You Can Leave Home and Still Receive Medicare-Covered Home Care

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At Goldfarb Abrandt Salzman & Kutzin LLP, all-too-often we hear from older adults who have been denied home care that should be covered by Medicare because of a provider’s overly restrictive interpretation of the rules. In many cases, providers tell patients that they no longer qualify for care because they are no longer “homebound” because they have briefly left the house to run an errand or attend an event—usually with considerable effort and discomfort.

According to the Centers for Medicare & Medicaid Services guidance documents, in order for a patient to be eligible for covered home health services a physician must certify that he or she is homebound. A person is homebound if one of the following two conditions exists:

  • He or she needs the aid of supportive devices such as canes, crutches, wheelchairs or walkers, the use of special transportation, or the assistance of another person to leave the home because of injury or illness.
  • He or she has a condition that makes leaving the home contraindicated.

If either of these conditions exists, the patient must also meet both of the following criteria to be considered homebound:

  • There is a normal inability to leave the home
  • Leaving the home requires a considerable and taxing effort.

You Can Leave the Home AND Be Homebound

Nowhere in these regulations does it say that a person must never leave his or her home in order to be eligible for Medicare-covered home care, yet this is precisely how many providers interpret the regulations. This is true in spite of further guidance that states that a patient is still considered homebound if:

  • The absences are infrequent
  • For periods of a relatively short duration
  • Attributable to the need to seek health care treatment.

Some examples of the kinds of out-of-the-home trips that should not disqualify a patient from Medicare-covered home care include the following:

  • Attendance at an adult day care to receive medical care
  • Kidney dialysis
  • Chemotherapy or radiation therapy

While it is expected that most absences from the home will be for the purpose of receiving health care services, the occasional walk, drive, attendance at a graduation, family reunion, or other unique and infrequent event would not necessarily mean that a person was not homebound for the purposes of Medicare benefits. If you have any questions as to whether you or a loved one would be considered homebound under this standard, you should speak to an elder law attorney about your situation as soon as you can.

Denied Medicare Benefits? We May Be Able to Help!

Every year, healthcare providers that do not fully understand the law wrongfully deny care to untold numbers of older adults. If you have found yourself without the care you need, the lawyers of Goldfarb Abrandt Salzman & Kutzin LLP may be able to help. With over 25 years of experience advocating for the rights of the elderly and disabled, we have the knowledge and expertise required to bring your case to the best resolution possible. To schedule a consultation with one of our lawyers, call our office today at (212) 387-8400 or contact us online.