doctor or church. Attending a son’s soccer game or catching a movie can be cause for termination of services.

The demonstration project removes this homebound restriction for qualified Medicare beneficiaries in the three test states, allowing them the freedom to leave home as they are able, except to do paid work.

The project was approved last summer as part of the Medicare prescription drug bill.

Who Benefits?

Qualified project participants are those who have a permanent, severe disability that is not expected to improve, and who meet the following criteria:

• Need permanent help with three of five activities of daily living (bathing, dressing, eating, toileting and transferring);
• Need permanent skilled nursing care and daily attendant visits to monitor, treat or provide help with activities of daily living;
• Require assistance to leave home;
• Are not working outside the home.

The project’s goal is to determine the cost impact of loosening homebound restrictions on these individuals. After the two-year project is finished, Congress will consider lifting restrictions for qualified beneficiaries nationwide.

HHA Resistance

However, some disability advocates are concerned that the demonstration will be harmed by resistance from home health agencies (HHAs) that provide in-home services. These agencies say they will lose money serving additional severely disabled beneficiaries.

“HHAs don’t have any motivation to recruit beneficiaries into the demonstration,” said David Jayne, a Georgia man with ALS (amyotrophic lateral sclerosis, or Lou Gehrig’s disease) who was the driving force behind the movement to amend the homebound restriction.

Jayne is concerned that fewer than 15,000 beneficiaries will be enrolled in the three states.

“If an adequate population sample is not achieved, CMS most likely will not report favorably to Congress, regardless of the data,” he said. “It’s critical for the success of the demo that the word reaches Medicare beneficiaries.

“We need a vigorous information campaign in the three states in particular, as well as nationally.”