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June 8, 2004
Three States to Offer More Freedom
To Homebound Medicare Beneficiaries
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.”
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